Latanoprost

Pharmacologic Category

Ophthalmic Agent, Antiglaucoma; Prostaglandin, Ophthalmic

Dosing: Adult

Elevated intraocular pressure: Ophthalmic: One drop in the affected eye(s) once daily in the evening; do not exceed the once daily dosage (may decrease the IOP-lowering effect)

* See Dosage and Administration in AHFS Essentials for additional information.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment: Adult

There is no dosage adjustment provided in manufacturer’s labeling. However, dosage adjustment unlikely due to low systemic absorption.

Dosing: Hepatic Impairment: Adult

There is no dosage adjustment provided in manufacturer’s labeling. However, dosage adjustment unlikely due to low systemic absorption.

Dosing: Pediatric

Reduction of intraocular pressure: Limited data available: Infants, Children, and Adolescents: Ophthalmic solution (eg, Xalatan): Ophthalmic: 1 drop to affected eye(s) once daily in the evening (Maeda-Chubachi 2013; Quaranta 2017).

Dosing: Renal Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely due to low systemic absorption.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely due to low systemic absorption.

Use: Labeled Indications

Elevated intraocular pressure: Reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma and ocular hypertension.

* See Uses in AHFS Essentials for additional information.

Class and Related Monographs

Ophthalmic Prostaglandin Analogues

Administration: Ophthalmic

May be used with other eye drops to lower IOP. If more than one topical ophthalmic drug is being used, administer the drugs at least 5 minutes apart. Remove contact lenses prior to administration and wait 15 minutes before reinserting.

Administration: Pediatric

Ophthalmic: Wash hands before use.

Solution: Unscrew the cap by turning in the direction of the arrows on top of the cap. Pull lower eyelid down slightly to form a pocket for the eye drop and tilt head back; administer 1 drop. Apply gentle pressure to lacrimal sac immediately following instillation (1 minute) or instruct patient to gently close eyelid after administration to decrease systemic absorption of ophthalmic drops (Urtti 1993; Zimmerman 1984). Avoid contact of bottle tip with skin or eye; remove contact lenses prior to administration and wait at least 15 minutes after instillation before reinserting soft contact lenses. If more than one topical ophthalmic drug is being used, separate administration by at least 5 minutes.

Storage/Stability

Emulsion: Store at 2°C to 25°C (36°F to 77°F). Protect from light. May be maintained at temperatures up to 40°C (104°F) for up to 8 days during shipment.

Solution: Store intact bottles under refrigeration at 2°C to 8°C (36°F to 46°F). Protect from light. Once opened, the container may be stored at room temperature up to 25°C (77°F) for 6 weeks.

Medication Patient Education with HCAHPS Considerations

What is this drug used for?

• It is used to treat glaucoma.

• It is used to lower high eye pressure.

Frequently reported side effects of this drug

• Blurred vision

• Burning

• Stinging

• Eyelash changes

• Foreign body sensation in eye

Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:

• Vision changes

• Eye pain

• Severe eye irritation

• Eye discharge

• Eye discoloration

• Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Medication Safety Issues

Sound-alike/look-alike issues:

Contraindications

Hypersensitivity to latanoprost, benzalkonium chloride, or any component of the formulation

Warnings/Precautions

Concerns related to adverse effects:

• Bacterial keratitis: Inadvertent contamination of multiple-dose ophthalmic solutions, has caused bacterial keratitis.

• Ocular effects: May change/increase brown pigmentation of the iris, the eyelid skin, and eyelashes; length and/or number of eyelashes may also be increased. Pigmentation of the iris is likely to be permanent although iris color change may not be noticeable for months to years; pigmentation of the periorbital tissue and eyelash changes may be reversible following discontinuation of therapy. Long-term consequences and potential injury to eye are not known.

• Ocular inflammation: Intraocular inflammation and exacerbation of inflammation may occur; use with caution in patients with a history of intraocular inflammation (eg, iritis/uveitis) and generally avoid use in patients with active intraocular inflammation.

Disease-related concerns:

• Herpetic keratitis: Use with caution in patients with a history of herpes simplex keratitis; reactivation may occur. Avoid use in patients with active herpes simplex keratitis.

• Ocular disease: Use with caution in aphakic patients, pseudophakic patients with a torn posterior lens capsule, or patients with risk factors for macular edema. Safety and efficacy have not been determined for use in patients with angle-closure, inflammatory, or neovascular glaucoma.

Special populations:

• Contact lens wearers: Solution contains benzalkonium chloride which may be absorbed by contact lenses; remove contacts prior to administration and wait 15 minutes before reinserting.

* See Cautions in AHFS Essentials for additional information.

Geriatric Considerations

Evaluate the patient's or caregiver's ability to safely administer the correct dose of ophthalmic medication.

Pregnancy Considerations

Information related to use in pregnancy is limited (DeSantis 2004).

