Medications to avoid in Retinitis Pigmentosa

By Jack C Crofoot Jr on Friday, February 13, 2015 at 2:40pm

Marc R. Grossman, O.D., has compiled this list. It is entirely his authorship.
Acne
Isotretinoin is a photosensitizing drug prescribed for acne that can make you more vulnerable
to cataracts and macular degeneration.
Minocycline, used to treat acne, may result in a pigmentation of the sclera typically a blue-
grey discoloration, worse in sunlight which goes away with discontinuation of the drug.
Drugs used to treat acne, such as Accutane can lead to sensations of dust in the eye,
redness, burning eyes, temporary vision distortion, dry eye syndrome and night blindness.
Alzheimer's
Cholinesterase hemorrhaging inhibitors, often prescribed to those suffering from Alzheimer's
disease, can contribute to hemorrhaging in the eye
Antibiotics
Whenever taking antibiotics make sure you take probiotics such acidophilus or bifidus and
vitamin C to help ward off some of the other side effects that affect the rest of the body.
Oral antibiotics have been tied to retinal detachment. Fluoroquinolones, such as ciprofloxacin
(Cipro, Zoxan, Proquin) and levofloxacine (Levaquin, Cravit), ("Oral Fluoroquinolones and the
Risk of Retinal Detachment", which was published in the April 4, 2012 edition of the Journal of
the American Medical Association (JAMA). Zoxan, Proquin
Topical application of prescribed antibiotics may result in allergic conjunctivitis (red eye).
Oral and intravenous antibiotics for fight bacterial infections may cause some visual
symptoms.
Synthetic penicillins (amoxicillin and ampicillin) can cause some mild redness of the eyes,
itching, and dry eyes. In rare cases they have been shown to cause hemorrhages of the blood
vessels in the conjunctiva and in the retina. They can contribute to allergic conjunctivitis.
Some antibiotics can increase light sensitivity, contribute to dry eye syndrome and risk of
glaucoma.
Amphotericin B can lead to hemorrhage of the blood vessels in the eyes
Fluroquinone, terbinafine, mefloquine type antibiotics are photosensitizing drugs that can
increase your risk of macular degeneration and cataracts
Tetracycline has similar side effects as synthetic penicillins in addition to causing light
sensitivity and blurred vision. It can contribute to allergic conjunctivitis.
Nalidixic acid is associated with increased fluid pressure around the brain, leading to
headache, vision disturbances, and swollen optic nerve.
The antibiotic linezolid can contribute to optic nerve damage.
Sulfonamide ("sulfa drugs," which many people are allergic to) can induce blurred vision,
light sensitivity, and hemorrhages in the eye. They can contribute to allergic conjunctivitis.
They have a photosensitizing effect and can make you more susceptible to cataracts and
macular degeneration.
Antibiotics are overused and can disrupt the body's natural chemistry and the fluid balance of
the eyes contributing to glaucoma.
If pregnant women take tetracycline antibiotics, it can cause cataracts in the developing fetus.

Recommendations if you must take antibiotics

Acidophilus Complex Max Potency 60 caps
 Vitamin C
Powerful antioxidant, essential for healthy bones, teeth & collagen.
Anti-Diuretics
Anti-diuretics are overprescribed and overused and can unbalance the chemistry of the as
well as the fluid balance of the eyes contributing to glaucoma.
Antihistamines
Antihistamines can be a contributing cause of cataracts, increase light sensitivity and
contribute to dry eye syndrome. They have a drying effect on your eyes in the same way that
they have a drying effect on your nose. Light sensitivity and dry eyes are common side effects.
In rare instances it may make your pupils dilate or become unequal in size. If so, report this to
your doctor.
Antihistamines (both prescription and non-prescription, such as alka seltzer) can be harmful
for people withangle closure glaucoma (narrow angle glaucoma) triggering an attack of angle
closure glaucoma resulting in blurred vision, redness, halos around lighted objects, and pain.
This is an emergency condition.
