Commonly Used Oral Drugs That Can Cause Eye Problems; Second of a Two-Part Series

In the December 2019 issue of Worst Pills, Best Pills News, we discussed several oral medications that are commonly used, particularly among the elderly, that can cause eye-related adverse effects.[1] We present additional types of these medications in this article, which concludes our discussion on this topic. Learn about these additional medications to protect your eyes from harm.

Acne drugs

The acne drug isotretinoin (ABSORICA, AMNESTEEM, CLARAVIS, MYORISAN, ZENATANE) and other drugs that are similar in structure to vitamin A are known to cause eye-related adverse effects.[2] Most troubling among these effects is the risk of increased pressure in the brain, causing blurred vision or even permanent loss of eyesight.[3]

Less seriously, the drug causes opacities (cloudiness) in the cornea, especially when it is taken in high doses.[4] These opacities, which can impair vision, resolve within weeks after the drug is discontinued. Isotretinoin can decrease night vision, which can be sudden and may persist after the drug is discontinued. Isotretinoin also can cause dry eye, which may cause trouble with wearing contact lenses, color-vision changes, and inflammation of the conjunctiva (white part) and other parts of the eye.

Therefore, isotretinoin users should be monitored carefully by their doctors. Patients who experience visual adverse effects may need to discontinue the drug and seek immediate medical care in the case of increased pressure in the brain.[5]

Anticholinergic drugs

Medications that have anticholinergic effects — including tricyclic antidepressants (such as desipramine [NORPRAMIN][6] and nortriptyline [PAMELOR][7]) and drugs for treatment of overactive bladder (such as oxybutynin [DITROPAN XL, GELNIQUE, OXYTROL, OXYTROL FOR WOMEN][8] and tolterodine [DETROL][9]) — dilate the pupils of the eye, which can trigger an attack of angle-closure or narrow-angle glaucoma (sudden increase of pressure in the eye because eye fluids cannot drain properly) in susceptible patients.[10] Therefore, before starting these drugs, patients may need to undergo eye examinations to determine whether they are at risk of this adverse effect. Patients with uncontrolled angle-closure glaucoma should not use these medications. Patients using these medications should watch for signs of increased eye pressure, such as severe headache, eye pain, blurred vision and eye redness.

Antiplatelet drugs and blood thinners

Drugs that prevent the aggregation of platelets, including clopidogrel (PLAVIX), as well as blood thinners, such as warfarin (COUMADIN, JANTOVEN), can increase the risk of bleeding in the retina and other parts of the eye.[11] Eye bleeding is a major concern, particularly in patients with diabetic retinopathy or age-related macular degeneration (deterioration of the central part of the retina), because it can lead to vision loss.[12] Therefore, it is important that such high-risk patients taking these drugs be monitored for this adverse effect. Furthermore, patients need to check with their doctors before undergoing eye surgery to check whether they should discontinue these medications before surgery.

Digoxin (LANOXIN)

Commonly used in patients with mild or moderate heart failure and in those with atrial fibrillation (a common type of irregular heart rhythm), digoxin often can cause toxicity at blood levels that are only slightly above the desired range.[13] Visual changes — including blurred vision, green-yellow color disturbances and halo effect (seeing colored circles around lights) — are frequent signs of digoxin toxicity. These visual changes also can occur with neurological changes (including headache, dizziness, confusion, anxiety and hallucinations). Digoxin users should contact their doctors if they experience these changes to check whether their dosages need to be decreased.

Lipid-lowering drugs

The cholesterol-lowering drug niacin (NIACOR, NIASPAN) can cause blurred vision, dry eye and swelling of the macula[14] (central portion of the retina). The drug also can cause toxic amblyopia (a disorder of the optic nerve), which can reduce visual acuity.[15]

Another cholesterol-lowering drug, lovastatin (ALTOPREV), may accelerate the progression of cataracts (cloudy areas in the lens) and cause eye movement disorders.[16] Postmarketing evidence suggests that all statin drugs may cause abnormal low-lying upper eyelid, double vision and ophthalmoplegia (paralysis or weakness of eye muscles).[17] According to this evidence, these three adverse effects resolve completely after statins are discontinued.