In general, if ophthalmic agents are needed in pregnancy, the minimum effective dose should be used in combination with punctal occlusion to decrease exposure to the fetus (Samples 1988).

Breast-Feeding Considerations

It is not known if latanoprost is present in breast milk.

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.

Briggs' Drugs in Pregnancy & Lactation

• Latanoprost Ophthalmic

Adverse Reactions

>10%:

Central nervous system: Foreign body sensation of eye (2% to 13%)

Ophthalmic: Eye pain (≤55%), stinging of eyes (≤55%), ocular hyperemia (41%), conjunctival hyperemia (8% to 15%), eye discharge (12%), increased eyelash length (11%)

1% to 10%:

Dermatologic: Erythema of eyelid (3%), hyperpigmentation of eyelashes (1%), allergic skin reaction (≤1%, including eyelid), skin rash (≤1%)

Infection: Influenza (≤3%)

Neuromuscular & skeletal: Arthralgia (≤1%), back pain (≤1%), myalgia (≤1%)

Ophthalmic: Punctate keratitis (1% to 10%), blurred vision (8%), increased eyelash thickness (8%), eye pruritus (5% to 8%), burning sensation of eyes (7%), iris hyperpigmentation (7%), decreased visual acuity (4%), eyelid pain (4%), lacrimation (4%), crusting of eyelid (3%), dry eye syndrome (3%), photophobia (2%), eyelid edema (1% to 2%), conjunctival edema (1%)

Respiratory: Nasopharyngitis (≤3%), upper respiratory tract infection (≤3%)

<1%, postmarketing, and/or case reports: Angina pectoris, asthma, bacterial keratitis, chest pain, conjunctivitis (including pseudopemphigoid of the ocular conjunctiva), corneal edema, corneal erosion, dizziness, dyspnea, exacerbation of asthma, eye disease (periorbital and lid changes resulting in deepening of the eyelid sulcus), headache, herpes simplex keratitis, hyperpigmentation of eyelids, increased growth in number of eyelashes, iris cyst, iritis, keratitis, macular edema (including cystoid macular edema), misdirected growth of eyelashes (including trichiasis), palpitations, pruritus, toxic epidermal necrolysis, unstable angina pectoris, uveitis

* See Cautions in AHFS Essentials for additional information.

Metabolism/Transport Effects

None known.

Drug Interactions Open Interactions

Bimatoprost: The concomitant use of Latanoprost and Bimatoprost may result in increased intraocular pressure. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: May diminish the therapeutic effect of Prostaglandins (Ophthalmic). Nonsteroidal Anti-Inflammatory Agents may also enhance the therapeutic effects of Prostaglandins (Ophthalmic). Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents (Ophthalmic): May diminish the therapeutic effect of Prostaglandins (Ophthalmic). Nonsteroidal Anti-Inflammatory Agents (Ophthalmic) may enhance the therapeutic effect of Prostaglandins (Ophthalmic). Risk C: Monitor therapy

Monitoring Parameters

Monitor IOP; regularly examine patients who develop increased iris pigmentation.

Advanced Practitioners Physical Assessment/Monitoring

Monitor for blurred vision, burning and stinging, conjunctival hyperemia, foreign body sensation, itching, increased pigmentation of the iris, and punctate epithelial keratopathy.

Nursing Physical Assessment/Monitoring

Monitor for blurred vision, burning and stinging, conjunctival hyperemia, foreign body sensation, itching, increased pigmentation of the iris, and punctate epithelial keratopathy.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Emulsion, Ophthalmic:

Xelpros: 0.005% (2.5 mL) [contains edetate disodium, propylene glycol]

Solution, Ophthalmic:

Xalatan: 0.005% (2.5 mL) [contains benzalkonium chloride]

Generic: 0.005% (2.5 mL)

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Ophthalmic:

Monoprost: 0.005% (0.2 mL) [contains edetate disodium]

Xalatan: 0.005% (2.5 mL) [contains benzalkonium chloride]

Generic: 0.005% (2.5 mL, 5 mL)

Anatomic Therapeutic Chemical (ATC) Classification

• S01EE01

Generic Available (US)

May be product dependent

Pricing: US

Emulsion (Xelpros Ophthalmic)

0.005% (per mL): $26.40

Solution (Latanoprost Ophthalmic)

0.005% (per mL): $7.78 - $38.11

Solution (Xalatan Ophthalmic)

0.005% (per mL): $102.61

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Mechanism of Action

Latanoprost is a prostaglandin F₂-alpha analog believed to reduce intraocular pressure by increasing the outflow of the aqueous humor

Pharmacodynamics/Kinetics

Onset of action: 3 to 4 hours

Peak effect: Maximum: 8 to 12 hours

Absorption: Through the cornea where the isopropyl ester prodrug is hydrolyzed by esterases to the biologically active acid. Peak concentration is reached in 2 hours after topical administration in the aqueous humor.