Antihistamines are photosensitizing drugs (they increase your sensitivity to the sun) that
absorb light energy and undergo a photochemical reaction resulting in chemical modification
of tissue. They can make you more susceptible to cataracts and macular degeneration.
Antihistamines, used for allergies, give rise to problems in attention and processing
information. These include Hydroxyline, Diphenhydramine, Tripoline, and Promethazine.
Anxiety
Tranquilizers are photosensitizing drugs (drugs that increase your sensitivity to the sun) that
can make you more susceptible to cataracts and macular degeneration.
Benzodiazepines prescribed for anxiety may cause blepharospasm (eye twitch).
Benzodiazepines also lead weaknesses in concentration and memory. These include
Midazolam, Trazolam, Temazepam, Oxazepam, Lorazepam, Alprazolam, Clonazepam,
Diazepam, Florazepam, Clorazepam, Zolpidem, Zopiclone and Zaleplon
Arthritis
Plaquenil (hydroxchloriquine sulfate), routinely prescribed by rheumatologists for rheumatoid
arthritis, it can cause irreversible retinal damage.
Arthritis see Anti-malaria (Chloroquine)
Asthma
Nasal steroids, commonly inhaled for asthma are connected to causing open angle glaucoma.
Birth Control
Birth control pills can contribute to dry eye syndrome
Oral contraceptives can lead to many eye problems by increasing pressure of the fluid around
the brain causing headache, vision changes, and swollen optic nerve.
Birth control pills can lead to many eye problems, including retinal vascular problems.
Many birth control pills have make you more sensitivity to sunlight and can result in chemical
modification of tissue. They can make you more susceptible to cataracts and macular
degeneration.
Birth Control Pills can lead to a higher incidence of migraine headaches, problems with
contact lenses due to dry eyes, and color vision disturbances.
Blood pressure
Blood pressure medications cause your body to excrete excess fluid and give your blood
vessels a break. But, in the eyes less fluid means dry eyes, light sensitivity, possible blurred
and/or double vision in some people. Beta blockers are sometimes used to reduce high blood
pressure by slowing the kidney's production of a protein called renin. Renin normally causes
the release of a powerful blood vessel constrictor called angiotensin II, which makes it harder
for blood to flow through the arteries (thus raising blood pressure) and also causes secretion
of hormones that cause water retention (which increases the amount of fluid in the blood). Two
common beta blockers are Inderal and Tenormin.
Blood pressure medications can contribute to dry eye syndrome and sensitivity to light.
Alpha-1 blockers, used to lower blood pressure can cause a condition (that doesn't affect
vision) called "floppy iris syndrome." If you are going to have eye surgery you should let your
doctor know that you've been taking this type of medication, especially tamsulosin.
Clonidine is a drug used to lower blood pressure. Prolonged use can contribute to damage to
the retina.
Analysis of data from the Beaver Dam Study, a 2 year study of nearly a thousand people aged
43-86, shows that use of vasodilator and hypertension medications increases the risk of
developing macular degeneration by 72%. This research continued through 2013 with almost
5000 patients with the same results.
Data from the same Beaver Dam Study found that use of beta blockers (ie Tenormin &
Lopressor) was tied to a 71% increased risk of wet macular degeneration, the more severe and
advanced form of AMD.
Blood Thinners
Heparin, coumadin, anisindione, and other oral anti-coagulants, prescribed to prevent blood
clotting can cause hemorrhaging in the eye
Cancer Drugs
5-fluoro-uracil (5-FU) a cancer chemotherapy drug can lead to scars and closing the tear
drainage system, resulting in eye tearing.
Tamoxifen, prescribed after breast cancer treatment, can lead to crystalline deposits in the
retina and in the cornea.
Depression
Antidepressants, which change how information is processed in the nerves in the brain. Any
medication that affects neurological function can affect vision and cause changes in the
cornea, optic nerve, lens, macula and retina.
