In the abstract of their article in the January 1994 issue of the Archives, Dr Ritch et al1 state that "psychoactive drugs should be prescribed cautiously in patients with known narrow angles." This conclusion is overinclusive. The majority of currently prescribed psychoactive medications are not at all or are only mildly anticholinergic and have not been reported to elicit acute angle closure. The selective serotonin reuptake inhibitors (eg, fluoxetine hydrochloride [Prozac], paroxetine hydrochloride [Paxil]), often first-line antidepressant therapy, are devoid of anticholinergic activity, as are benzodiazepine anxiolytics, lithium, and other mood stabilizers. However, some of the older tricyclic antidepressants (amitriptyline hydrochloride, imipramine hydrochloride, doxepin hydrochloride, protriptyline hydrochloride, and triimipramine hydrochloride), some antipsychotics (thioridazine hydrochloride, chlorpromazine hydrochloride, and others), and clearly drugs like benztropine mesylate are indeed anticholinergic and could potentially trigger acute angle closure. Although few documented cases of a temporal association between ingestion of drugs with anticholinergic properties
Kramer M, Reines S. Oral Imipramine and Acute Angle-Closure Glaucoma. Arch Ophthalmol. 1995;113(6):698–699. doi:10.1001/archopht.1995.01100060020009
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