Distribution: V_d: 0.16 ± 0.02 L/kg

Metabolism: Primarily hepatic via fatty acid beta-oxidation

Half-life elimination: 17 minutes

Excretion: Urine (as metabolites)

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

No significant effects or complications reported

Effects on Bleeding

No information available to require special precautions

FDA Approval Date

June 05, 1996

References

De Santis M, Lucchese A, Carducci B, et al. Latanoprost exposure in pregnancy. Am J Ophthalmol. 2004;138(2):305-306. doi: 10.1016/j.ajo.2004.03.002.[PubMed 15289149]

Maeda-Chubachi T, Chi-Burris K, Simons B, et al. Impact of age, diagnosis, and history of glaucoma surgery on outcomes in pediatric patients treated with latanoprost. J Glaucoma. 2013;22(8):614-619.[PubMed 23524858]

Monoprost (latanoprost) [prescribing information]. Oakville, Ontario, Canada: Labtician Ophthalmics Inc.; July 2016.

Patel SS and Spencer CM, “Latanoprost: A Review of Its Pharmacological Properties, Clinical Efficacy and Tolerability in the Management of Primary Open-Angle Glaucoma and Ocular Hypertension,” Drugs Aging, 1996, 9(5):363-78.[PubMed 8922563]

Quaranta L, Biagioli E, Riva I, et al. The Glaucoma Italian Pediatric Study (GIPSy): 1-Year Results. J Glaucoma. 2017;26(11):987-994.[PubMed 28957960]

Samples JR, Meyer SM. Use of ophthalmic medications in pregnant and nursing women. Am J Ophthalmol. 1988;106(5):616-623.[PubMed 2903673]

Urtti A, Salminen L. Minimizing systemic absorption of topically administered ophthalmic drugs. Surv Ophthalmol. 1993;37(6):435-456.[PubMed 8100087]

Xalatan (latanoprost) [prescribing information]. New York, NY: Pfizer; April 2017.

Xalatan (latanoprost) [prescribing information]. New York, NY: Pfizer; September 2018.

Xelpros (latanoprost) [prescribing information]. Cranbury, NJ: Sun Pharmaceuticals; September 2018.

Zimmerman TJ, Kooner KS, Kandarakis AS, Ziegler LP. Improving the therapeutic index of topically applied ocular drugs. Arch Ophthalmol. 1984;102(4):551-553.[PubMed 6704011]

Brand Names: International

9 PM eye drops (IN); Akistan (AT, CZ, DE, HU, PL); Arulatan (BG, BR, EE, ES, SK); Astapro (PH); Ciptan (HU); Drenatan (BR); Enicil (PT); Exalo (MX); Exprosol (NL); Gaap Ofteno (CR, DO, GT, HN, NI, PA, SV); Glaumax (EE); Glautan (IL); Hysite Eye Drops (NZ); Ioprost (EG); Iprost (BD); Jaskroptic (PL); Kivixkenl (MX); Lanoprost (TW); Lanotan (KR, TH, UA); Laprost (DE, VE); Latacris (AT, IE, PL); Latalux (CZ, LT, LV, SK); Latano (BH, ET); Latanoflax (CO); Latanopress (VE); Latanox (CO, EG, UA); Latapres (BD, HR); Lataprost (MY); Lataro (KR); Lataz (TR); Latep (LK); Latipress (ID, PH); Latizodil (LV); Latnoprost (AU); Latochek (SG); Latof (PY, UY); Latop (IE); Latoprost (LK); Louten (AR, BR, CL, EC, LB, PE, PY, UY); Lumoprost (TH); Monopost (AT, CZ, DE, DK, GB, IE, LT); Monoprost (BE, BG, CL, ES, NL, PT); Ocuprost (BD, PE); Prosdrop (TH); Protan (KR); Rasguna (CR, DO, GT, HN, NI, PA, SV); Tonlit (ES); Unilat (EE, HR, HU, LT, RO); Vislat (LK); Vizilat (BG); Vizilatan (CZ, NL); Xalaprost (AU, BD, MT); Xalatan (AE, AR, AT, AU, BB, BE, BG, BH, BO, BR, CH, CL, CN, CO, CY, CZ, DE, DK, EE, EG, ES, FI, FR, GB, GR, HK, HR, HU, ID, IE, IL, IN, IQ, IR, IS, IT, JO, KR, KW, LB, LT, LU, LV, LY, MT, MX, MY, NL, NO, OM, PE, PH, PK, PL, PR, PT, QA, RO, RU, SA, SE, SG, SI, SK, SY, TH, TR, TW, UA, UY, VE, VN, YE, ZA, ZW); Xalavist (PH); Xalof (BE); Xaloftal (BR); Xaprost (TH)

Last Updated 1/29/20