Tamoxifen (SOLTAMOX)

The breast cancer drug tamoxifen is associated with an increased risk of developing cataract and needing cataract surgery.[18] It also can cause macular edema and deposition of crystal material on the retina, which can result in visual changes. [19] These changes occur more frequently in patients who start on higher doses of tamoxifen.[20] Patients may need to discontinue this drug if they experience visual changes. Some experts recommend that patients who take this drug undergo eye examinations and color vision testing before and during therapy.[21]

What You Can Do

Always read the labels of your medications to see if they cause eye-related adverse effects. If any of your medications causes eye-related adverse effects, undergo the specific eye examinations recommended by your doctor even if your vision seems fine.

Importantly, be alert about the specific symptoms of eye problems and notify your doctor if they occur. Seek immediate medical care if you experience a sudden decline in or loss of your vision.

Report all serious adverse events related to your medications to the FDA’s MedWatch adverse event reporting program by visiting http://www.fda.gov/MedWatch or by calling 800-FDA-1088.
 

References

[1] Commonly used oral drugs that can cause eye problems; first of a two-part series. Worst Pills, Best Pills News. December 2019. /newsletters/view/1300. Accessed December 11, 2019.

[2] Labriola LT, Jeng D, Fawzi AA. Retinal toxicity of systemic medications. Int Ophthalmol Clin. 2012;52(1):149-166.

[3] Sun Pharmaceutical Industries. Label: isotretinoin (ABSORICA). August 2018. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/021951s014lbl.pdf. Accessed November 22, 2019.

[4] Ibid.

[5] Ibid.

[6] Validus Pharmaceuticals. Label: desipramine (NORPRAMIN). November 2018. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/014399s071lbl.pdf. Accessed December 3, 2019.

[7] Mallinckrodt Pharmaceuticals. Label: nortriptyline (PAMELOR). April 2019. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/018013s064lbl.pdf. Accessed December 3, 2019.

[8] Janssen Pharmaceuticals. Label: oxybutynin (DITROPAN XL). September 2019. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020897s037lbl.pdf. Accessed December 3, 2019.

[9] Pfizer. Label: tolterodine (DETROL LA). July 2018. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/021228s023lbl.pdf. Accessed December 3, 2019.

[10] Li J, Tripathi RC, Tripathi BJ. Drug-induced ocular disorders. Drug Saf. 2008;31(2):127-141.

[11] Drug-induced retinal disorders. Prescrire Int. 2019;28(204):124-127.

[12] Wren VQ. Ocular and visual side effects of systemic drugs. J Behav Optom. 2000;11(6):149-157.

[13] Concordia Pharmaceuticals. Label: Digoxin (LANOXIN). February 2019. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020405s015lbl.pdf. Accessed November 22, 2019.

[14] Wren VQ. Ocular and visual side effects of systemic drugs. J Behav Optom. 2000;11(6):149-157.

[15] Avondale Pharmaceuticals. Label: niacin (NIACOR). November 2018. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=3b3e7629-1a19-46c9-8795-8e280b318af3&type=display. Accessed November 22, 2019.

[16] Covis Pharma. Label: Lovastatin (ALTOPREV). February 2018. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/021316s035lbl.pdf. Accessed November 22, 2019.

[17] Fraunfelder FW, Richards AB. Diplopia, blepharoptosis, and ophthalmoplegia and 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitor use. Ophthalmology. 2008;115(12):2282-2285.

[18] Ranbaxy, Inc. Label: tamoxifen (SOLTAMOX). April 2019. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/021807s006lbl.pdf. Accessed November 22, 2019.

[19] Drug-induced retinal disorders. Prescrire Int. 2019;28(204):124-127.

[20] Labriola LT, Jeng D, Fawzi AA. Retinal toxicity of systemic medications. Int Ophthalmol Clin. 2012;52(1):149-166.

[21] Li J, Tripathi RC, Tripathi BJ. Drug-induced ocular disorders. Drug Saf. 2008;31(2):127-141.