Dear Dr. Roach: I am a 74-year-old woman and was diagnosed with open horn glaucoma a few years ago. My ophthalmologist instructed me to use Lumigan in both eyes three times a day in my right eye and at bedtime. I’ve been doing this for over a year. Both eyes are always red. My right eyelid is very red and swollen, and I shed tears in the cold weather.
Simbrinza’s Patient Information Guide states that you use less than twice a day. I had met him and spoke to my doctor about this time when I hadn’t received a satisfactory response. My eye pressure was down to 16 mmHg, which is good, but I’m worried that it’s beyond the manufacturer’s instructions for Simbrinza and clearly has side effects.
Is this just a doctor’s arrogance? I would like to resort to using Simbrinza twice a day, but if I do this there is no way to check the pressure of the eye.
– PW
Dear PW: Most studies on the combination of eye-absorbing brinzolamide and brimonidine (Symbrinza) dictate that the drug’s package insert should be used three times a day, and that the drug’s physician package insert should be used three times a day. However, I say the patient’s information sheet twice a day. This applies to patient information sheets published in the US, Canada and the UK.
This is unique in my experience. I called the manufacturer who agreed that this was unusual, but they haven’t returned to me yet about what they’re planning about it. I have found studies that twice a day symbrinza is effective in lowering intraocular pressure and reduces the risk of progression of glaucoma, including vision loss. A pressure level of 16 mmHg may be appropriate, but this is a decision that your ophthalmologist should be specifically done in your anatomy and glaucoma stage. (Glaucoma is an optic nerve disease and is usually associated with eye pressure, but can occur with normal intraocular pressure. Furthermore, people with high intraocular pressure do not suffer from optic nerve damage.)
While Symbrinza may cause side effects of redness and tear, Lumigan is more likely to be associated with these symptoms. It is certainly wise to discuss changing your medication with your ophthalmologist and warn you against stopping it before discussing it.
I would say it’s not arrogance on your doctor’s side. It really seems like a misunderstanding by pharmaceutical companies about the frequency of drug administration.
Dear Dr. Roach: I have been using famotidine for gastroesophageal reflux disease (GERD) for the past five years. My question is, am I hurting myself? I currently take two 40 mg tablets a day.
-Anon.
Dear Anon: All medications have the potential for side effects, so taking medications that you don’t need is not recommended. I often have patients try it without using daily famotidine or similar drugs (a class called histamine H2 blockers). Many people can do very well by taking them from time to time, while others actually need daily medications to prevent real discomfort. The side effects of mentality from H2 blockers are rare. Like PPI, they can sometimes cause low B12 levels. Headaches and agitation can be reported. One H2 blocker, ranitidine, had manufacturing contamination with the carcinogen NDMA, but this is not occurring with famotidine.
If daily famotidine is required, the chances of harm are low.Readers can email questions to Toyourgoodhealth@med.cornell.edu.
