A 50-year-old female fitness instructor was referred for management of raised intraocular pressures. Gonioscopy revealed bilateral narrow angles so she was treated with bilateral peripheral iridotomies.
Topical medication was also required to achieve the desired intraocular pressures. Latanoprost caused irritable red eyes, and beta blockers were avoided because of a history of asthma. The patient was able to tolerate brinzolamide, a carbonic anhydrase inhibitor, with the brand name of Azopt.
The patient filled the second month's prescription in the late afternoon at her busy local pharmacy. This computer-generated script was for Azopt 1% twice a day to both eyes.
Noticing a different red top on the bottle, the patient checked the name was correct on the pharmacy label, which obscured the manufacturer's label on the bottle. She thought the red-topped bottle must be a 'generic brand'. She used the drops in both eyes that night.
In the morning, the patient telephoned complaining of bilateral large pupils, glare intolerance while driving to work and blurred vision in both eyes. She also mentioned her new red topped bottle. On examination, her pupils were fixed and dilated. The optic discs showed no pulsation or haemorrhages, and her vision corrected to normal in both eyes. The intraocular pressures were within the normal range and the peripheral iridotomies were patent.
After the drops were stopped, the patient's main problem was glare while driving. She was able to work as there was little reading involved. After five days, the glare and blur had significantly improved.
Health professionals can confuse drugs with similar brand names. This exposes patients to unnecessary harm. In the case of Atropt and Azopt the confusion can blind the patient. There is less chance of confusing the generic names, but if brand names are used the prescription should be clearly written and carefully read when dispensed.
- Yip JL, Foster PJ. Ethnic differences in primary angle-closure glaucoma. Curr Opin Ophthalmol 2006;17:175-80.
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