Venlafaxine, prescribed for depression can lead to optic nerve damage and/or glaucoma
Antidepressants (including fluvoxamine (Luvox), venlafaxine (Effexor), and paraxetine (Paxil)
raise risk of cataracts by 23 39%, (June 2010, Ophthamology), ("Selective serotonin reuptake
inhibitors and the risk of cataracts; a nested case control study" Mahyar Etminan, PharmD,
Univ. Brit Columbia, Vancouver, Canada)
Many antidepressants are drugs that increase your sensitivity to the sun and can make you
more susceptible to cataracts and macular degeneration.
Anti-depressants - can cause dry eyes and contribute to cataract formation.
Venlafaxine can cause the eye's blood vessels to hemorrhage
Antidepressants, prescribed for depression, such as amitriptyline (tri-cyclic antidepressants),
increase the risk of acute angle closure glaucoma, but do not increase the risk for "open
angle" glaucoma.
Mirtazapine, prescribed for depression can lead to optic nerve damage and/or glaucoma
Prozac may cause dilated pupils, double vision, blurred vision, and dry eyes. It can also
cause eye pain, eye lid infection (blepharitis), cataracts, glaucoma, ptosis (eyelid droop), and
an inflammation of the iris (iritis). These side effects can only be avoided by discontinuing the
medication, so if you are taking Prozac be aware that these visual symptoms are normal when
taking this drug.
Tricyclic antidepressants (amitriptyline, desipramine, imipramine, and nortriptyline) may
cause such visual effects as loss of the ability to focus up close, dilated pupils, double vision,
and dry eyes.
Valium may cause red eyes, involuntary eye twitching, and some paralysis of the eye
muscles.
Zoloft has very few visual side effects but can cause changes to the cornea.
Tricyclic antidepressants give rise to problems attention and processing information. These
include Amitriptyline and Imipramine.
Cymbalta has been found to increase the risk of glaucoma.
Diabetes
Oral anti-diabetes drugs are photosensitizing. They absorb light energy and undergo a
photochemical reaction resulting in chemical modification of tissue. They can make you more
vulnerable to cataracts and macular degeneration.
Patients taking diabetes drugs known as thiazolidinediones, pioglitazone and rosiglitazone
have 3 to 6 times increased risk of developing diabetic macular edema. ("TZDs, GLP 1 agonist
may worsen diabetic retinal disease , June 27, 2011 Medical Economics EConsult)
Diabetic medications such as Chlorpropamide are rarely connected to optic nerve
degeneration.
Dilate pupils
Any drug that dilates your pupils may increase the risk of angle closure glaucoma (narrow
angle glaucoma) and optic nerve damage.
Glaucoma
Long-term utilization of antiglaucoma drugs can effect macula sensitivity. Periodic macula
evaluation is recommended for any patients who are taking antiglaucomatous drugs.
Erectile dysfunction
Erectile dysfunction drugs tadalafil, vardenafil hydrocholoride, and sildenafil citrate (Viagra)
may lead to nonarteritic anterior ischemic optic neuropathy (sudden vision loss) especially if
the patient has had a past heart attack. (June, 2006, Health Canada Public Communication),
("Feb. 2006, British Journal of Ophthalmology")
Heart Medications
Amiodarone, a cardiac medication is associated with changes to the cornea (a whorl-like
pattern on the surface of the cornea), which rarely may cause vision disturbance. The
condition goes away when the medication ceases.
Digoxin, used for heart failure or heart irregularity, increases light sensitivity resulting in glare
symptoms, halos around lighted objects, or yellowish vision.
Digoxin can cause changes to the cornea. Common visual side effects are color vision
changes. You may experience light flashes, blind spots, and light sensitivity.
Pentoxifylline, prescribed to improve circulation can cause hemorrhaging in the eye
There is an association between amodarone and optic neuritis or optic neuropathy. Patients
taking this medication should have regular ophthalmic examinations.
High Cholesterol
Simvastatin, prescribed for high cholesterol can lead to optic nerve damage and/or glaucoma
Patients who take statins like zocor or lipitor, are 27% more likely to develop cataracts.
Hormone Replacement
Estrogen or Androgen replacement with synthetic hormones can cause blood clotting, and
reduction of blood circulation in the eyes
Estrogen hormone replacement may cause blepharospasm or eye twitching.
