Trazodone Use in Patients with Glaucoma Risk Factors

Introduction to Trazodone and Glaucoma Risk

Family history of glaucoma is a significant risk factor for developing primary open-angle glaucoma (POAG), with 9.2-fold higher odds for individuals with a first-degree relative with confirmed POAG, and the risk increases further when multiple family members are affected, rising to fivefold higher when two or more siblings have glaucoma 1, 2
The American Academy of Ophthalmology identifies several risk factors for glaucoma, including family history, older age, African, Latino, or Hispanic ethnicity, thin central corneal thickness, elevated intraocular pressure (IOP), myopia, type 2 diabetes mellitus, and low ocular perfusion pressure 1, 2

For patients with a family history of glaucoma but no personal diagnosis, the American Academy of Ophthalmology recommends performing gonioscopy to assess anterior chamber angle anatomy before prescribing trazodone, and if angles are open and normal, trazodone can be prescribed with appropriate monitoring 2
Patients with family history of glaucoma who are prescribed trazodone should undergo regular comprehensive eye examinations to monitor for symptoms of angle closure, according to the American Academy of Ophthalmology guidelines 2
Individuals with a family history of glaucoma should undergo regular comprehensive eye examinations to monitor for early signs of glaucoma, according to the American Academy of Ophthalmology 1, 2

The American College of Physicians recommends avoiding trazodone in patients with known narrow angles unless the patient has had a patent iridectomy, and considering alternative antidepressants with less risk of pupillary effects 2
Patients with a family history of glaucoma should avoid taking glucosamine supplements due to the increased risk of developing glaucoma, as recommended by the American Academy of Ophthalmology 1, 2
If glucosamine must be used for other medical reasons, the American Academy of Ophthalmology recommends ensuring regular monitoring of intraocular pressure by an ophthalmologist 1, 2

The American Academy of Ophthalmology suggests educating patients about symptoms of angle closure that require immediate medical attention, including eye pain, blurred vision, halos around lights, headache, and nausea, and considering baseline ophthalmologic evaluation before starting therapy in high-risk patients 2
For those with osteoarthritis who are considering glucosamine, the American Academy of Ophthalmology suggests discussing alternative treatment options with their healthcare provider 1, 2