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Bimatoprost

Pronunciation

Pronunciation

(bi MAT oh prost)

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, External:

Latisse: 0.03% (3 mL, 5 mL) [contains benzalkonium chloride]

Solution, Ophthalmic:

Lumigan: 0.01% (2.5 mL, 5 mL, 7.5 mL); 0.03% (2.5 mL [DSC], 5 mL [DSC], 7.5 mL [DSC]) [contains benzalkonium chloride]

Generic: 0.03% (2.5 mL, 5 mL, 7.5 mL)

Brand Names: U.S.

  • Latisse
  • Lumigan

Pharmacologic Category

  • Ophthalmic Agent, Antiglaucoma
  • Prostaglandin, Ophthalmic

Pharmacology

As a synthetic analog of prostaglandin with ocular hypotensive activity, bimatoprost decreases intraocular pressure by increasing the outflow of aqueous humor. Bimatoprost may increase the percent and duration of hairs in the growth phase, resulting in eyelash growth.

Distribution

Vd: 0.67 L/kg

Metabolism

Undergoes oxidation, N-deethylation, and glucuronidation after reaching systemic circulation; forms metabolites

Excretion

Urine (67%); feces (25%)

Onset of Action

Reduction of IOP: ~4 hours; Peak effect: Maximum reduction of IOP: ~8 to 12 hours

Time to Peak

≤10 minutes

Half-Life Elimination

IV: ≤45 minutes

Protein Binding

~88%

Use: Labeled Indications

Elevated intraocular pressure (Lumigan only): Reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension

Hypotrichosis of the eyelashes (Latisse only): Treatment of hypotrichosis of the eyelashes

Contraindications

There are no contraindications listed in the manufacturer's labeling.

Dosing: Adult

Elevated intraocular pressure (Lumigan): Ophthalmic: Instill 1 drop into affected eye(s) once daily in the evening; do not exceed once-daily dosing (may decrease IOP-lowering effect). If used with other topical ophthalmic agents, separate administration by at least 5 minutes.

Hypotrichosis of the eyelashes (Latisse): Ophthalmic, topical: Place one drop on applicator and apply evenly along the skin of the upper eyelid at base of eyelashes once daily at bedtime; repeat procedure for second eye (use a clean applicator).

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Elevated intraocular pressure (Lumigan): Adolescents ≥16 years: Refer to adult dosing.

Hypotrichosis of the eyelashes (Latisse): Children ≥5 years and Adolescents: Refer to adult dosing.

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer's labeling.

Administration

Latisse: Remove make-up and contact lenses prior to application; ensure face is clean. Apply with the sterile applicator provided only; do not use other brushes or applicators. Use a tissue or cloth to blot any excess solution on the outside of the upper eyelid margin; do not apply to lower eyelash line. Do not reuse applicators; use new applicator for second eye. Applying more than once nightly will not increase eyelash growth; eyelash growth is expected to return to baseline when therapy is discontinued. May reinsert contacts 15 minutes after application.

Lumigan: May be used with other eye drops to lower intraocular pressure. If using more than one ophthalmic product, wait at least 5 minutes in between application of each medication. Remove contact lenses prior to administration and wait 15 minutes before reinserting.

Storage

Store between 2°C to 25°C (36°F to 77°F).

Drug Interactions

Latanoprost: The concomitant use of Latanoprost and Bimatoprost may result in increased intraocular pressure. Consider therapy modification

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

Adverse Reactions

Adverse reactions and percentages are for Lumigan unless noted:

>10%:

Dermatologic: Increased growth in number of eyelashes

Ophthalmic: Conjunctival hyperemia (25% to 45%; Latisse: <4%), eye pruritus (>10%; Latisse: <4%)

1% to 10%:

Central nervous system: Headache (1% to 5%), foreign body sensation of eye

Dermatologic: Erythema of eyelid (1% to 10%; Latisse: <4%), skin hyperpigmentation (Latisse: <4%), hyperpigmentation of eyelashes, pigmentation of the periocular skin

Endocrine & metabolic: Hirsutism

Hepatic: Abnormal hepatic function tests (1% to 5%)

Infection: Infection (10% [primarily colds and upper respiratory tract infections])

Neuromuscular & skeletal: Weakness (1% to 5%)

Ophthalmic: Dry eye syndrome (1% to 10%; Latisse: <4%), eye irritation (1% to 10%; Latisse: <4%), allergic conjunctivitis, asthenopia, blepharitis, burning sensation of eyes, cataract, conjunctival edema, conjunctival hemorrhage, eye discharge, eye pain, iris hyperpigmentation (may be delayed), lacrimation, photophobia, superficial punctate keratitis, visual disturbance

<1% (Limited to important or life-threatening): Hair breakage, hypersensitivity reaction, hypertension, iritis, macular edema, madarosis, skin rash (including macular and erythematous), uveitis

Warnings/Precautions

Concerns related to adverse effects:

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

• Ocular effects: May permanently change/increase brown pigmentation of the iris, the eyelid skin, periorbital tissue, and eyelashes. In addition, may increase the length, thickness, and/or number of eyelashes (may vary between eyes); changes occur slowly and may not be noticeable for months or years. Pigmentation of the iris is likely to be permanent, while pigmentation of the periorbital tissue and eyelash changes may be reversible following discontinuation of therapy. Long-term consequences of increased pigmentation are not known.

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

Disease-related concerns:

• 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 of Lumigan have not been determined for use in patients with angle-closure-, inflammatory-, or neovascular glaucoma.

Special populations:

• Contact lens wearers: Contains benzalkonium chloride which may be adsorbed and cause discoloration of soft contact lenses; remove contacts prior to administration and wait 15 minutes before reinserting.

Dosage form specific issues:

• Latisse: Patients receiving medications to reduce intraocular pressure should consult their healthcare provider prior to using; may interfere with desired reduction of intraocular pressure. Unintentional hair growth may occur on skin that has repeated contact with solution; apply to upper eyelid only, blot away excess.

Monitoring Parameters

Monitor IOP

Pregnancy Risk Factor

C

Pregnancy Considerations

Adverse events have been observed in animal reproduction studies.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience eyelid/eyelash changes. Have patient report immediately to prescriber vision changes, eye pain, severe eye irritation, sensitivity to light, eye discharge, or eye discoloration (HCAHPS).

• Educate patient about signs of a significant reaction (eg, 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. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

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