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C. Rodarte, J. D. Stein, D. C. Musch; Co-administration of Topical and Oral β-blockers in Patients with Glaucoma: Quantifying a Potentially Inappropriate Practice Pattern in a Large U.S. Managed-care Network. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4077.
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Previous studies suggest that in patients using systemic β-blockers, the simultaneous use of a topical β-blocker increases the risk for adverse events and diminishes the therapeutic effect. The purpose of this project is to determine the frequency of simultaneous topical and oral β-blocker use in a large group of U.S. patients with glaucoma or suspected glaucoma.
De-identified electronic enrollment and claims records were reviewed to identify all patients ≥ 18 years old in a U.S. managed care network who had received a diagnosis of glaucoma or suspected glaucoma during 2003-2007. Of these beneficiaries, the proportions of patients using an oral β-blocker, a topical β-blocker, and at least one of both drug types simultaneously were determined from billing records.
A total of 26,498 patients in the network received a diagnosis of glaucoma or suspected glaucoma. Among these patients, 6565 (25%) received at least one 30-day prescription for an oral β-blocker and 2997 (11%) received at least one 30-day prescription for a topical β-blocker. Simultaneous prescriptions for both drug types were received by 918 patients, representing 30% of topical β-blocker users and 14% of oral β-blocker users.
In a relatively large managed-care network, fully one-quarter of all patients with a diagnosis of glaucoma or suspected glaucoma were receiving oral β-blocker therapy for a comorbid medical condition. Although simultaneous oral-topical β-blocker treatment is associated with an increased risk for side effects and potentially reduced efficacy, 30% of topical β-blocker users were also taking oral β-blockers, consistent with previously reported findings from Australia. This result underscores the need for physicians to be aware of optimal prescribing practices concerning the treatment of glaucoma in patients with comorbid medical conditions for which oral β-blockers are clinically indicated.
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