Dosage Forms
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)
Pharmacology
Mechanism of Action
Latanoprost is a prostaglandin F2-alpha analog believed to reduce intraocular pressure by increasing the outflow of the aqueous humor
Pharmacokinetics/Pharmacodynamics
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
Vd: 0.16 ± 0.02 L/kg
Metabolism
Primarily hepatic via fatty acid beta-oxidation
Excretion
Urine (as metabolites)
Onset of Action
3 to 4 hours; Peak effect: Maximum: 8 to 12 hours
Half-Life Elimination
17 minutes
Use: Labeled Indications
Elevated intraocular pressure: Reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma and ocular hypertension.
Contraindications
Hypersensitivity to latanoprost, benzalkonium chloride, or any component of the formulation
Dosage and Administration
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)
Dosing: Geriatric
Refer to adult dosing.
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).
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.
Storage
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.
Drug Interactions
Bimatoprost: The concomitant use of Latanoprost and Bimatoprost may result in increased intraocular pressure. 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). 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). Monitor therapy
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
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.
Monitoring Parameters
Monitor IOP; regularly examine patients who develop increased iris pigmentation.
Pregnancy
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).
Patient Education
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.
