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Travoprost

Class: Prostaglandin Analogs
VA Class: OP109
Chemical Name: [1R-[1α(Z),2β(1E,3R*),3α,5α]]-7-[3,5-dihydroxy-2-[3-hydroxy-4-[3-(trifluoromethyl)phenoxy]-1-butenyl]cyclopentyl]-5-heptenoic acid 1-methylethyl ester
CAS Number: 157283-68-6
Brands: Travatan Z

Medically reviewed by Drugs.com on Nov 9, 2020. Written by ASHP.

Introduction

Ocular hypotensive agent; a synthetic analog of prostaglandin F (PGF).

Uses for Travoprost

Ocular Hypertension and Glaucoma

Reduction of elevated IOP in patients with open-angle glaucoma or ocular hypertension.

Safety and efficacy not established for the treatment of angle-closure, inflammatory, or neovascular glaucoma.

Mean reductions in IOP may be up to 1.8 mm Hg greater in black patients than in other races; not known whether this difference is related to race or to heavily pigmented irides.

May be more effective than timolol 0.5% and equally or more effective than latanoprost 0.005% in reducing IOP in patients with open-angle glaucoma or ocular hypertension. Appears to be superior to timolol 0.5% or latanoprost 0.005% in reducing IOP in black patients.

Addition of travoprost 0.004% to timolol 0.5% therapy may result in additional reduction in IOP.

When selecting an initial ocular hypotensive agent, consider extent of the required IOP reduction, coexisting medical conditions, and drug characteristics (e.g., dosing frequency, adverse effects, cost). With single-agent regimens, the reduction in IOP is approximately 25–33% with topical prostaglandin analogs; 20–25% with topical β-adrenergic blocking agents, α-adrenergic agonists, or miotic (parasympathomimetic) agents; 20–30% with oral carbonic anhydrase inhibitors; 18% with topical rho kinase inhibitors; and 15–20% with topical carbonic anhydrase inhibitors.

A prostaglandin analog frequently is considered for initial therapy in the absence of other considerations (e.g., contraindications, cost considerations, intolerance, adverse effects, patient refusal) because of relatively greater activity, once-daily administration, and low frequency of systemic adverse effects; however, ocular adverse effects can occur.

Goal is to maintain an IOP at which visual field loss is unlikely to substantially reduce quality of life during the patient's lifetime.

Reduction of pretreatment IOP by ≥25% shown to slow progression of primary open-angle glaucoma. Set an initial target IOP (based on extent of optic nerve damage and/or visual field loss, baseline IOP at which damage occurred, rate of progression, life expectancy, and other considerations) and reduce IOP toward this goal. Adjust target IOP up or down as needed over course of disease.

Combination therapy with drugs from different therapeutic classes often required to control IOP.

Travoprost Dosage and Administration

Administration

Ophthalmic Administration

Apply topically to the affected eye(s).

Avoid contamination of the solution container. (See Bacterial Keratitis under Cautions.)

Remove contact lenses before administering each dose; may reinsert lenses 15 minutes after the dose.

If more than one topical ophthalmic drug is used, administer the drugs at least 5 minutes apart.

Dosage

Adults

Ocular Hypertension and Glaucoma
Ophthalmic

Travoprost 0.004% ophthalmic solution: One drop in the affected eye(s) once daily in the evening.

More frequent dosing may paradoxically diminish the IOP-lowering effect of the drug.

If target IOP not achieved, may initiate additional or alternative ocular hypotensive agents. (See Ocular Hypertension and Glaucoma under Uses.)

Special Populations

No special population dosage recommendations at this time.

Cautions for Travoprost

Contraindications

  • Manufacturer states none known.

Warnings/Precautions

Pigmentation

Increased pigmentation of the iris and periorbital tissue (eyelid) reported. Pigmentation expected to increase as long as travoprost is administered. Following discontinuance of therapy, pigmentation of the iris is likely to be permanent, while pigmentation of periorbital tissue reportedly is reversible in some patients. Long-term effects of increased pigmentation unknown.

Increased pigmentation of the iris may not be evident until after several months to years of travoprost therapy. May continue therapy in patients who develop noticeably increased iris pigmentation; however, examine these patients regularly.

Eyelash Changes

Possible gradual change in eyelashes and vellus hair in the treated eye, including increased length, thickness, pigmentation, and number of eyelashes and/or misdirected growth of eyelashes. Usually reversible upon discontinuance of therapy.

Intraocular Inflammation

Use with caution in patients with active intraocular inflammation (e.g., uveitis); may exacerbate inflammation.