Inflammation
The whole family of NSAIDS (non-steroidal anti-inflammatory drugs) can cause side effects
that impact the eyes including cataracts, dry eyes, and retinal hemorrhages that may result
from long term use. These include ibuprofin (Advil, Motrin, Bayer, Aleve, aspirin, flurbiprofen,
ketoprofen and naproxen sodium. Also Tylenol (acetaminophen), though not an NSAID, can be
harmful to the eyes. In 2014 the FDA asked doctors to stop recommending combination drugs
that contain high levels of acetaminophen.
NSAIDS (ie, aspirin, ibuprofin, advil, meclofen) are photosensitizing drugs (drugs that
increase your sensitivity to the sun) that absorb light energy and undergo a photochemical
reaction resulting in chemical modification of tissue. They can make you more susceptible to
cataracts and macular degeneration.
Anti-inflammatory drugs such as indomethacin can rarely lead to whorl-like patterns on the
cornea surface, but rarely causes visual symptoms.
NSAIDs, Non-steroidal anti-inflammatory drugs can contribute to optic nerve damage and/or
glaucoma
Insomnia
Benzodiazepines prescribed for insomnia may cause blepharospasm (eye twitch).
Benzodiazepines also lead to weaknesses in concentration and memory. These include
Midazolam, Trazolam, Temazepam, Oxazepam, Lorazepam, Alprazolam, Clonazepam,
Diazepam, Florazepam, Clorazepam, Zolpidem, Zopiclone and Zaleplon
Malaria
Anti-malarial drugs including chloroquine, quinacrine, and hydroxychloroquine can cause
changes in the cornea. Symptoms such as halos around lights, glare and light sensitivity may
occur. There is no change in the person's visual acuity. Once drug therapy is stopped both
subjective symptoms and objective corneal signs disappear.
Quinine may (rarely) affect night vision.
Chloroquine may lead to retinal detachment, degeneration of the optic nerve, reduced color
vision, blind spots, and blurred central vision. (This may be related to the total amount of the
medication taken over time.)
Quinine, taken by pregnant women, can lead to optic nerve hypoplasia" in the fetus, which is
an under-developed optic nerve
Anti-malarial drugs contribute to sensitivity to light
Muscle spasms
Gastric antispasmodics, prescribed to stop muscle spasms can lead to optic nerve damage
and/or glaucoma
Benzodiazepines prescribed for muscle spasms or seizures can cause blepharospasm.
Pain relief
Aspirin, may exaggerate bleeding of the eye, and usually surgeons recommend discontinuing
aspirin for at least a week before eye surgery.
The whole family of NSAIDS (non-steroidal anti-inflammatory drugs) can cause side effects
that impact the eyes including cataracts, dry eyes, macular degeneration and retinal
hemorrhages that may result from long term use. These include ibuprofin (Advil, Motrin, Bayer,
Aleve, aspirin, flurbiprofen, ketoprofen and naproxen sodium. Also Tylenol (acetaminophen),
though not an NSAID, can be harmful to the eyes. They (ie, aspirin, ibuprofin, advil, meclofen)
are photosensitizing drugs (drugs that increase your sensitivity to the sun) that absorb light
energy and undergo a photochemical reaction resulting in chemical modification of tissue.
Overuse of what are considered "harmless" drugs can be damaging to the body and eyes.
When drugs are used excessively, they can induce photosensitivity, dry eyes, corneal deposits,
gastrointestinal tract damage, and even cataracts.
Parkinson's Drugs
Drugs for Parkinson's, such as levodopa, may aggravate or cause blepharospasm.
Amantadine is often prescribed for patients with Parkinson's. For some, this treatment brings
about abnormal cornea changes which usually begin soon after starting treatment and go
away a few weeks after stopping treatment; sometimes the conditions arise after the patient
has been taking the drug for some years in which case the damage may be permanent.
Researchers have found that the cumulative intake or longest treatment duration have the most
significant changes to endothelial cell density (these cells help keep excess water out of the
cornea, and protecting against swelling. Extra care is recommended in monitoring cornea
edema in such patients, as well as patients who have had cataract surgery or who have
glaucoma, uveitis, or Fuch's dystrophy.
