The study by Stewart and coworkers1 in the March issue of the Archives is, to my knowledge, the first relatively long-term investigation demonstrating that 0.5% apraclonidine hydrochloride apparently has a role in the long-term therapy for glaucoma. Its use may be appropriate for individuals whose intraocular pressure (IOP) is not sufficiently decreased with a nonselective β-blocker.
Apraclonidine (formerly known as ALO 2145, p-aminoclonidine, and aplonidine hydrochloride), like clonidine, is a relatively selective α2-agonist. It differs from clonidine in that an amino group is substituted on the C4 position of the benzene ring. This seemingly trivial structural change alters its pharmacologic properties compared with clonidine.2 Despite this small chemical change, its IOP-lowering effect remains comparable to that of clonidine. However, there is no compromise in systemic safety or systemic hypotension.3,4 This safe IOP lowering opened the door for new uses of the 1% solution.
Robin AL. Questions Concerning the Role of Apraclonidine in the Management of Glaucoma. Arch Ophthalmol. 1995;113(6):712-714. doi:10.1001/archopht.1995.01100060036026