Safety of Breztri in Patients with Open Angle Glaucoma

Understanding the Components and Concerns

• The American Academy of Ophthalmology suggests that glycopyrrolate, an anticholinergic bronchodilator, should be used with caution in patients with narrow-angle glaucoma, but is generally considered safer in open-angle glaucoma 1
• The use of formoterol, a long-acting beta-agonist, may have interactions with beta-blockers used for glaucoma treatment 2

Risk Assessment

• The mode of administration of corticosteroids is a risk factor for steroid-induced IOP elevation, according to the American Academy of Ophthalmology 3
• A personal or family history of primary open-angle glaucoma is a significant risk factor for steroid responsiveness, as stated by the National Eye Institute 1, 4

Clinical Decision Algorithm

• The American College of Physicians recommends assessing baseline risk by determining the severity of existing open-angle glaucoma and checking current IOP control 1, 3
• The FDA suggests considering alternative treatments if glaucoma is severe or poorly controlled, such as other classes of respiratory medications with lower risk of affecting IOP 3, 5

Comparative Medication Considerations

• The American Academy of Ophthalmology notes that anticholinergics, like glycopyrrolate in Breztri, should be used with caution in patients with narrow-angle glaucoma, but are generally considered safer in open-angle glaucoma 2
• The National Eye Institute states that beta-blockers used for glaucoma treatment may have interactions with beta-agonists, like formoterol in Breztri 5, 3