For some time, I’ve wanted to compile a list of all the medicines I hear mentioned in practice, for those of you who are still at university or in your pre-reg year. Eventually I hope to produce a complete list of common medications, their use and their ocular effects (if any). I’m planning on adding to it over time so this is far from the finished article.
For ease of use, I’m going to group the drugs by what they treat. The most popular medicine in that category will be at the top, the least popular at the bottom. When I say popular, I mean they are the ones mentioned most frequently in my practice.
Okay, so let’s start with painkillers. One in five people in the UK suffer from chronic pain and they will usually take a selection of drugs ranging from opiate painkillers to mild anti-depressants.
- Paracetamol – very commonly prescribed for mild to moderate pain relief.
- Ibuprofen – a non-steroidal anti-inflammatory used to treat mild to moderate pain.
- Co-codamol and its family: Solpadol, Co-dydramol (with dihydrocodeine), Migraleve (with added antiemetic). Again, these are for mild to moderate pain. Codeine can cause “blurry vision” and pupil miosis.
- Tramadol – for moderate to severe pain. This, like codeine, is an opioid painkiller and can cause blurred vision, pupil miosis and a weird range of side effects including hallucinations* and headaches.
- Amitriptyline – this is an antidepressant which is used in small doses (unlicensed, according to my very old BNF) to treat neuropathic pain (from 10 to 75mg daily). This drug has side effects including blurred vision and may very rarely cause closed angle glaucoma. It also makes you sleepy. This tends to go hand in hand with tramadol.
- Naproxen – our local GP’s go to drug for inflammatory pain. It has one of the lowest incidence of side effects of the NSAIDs.
- Diclofenac – non-steroidal anti-inflammatory, used for a selection of issues including migraine, rheumatic pain and acute gout***. Many of my patients remember this one as the “brown tablet”.
- Gabapentin – used for neuropathic pain, epilepsy and to prevent migraine. This has a terrifying array of side effects including incontinence, confusion and depression. It also has dry mouth as a side effect so I would assume it would have the same effect on the eye. It also can cause EOM dysfunction, according to my old uni notes.
- Pregabalin – similar use to gabapentin but with even more side effects.
- Oxycodone – treats moderate to severe pain. Has the same opioid effects on the eye as before.
- Morphine – again, an opioid painkiller. It’s used after surgery and for severe pain. All of the usual ocular side effects plus nystagmus. If you’ve ever had an operation, you’ve probably had morphine.
- Methadone – I have several patients who are on methadone because they are recovering from substance abuse but it can also be used as a painkiller (you would have to be in a very bad way to have this as a painkiller, though).
* I recently spoke to someone who told me their friend, on taking tramadol for back pain, had hallucinations of a fox in a waistcoat running up and down her walls. While it’s great that Basil Brush** is still in people’s minds and hearts, any sort of hallucination is scary when it’s happening, even if it is awesome.
** Look it up, young ones. Boom boom.
*** Allopurinol is used to prevent gout, not treat acute gout (a fact I’ve just learned this moment thanks to my trusty BNF).