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Medications for attention deficit hyperactivity disorder associated with increased risk of developing glaucoma



Attention deficit hyperactivity disorder (ADHD) therapies including atomoxetine, methylphenidate, and amphetamines are some of the most prescribed medications in North America. Due to their sympathomimetic action, these drugs are contraindicated in patients with a history of angle closure glaucoma (ACG). This study aims to determine the risk of ACG and open angle glaucoma (OAG) among users of these treatments.


This is a retrospective cohort study with a case control analysis using the PharMetrics Plus Database (IQVIA, USA). We created a cohort of new users of atomoxetine, methylphenidate, and amphetamines and they were followed to the first diagnosis of (1) ACG or OAG; or (2) end of follow up. For each case, four age-matched controls were selected. A conditional logistic regression model was used to adjust for confounders and to calculate adjusted incidence-rate-ratios (aIRRs).


A total of 240,257 new users of the ADHD medications were identified. The mean age was 45.0 ± 19.4 years and 55% of the cohort was female. Regular users of atomoxetine and amphetamines had a higher aIRR for developing ACG compared with non-users (aIRR = 2.55 95% CI [1.20–5.43] and 2.27 95% CI [1.42–3.63], respectively); while users of methylphenidate had a higher aIRR for developing OAG (aIRR = 1.23 95% CI [1.05–1.59]).


Use of amphetamines and atomoxetine had a higher risk for ACG, while use of methylphenidate was associated with a higher risk for OAG. Given the prevalence of ADHD medication use (medically and recreationally), our current data on their associated risk of glaucoma have profound public health implications.

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Data availability

Data can be provided upon a reasonable request. The authors can share the complete data set creation plan and the analytic code upon request; please contact Dr. Mahyar Etminan. The data sets utilized in this study are accessible with permission from IQVIA. However, there are restrictions on the availability of this data, as it was used under license for this study and is not publicly accessible.


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This study was funded by the Glaucoma Research Society of Canada Project Grant.


This study was funded by the Glaucoma Research Society of Canada Project Grant.

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Authors and Affiliations



RD was responsible for designing the study, conducting the search, analysing, and interpreting results, and writing the report. BH contributed to the design of the research and provided feedback on the report. ME and BE supervised the design of the study, writing the report, extracting and analysing data, interpreting the results, and provided feedback on the report.

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Correspondence to Mahyar Etminan.

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Darwich, R., Etminan, M., He, B. et al. Medications for attention deficit hyperactivity disorder associated with increased risk of developing glaucoma. Eye (2024).

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