Psychiatric medications
Psychiatric medications, such as the phenothiazines, ie Chlorpromazine (Thorazine) and
Mellaril (thioridazine), in large doses, can lead to pigmentation of the conjunctiva, cornea, and
eyelids.
Antipsychotic medications, such as haldol, increase the risk for angle closure glaucoma, but
do not increase the risk for open angle glaucoma.
Schizophrenia - Thioridazine it can cause pigmentary retinopathy (retinitis pigmentosa) as
well as other side effects
Benzodiazepines prescribed for alcohol withdrawal or anxiety can cause blepharospasm.
Recreational Drugs
Cocaine has been shown to lead to retinal artery occlusion, and rapid and often irreversible
loss of vision. Cocaine can lead to corneal ulcers that may be infected with bacteria or might
be sterile.
Smoking tobacco increases the risk of macular degeneration, optic nerve damage and
formation of cataracts.
Many recreational drugs make you more light sensitive, cause photochemical tissue changes
and may make you more vulnerable to cataracts and macular degeneration.
Sea sickness
Stimulants such as ephedrine, sometimes prescribed for sea-sickness, giving rise to dilation
of the pupils, may increase risk of angle closure glaucoma.
Steroids
If you must take steroids, we recommend that you also take theAdvanced Eye & Vision
Support Formula to protect your vision.
Steroids, such as Glucocorticoids (Prednisone), are photosensitizing drugs (drugs that
increase your sensitivity to the sun) and undergo a photochemical reaction resulting in
chemical modification of tissue. They can make you more susceptible to cataracts and macular
degeneration.
 Central serous choroidopathy (CSC, CSR) can be triggered or aggravated by corticosteroids,
such as cortisone, or they can cause a relapse.
Steroids contribute to cataracts, glaucoma and macular degeneration. Steroids work by
mimicking body's own hormones to fight inflammation and are often prescribed for such
diseases as rheumatoid arthritis, Crohn's Disease, and lupus. Long term steroid use can
contribute cataracts and increases in intraocular pressure in up to 50% of people who take
daily doses of 10 to 15 milligrams of prednisone over a period of one to two years. Cataracts
caused by steroids are very dense and can cause a rapid loss of vision.
Though not as common as the development of cataracts, another side effect of continued
steroid treatment is increased intraocular pressure, which can lead to glaucoma and optic
nerve damage. If one stops taking steroids regularly pressures will return to normal, but
damage done by the elevated eye pressure will remain. Steroid use can cause an increase in
blood sugar therefore leading to diabetes, which can then lead to diabetic retinopathy. If you
must take steroids, be sure to take high doses of antioxidants such as alpha lipoic acid, lutein,
vitamin C, and vitamin E, lutein to help prevent these conditions.

Tuberculosis
Ethambutol and isoniazid, used for tuberculosis rarely lead to optic nerve degeneration.
Ulcers
Anti-ulcer medications, such as Cimetidine, can cause hemorrhaging in the eye and can
rarely lead to angle closure glaucoma (not open angle glaucoma).
Proton pump medications can cause hypersensitivity, especially Omeprazole.
Vitamins
Mega-doses of vitamin A can increase the pressure of fluid around the brain, which in turn
can cause swelling of the optic nerve, headache, and visual distortions.
Weight Loss
Appetite suppressants (amphetamines, dextroamphetamines, methamphetamines, and
phenmetrazine compounds) may contribute to the following visual side effects: dilated pupils,
difficulty focusing the eyes, and difficulty converging the eyes when reading.
Fenfluramine, prescribed for weight loss can lead to optic nerve damage and/or glaucoma
Appetite suppressants contribute to dry eye syndrome
Amphetamines can contribute to optic nerve damage and/or glaucoma and lead to a reduced
focusing capacity and a risk for acute angle closure glaucoma, a serious eye emergency.
Stimulants such as ephedrine, giving rise to dilation of the pupils, may increase risk of angle
closure glaucoma.