Rutin May Have a Role in the Treatment of Glaucoma

What is Rutin?

Rutin is a flavonoid naturally found in apples, buckwheat, elder flowers, eucalyptus, Ginkgo biloba, hawthorn leaves and flowers, Japanese pagoda tree, lime tree flowers, rue, St. John’s Wort, among other fruits and vegetables. It is most concentrated in Ziziphus Jujuba (Chinese/Korean Date). It appears to have antioxidant properties.[1] Rutin is converted in the gastrointestinal tract to quercetin[D1] , which is believed to be responsible for many of the touted benefits of Rutin.

Evidence that Rutin can be effective in the treatment of Glaucoma

There is no direct evidence that Rutin could have an IOP lowering effect on the eye.  However, two studies have evaluated the effect of Rutin combined with Forskolin (Coleus) on IOP in patients with glaucoma. The specific product studied was Kronek® (SOOFT Italia, Montegiorgio, Italy) which contains Rutin 200mg, Forskolin (Coleus) 15mg, Vitamin B1 0.7mg, and Vitamin B2 0.8mg.

The first study evaluated the use of Kronek® in patients with medically controlled primary open angle glaucoma. It was a small study (only 16 patients) and without the benefit of a placebo control. Despite these severe limitations, the IOP appeared to decrease by an average of 20% after 40 days of use.[2]

The most impressive study evaluated Rutin and Forskolin (Coleus) in patients awaiting glaucoma surgery.  These patients had uncontrolled IOP on maximum tolerated medical therapy (MTMT).  Patients in the study treatment arm were instructed to take the supplement twice daily.

In those patients taking the supplement, IOP dropped by an average of 10% after one to three weeks of treatment. The IOP lowering effect appeared to be dependent upon the initial pre-treatment IOP. In other words, the higher the initial IOP, the greater the IOP lowering effect of the supplement.[3]

In addition to the IOP lowering potential, there is evidence that Kronek® may also improve the symptoms of ocular surface disease related to the use of BAK-containing glaucoma drops.[4]

Potential Side Effects and Risks:

Use of Rutin has been associated with flushing, headache, mild gastrointestinal distress, and skin rashes.[5]

Potential Drug Interactions

None known.

Recommended Dosage

Based on the studies evaluating the effect of combined Rutin and Forskolin (Coleus) on IOP, it would be reasonable to use 400mg of Rutin and 30mg of Forskolin (Coleus) per day (divided into two doses). Because supplements can vary widely in quality and concentration of the active ingredients, I recommend use of the actual studied brand, Kronek®, if available locally or online.

References
  1. Kostyuk VA, Potapovich AI. Antiradical and chelating effects in flavonoid protection against silica-induced cell injury. Arch Biochem Biophys 1998;355:43-8.
  2. Pescosolido N, Librando A. Oral administration of an asociation of forskolin, rutin and vitamins B1 and B2 potentiates the hypotonising effects of pharmacologic treatments in POAG patients. Clin Ter 2010;161(3):e81-5.
  3. Vetrugno M, Uva M, Russo V, et al. Oral administration of forskolin and rutin contributes to Intraocular Pressure Control in Primary Open Angle Glaucoma Patients Under Maximum Tolerated Medical Therapy. J ocul Pharmacol Ther 2012;28(5):536-41.
  4. Nebbioso M, Rusciano D, Pucci B, et al. Treatment of glaucomatous patients by means of food supplement to reduce the ocular discomfort: a double blind randomized trial. Eur Rev Med Pharmacol Sci 2013;17(8):1117-1122.
  5. Mehta DK (Ex Ed). British National Formulary, Number 37. British Medical Association and Royal Pharmaceutical Society of Great Britain: London, England, March 1999.

Looking for an Ophthalmologist in California?

Dr. David Richardson is taking new patients at his office in San Marino, CA., and is always willing to provide a second opinion for those who would like the peace-of-mind that such a consultation would provide.

For Inquiries or Consultation, Call (626) 289-7856
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