Acute Angle Closure Associated With 61 Systemic Drugs, Review Finds

A population-based study published in JAMA Ophthalmology distinguishes 61 drugs associated with acute angle closure (AAC) onset, including several drugs not previously suspected. 

Investigators examined diagnosis and procedure codes, along with prescribed drugs recorded in the Health Insurance Review and Assessment Service database, consisting of the full Korean population. They included 13,531 patients with AAC who received at least 1 medical procedure in the 2 weeks prior to, or 4 weeks after, AAC incidence during the years 2013 to 2019. For this sample, 949 total drugs were prescribed between 1 and 180 days before the initial claim date of an AAC diagnosis.

Systemic medications were classified into 8 physiological system groups. Altogether, 12 of the 61 drugs were from the nervous system category, 14 from respiratory prescriptions, 13 alimentary tract or metabolism medicines, and 11 musculoskeletal drugs.

Among the drugs with the highest odds ratio for AAC association, 3 come from the nervous system category: the antimigraine agent sumatriptan (OR, 12.60; CI, 95%, 4.13–38.44), an antiepileptic drug, topiramate (OR, 5.10; CI, 95%, 2.22–11.70), and the antidepressant duloxetine (OR 4.04; CI 95%, 2.95–5.54).

Of all the participants, 36.6% had drug-associated AAC, resulting from an average of 2.83 AAC-associated first-time drug prescription in the month prior to the AAC diagnosis. The researchers attribute this outcome to a combination of 4 primary factors. “First, multiple drugs that can induce AAC may be prescribed and taken simultaneously, thereby increasing the possibility of AAC occurrence. Second, there may be some drugs that do not induce AAC that are often prescribed along with other drugs that can cause AAC. Third, several medications may be prescribed for the treatment of diseases associated with AAC. Fourth, several medications may be prescribed for the treatment of AAC symptoms prior to AAC diagnosis,” the study authors explain.

Further, disorders the drugs are meant to treat could provoke AAC, such as Valsalva maneuver in digestive illnesses. Also, patients given a prescription for headache may actually be experiencing symptoms of AAC, not migraine.

Lactulose and metoclopramide are among those not previously connected to AAC. “Clinicians should be aware of the increased risk, provide appropriate explanations to the patient, conduct an ophthalmic examination, and take precautionary measures when other risk factors for AAC are present,” the study explains. 

A limitation of this investigation involves claims code identification that does not include patient context, as well as no information on whether prescriptions were actually taken.