Bevacizumab is another VEGF inhibitor that has been shown to have similar efficacy and safety as the previous two drugs, however, is not currently indicated for AMD. AMD can also be treated with laser coagulation therapy.A randomized control trial found that bevacizumab and ranibizumab had similar efficacy, and reported no significant increase in adverse events with bevacizumab. A 2014 Cochrane review found that the systemic safety of bevacizumab and ranibizumab are similar when used to treat neovascular AMD, except for gastrointestinal disorders. Bevacizumab however is not FDA approved for treatment of macular degeneration. A controversy in the UK involved the off-label use of cheaper bevacizumab over the approved, but expensive, ranibizumab. Ranibizumab is a smaller fragment, Fab fragment, of the parent bevacizumab molecule specifically designed for eye injections. Other approved antiangiogenic drugs for the treatment of neo-vascular AMD include pegaptanib and aflibercept.These anti-VEGF agents may be administered monthly or adaptively. For adaptive anti-VEGF treatment, two approaches are conventionally applied. In the case of pro re nata, the patient comes at fixed intervals, but treatment is only administered if an activity is detected (i.e., presence of fluid). In the case of treat-and-extend, the patients always receive treatment, but the interval to the next visit is extended if the lesion was inactive. Recently, researchers have started to apply AI algorithms to predict the future need for treatment. But these approaches have not been validated for clinical use as of today.
Atenolol/chlorthalidone, also known as co-tenidone, is a combination medication used to treat high blood pressure. It is made up of atenolol, a beta-blocker and chlortalidone, a diuretic. It is not recommended as an initial treatment but may be used in those who are taking atenolol and chlortalidone individually. It is taken by mouth.Common side effects include gastrointestinal upset and gout. Serious side effects may include liver problems, pancreatitis, and psychosis. Use is not recommended during pregnancy. Use during breastfeeding may harm the baby. Atenolol works by blocking β1-adrenergic receptors in the heart, thus decreasing the heart rate and workload. Chlorthalidone works by increasing the amount of sodium lost by the kidneys.The combination was approved for medical use in the United States in 1984. It is available as a generic medication. In 2017, it was the 295th most commonly prescribed medication in the United States, with more than one million prescriptions. References
External links
"Atenolol mixture with chlorthalidone". Drug Information Portal. U.S. National Library of Medicine.