Which medications in the drug class NMDA Antagonists are used in the treatment of Primary Open-Angle Glaucoma (POAG)?

Updated: Mar 16, 2020
  • Author: Kristin Schmid Biggerstaff, MD; Chief Editor: Inci Irak Dersu, MD, MPH  more...
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Answer

NMDA Antagonists

Neuroprotection in glaucoma has been aimed at protecting those neurons that are damaged or likely to be damaged in glaucomatous optic neuropathy, which consists of neurons along the entire visual pathway, chiefly the retinal ganglion cells (RGC) axons. Using an NMDA antagonist may prevent RGC loss where excitotoxicity, resulting from NMDA receptor overactivation, is implicated.

Memantine (Namenda, Namenda XR)

Memantine is a noncompetitive, low-affinity, open channel blocker that exhibits selective blockade of the excessively open channels with a fast-off rate, thus inhibiting excessive N-methyl-D-aspartate (NMDA) receptor activity while maintaining normal neuronal cell function as it does not accumulate significantly within the channel.

Indicated for moderate-to-severe Alzheimer disease; memantine failed initial phase III trial endpoints for glaucoma indication, although subgroup analysis shows possible efficacy for patients with severe visual loss from glaucoma; possible neuroprotective systemic treatment of glaucoma, although as of now, this is a non-FDA approved off-label use of the drug.


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