Risk of angle-closure glaucoma with bupropion and topiramate

JAMA Ophthalmol. 2015 Oct;133(10):1187-9. doi: 10.1001/jamaophthalmol.2015.2180.


Importance: Epidemiologic studies have shown that antidepressants may increase the risk of angle-closure glaucoma. We examined the risk of angle-closure glaucoma with bupropion hydrochloride, a unique, popular antidepressant also marketed as a smoking cessation aid.

Observations: A nested case-control study was conducted using a large health claims database in the United States from January 1, 2006, to March 31, 2014. The database contained deidentified information pertaining to a cohort of 6 110 723 patients. Cases were defined according to the first coding for angle-closure glaucoma. For each case, 10 control participants were selected and matched to the cases using density-based sampling. Adjusted rate ratios were computed for bupropion, topiramate (positive control group drug), and esomeprazole (negative control group drug). The adjusted rate ratio was 1.09 (95% CI, 0.75-1.59) for bupropion and 2.59 (95% CI, 1.56-4.30) for topiramate. In a prespecified analysis of patients younger than 50 years, the adjusted rate ratio was 1.98 (95% CI, 1.02-3.84) for bupropion and 5.30 (95% CI, 2.54-11.04) for topiramate.

Conclusions and relevance: Both bupropion and topiramate are widely prescribed drugs. The risk of angle-closure glaucoma in patients younger than 50 years was twice as high in patients taking bupropion and more than 5 times higher in patients taking topiramate.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anticonvulsants / adverse effects*
  • Antidepressive Agents, Second-Generation / adverse effects*
  • Bupropion / adverse effects*
  • Case-Control Studies
  • Databases, Factual
  • Esomeprazole / adverse effects
  • Female
  • Fructose / adverse effects
  • Fructose / analogs & derivatives*
  • Glaucoma, Angle-Closure / chemically induced*
  • Glaucoma, Angle-Closure / diagnosis
  • Humans
  • Intraocular Pressure
  • Male
  • Middle Aged
  • Odds Ratio
  • Proton Pump Inhibitors / adverse effects
  • Retrospective Studies
  • Risk Factors
  • Tonometry, Ocular
  • Topiramate
  • Young Adult


  • Anticonvulsants
  • Antidepressive Agents, Second-Generation
  • Proton Pump Inhibitors
  • Bupropion
  • Topiramate
  • Fructose
  • Esomeprazole