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This study illustrates the difficulty of sorting out basic mechanisms of action with clinical techniques
When the prostaglandin analogues were introduced a frequently asked question was would the use of an oral non-steroid anti-inflammatory drug (NSAID) blunt the effect of prostaglandin analogues on intraocular pressure (IOP)? Prostaglandins act directly on the prostanoid receptor, and NSAIDs exert their effect through inhibiting production/release of prostaglandins in the tissue, one would not expect an interaction between the two drugs. Thus, combining prostaglandin analogues and an oral NSAID has never been considered a problem. Still, in this issue of BJO, Chiba and co-workers (p 314) report that adding a topical NSAID (bromfenac) to eyes already treated with latanoprost induces a small increase in IOP, suggesting that NSAIDs after all blunt some of the effect of latanoprost on IOP. The authors do not suggest an interaction between the two drugs, but they put forward the idea that the explanation is that part of the effect of latanoprost on IOP is mediated by a release of naturally occurring prostaglandins. Thus, the effect on IOP of latanoprost, and presumably of the other PGF2α analogues, should be a combination of two effects. One is a direct effect on the FP receptor mediated by the …
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