A Prospective Study of Oral Nadolol in the Management of Patients with Newly Diagnosed Chronic Simple Glaucoma

Abstract

Thirty patients with newly diagnosed chronic open angle glaucoma were initially treated with once daily oral Nadolol at a dose of 20 mg. This was increased to 40 mg where control was considered inadequate. Topical therapy was then added as necessary if control was still not maintained. Significant decreases in intra-ocular pressure (IOP) were achieved with a dose of 20 mg, but there was no significant further reduction when the dose was increased to 40 mg. One patient was controlled throughout the study period with 40 mg Nadolol daily and 4% Pilocarpine four times daily. At best, only temporary control was achieved in the remaining 29 patients. Intra-ocular pressures were measured 24 hours after the previous dose of Nadolol in 13 patients who were controlled for a minimum of 1 month on Nadolol alone and then again 3 hours after their normal dose. Control of IOP was lost in all patients at 24 hours pre-dose but was regained by 3 hours post-dose. Four patients were withdrawn because of mild side effects attributable to the beta-blocking action of Nadolol. The treatment regime used in this study was ineffective at controlling the IOP in the group of patients studied. A once daily regime of Nadolol does not control IOP over a full 24 hours.