Macular Edema

Macular edema, including cystoid macular edema, reported. Use with caution in aphakic patients, in pseudophakic patients with a torn posterior lens capsule, or in patients with known risk factors for macular edema.

Bacterial Keratitis

Bacterial keratitis reported with use of multiple-dose containers of topical ophthalmic preparations. Containers were inadvertently contaminated by patients, most of whom had concurrent corneal disease or disruption of the ocular epithelial surface.

Improper handling of ophthalmic solutions can result in contamination of the solution by common bacteria known to cause ocular infections. Serious damage to the eye and subsequent loss of vision may result from using contaminated ophthalmic solutions. (See Advice to Patients.)

Use with Contact Lenses

Remove contact lenses before administering each dose; may reinsert lenses 15 minutes after the dose.

Specific Populations

Pregnancy

Category C.

Use only if potential benefits justify possible risks to the fetus.

Lactation

Travoprost and/or its metabolites distribute into milk in animals; not known whether the drug or its metabolites distribute into milk in humans. Caution if used in nursing women.

Pediatric Use

Use in pediatric patients <16 years of age not recommended because of potential safety concerns related to increased pigmentation following long-term use. (See Pigmentation under Cautions.)

Geriatric Use

No overall differences in safety and efficacy relative to younger adults.

Hepatic Impairment

No clinically important changes in laboratory test results (i.e., hematology, blood chemistry, urinalysis) observed.

Renal Impairment

No clinically important changes in laboratory test results (i.e., hematology, blood chemistry, urinalysis) observed.

Common Adverse Effects

Ocular hyperemia, decreased visual acuity, ocular discomfort, foreign body sensation, pain, pruritus.

Interactions for Travoprost

None currently known.

Travoprost Pharmacokinetics

Absorption

Bioavailability

Prodrug; absorbed through the cornea following ocular instillation and hydrolyzed to active form (travoprost free acid).

Peak plasma concentrations of travoprost free acid occur within 30 minutes.

Onset

Reduction in IOP generally occurs within 2 hours after topical application and peaks within 12 hours.

Distribution

Extent

Distributed into milk in animals; not known whether the drug or its metabolites distribute into milk in humans.

Elimination

Metabolism

Hydrolyzed by esterases in the cornea to biologically active form (travoprost free acid). Systemically, travoprost free acid is metabolized to inactive metabolites.

Travoprost free acid is rapidly eliminated from plasma; plasma concentrations are below the limit of quantitation within one hour following ocular instillation.

Elimination Route

Less than 2% of the topical ocular dose is excreted in urine within 4 hours as travoprost free acid.

Half-life

Mean terminal elimination half-life of travoprost free acid is 45 minutes.

Stability

Storage

Ophthalmic

Solution

2–25°C.

Actions

  • Selective prostanoid agonist; mimics the effects of PGF at its prostanoid receptor.

  • Appears to reduce IOP by increasing uveoscleral outflow of aqueous humor.

Advice to Patients

  • Importance of not exceeding once-daily dosing; more frequent administration may decrease IOP-lowering effect of travoprost.

  • Risk of permanent increase in brown pigmentation of the iris; risk of darkening of the skin around the eyes (eyelid), which may be reversible after discontinuance of travoprost.

  • Risk of changes in eyelashes and vellus hair in the treated eye. Potential for disparity between eyes in length, thickness, pigmentation, or number of eyelashes or vellus hairs and/or direction of eyelash growth. Eyelash changes usually are reversible after discontinuance of travoprost.

  • Importance of learning and adhering to proper administration techniques to avoid contamination of the solution with common bacteria that can cause ocular infections. Instruct patients that the tip of the dispensing container should not touch the eye or surrounding structures, fingers, or any other surface. Serious damage to the eye and subsequent loss of vision may result from using contaminated ophthalmic solutions.

  • Advise patients to immediately contact their clinician for advice regarding continued use of travoprost ophthalmic solution if an intercurrent ocular condition (e.g., trauma, infection) or ocular reaction (particularly conjunctivitis and eyelid reaction) develops or ocular surgery is planned.

  • Importance of removing contact lenses before administering each dose and delaying reinsertion for at least 15 minutes after the dose.

  • If using more than one topical ophthalmic preparation, importance of administering the preparations at least 5 minutes apart.

  • Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.

  • Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Travoprost

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Ophthalmic

Solution

0.004%*

Travatan Z

Alcon

Travoprost Ophthalmic Solution

AHFS DI Essentials™. © Copyright 2021, Selected Revisions November 9, 2020. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

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