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
Ocular hypotensive agent;6 7 a synthetic analog of prostaglandin F2α (PGF2α).1 5
Uses for Travoprost
Ocular Hypertension and Glaucoma
Reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension who are intolerant of other IOP-lowering drugs or who have not responded adequately (i.e., failed to achieve target IOP as determined after multiple measurements over time) to another IOP-lowering drug.1
Safety and efficacy not established for the treatment of angle-closure, inflammatory, or neovascular glaucoma.1
Mean reductions in IOP may be up to 1.8 mm Hg greater in black patients than in other races;1 not known whether this difference is related to race or to heavily pigmented irides.1
May be more effective than timolol 0.5%2 8 9 and equally or more effective than latanoprost 0.005% in reducing IOP in patients with open-angle glaucoma or ocular hypertension.3 9 Appears to be superior to timolol 0.5% or latanoprost 0.005% in reducing IOP in black patients.9
Addition of travoprost 0.004% to timolol 0.5% therapy may result in additional reduction in IOP.1 7 10
Travoprost Dosage and Administration
Apply topically to the affected eye(s).1
Avoid contamination of the solution container.1
If more than one topical ophthalmic drug is used, administer the drugs at least 5 minutes apart.1
Ocular Hypertension and Glaucoma
One drop of a 0.004% solution in the affected eye(s) once daily in the evening.1
More frequent dosing may paradoxically diminish the IOP-lowering effect of the drug.1
Cautions for Travoprost
Known hypersensitivity to travoprost, benzalkonium chloride, or any ingredient in the formulation.1
Increases in brown pigmentation of the iris8 9 and periorbital tissue (eyelid) or increases in length, thickness, number, and pigmentation of eyelashes reported;7 may be permanent.1 2 3
Increased pigmentation of iris develops slowly; may not be evident until after several months to years of travoprost therapy.1 Long-term effects of these changes are unknown.1
Patients should be examined regularly; therapy may be discontinued if increased pigmentation persists.1
Macular edema, including cystoid macular edema, reported with other prostaglandin F2α analogs.1 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.1
Use with caution in patients with a history of intraocular inflammation (e.g., iritis, uveitis); use generally not recommended in patients with active intraocular inflammation.1
Distributed into milk in animals.1 Caution if used in nursing women.1
Safety and efficacy not established in children <11 years of age.1 7
No substantial differences in safety and efficacy relative to younger adults.1
Common Adverse Effects
Ocular hyperemia,1 2 3 4 5 8 9 decreased visual acuity,1 ocular discomfort,1 foreign body sensation,1 pain,1 pruritus.1
Interactions for Travoprost
None currently known.7
Prodrug; absorbed through the cornea following ocular instillation and hydrolyzed to active form (travoprost free acid).1
Peak plasma concentrations of travoprost free acid occur within 30 minutes.1
Reduction in IOP generally occurs within 2 hours after topical application and peaks within 12 hours.1
Distributed into milk in animals; not known whether the drug or its metabolites distribute into milk in humans.1
Hydrolyzed by esterases in the cornea to biologically active form (travoprost free acid).1 Systemically, travoprost free acid is metabolized to inactive metabolites.1
Travoprost free acid is rapidly eliminated from plasma; plasma levels are below the limit of quantitation within one hour following ocular instillation.1
Less than 2% of the topical ocular dose is excreted in urine within 4 hours as travoprost free acid.1
Mean terminal elimination half-life of travoprost free acid is 45 minutes.1
Selective prostanoid agonist;1 mimics the effects of PGF2α at its prostanoid receptor.7
Appears to reduce IOP by increasing uveoscleral outflow of aqueous humor.1
Advice to Patients
Risk of changes in eyelashes and permanent darkening of iris, eyelashes, or skin around the eyes associated with therapy.1 Potential for disparity between eyes if only one eye is treated.1
Importance of learning and adhering to proper administration techniques to avoid contamination of the solution with common bacteria that can cause ocular infections.1 Serious damage to the eye and subsequent loss of vision may result from using contaminated ophthalmic solutions.1
Importance of informing clinicians if an intercurrent ocular condition (e.g., trauma, infection) develops or ocular surgery is planned.1 Importance of immediately reporting ocular reactions, particularly conjunctivitis and eyelid reactions.1
Importance of delaying insertion of contact lenses for at least 15 minutes after travoprost instillation, since benzalkonium chloride preservative may be absorbed by soft lenses.1
Importance of administering different topical ophthalmic preparations at least 5 minutes apart.1
Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs.1
Importance of women informing clinicians if they are or intend to become pregnant or plan to breast-feed.1
Importance of informing patients of other important precautionary information.1 (See Cautions.)
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.
Travatan (with benzalkonium chloride)
AHFS DI Essentials. © Copyright 2017, Selected Revisions July 1, 2006. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.
1. Alcon Pharmaceuticals. Travatan (travoprost) ophthalmic solution 0.004% prescribing information. Fort Worth, TX; 2004 May.
2. Orgul S and the Travoprost Study Group. The safety and IOP lowering efficacy of a new topical ocular prostaglandin analogue, travoprost (0.015% and 0.004%), compared to timolol 0.5%, in a nine-month multicenter study. Abstract presented at Third International Glaucoma Symposium. Prague, Czech Republic: 2001 Mar 21-5. From .
3. Netland PA and the Travoprost Study Group. Comparison of the safety and efficacy of travoprost, latanoprost and timolol in patients with open-angle glaucoma or ocular hypertension. Abstract presented at Third International Glaucoma Symposium. Prague, Czech Republic: 2001 Mar 21-5. From .
4. Dean T, Garadi R, Landry T et al and the Travoprost Study Group. Dose response studies with travatan a new prostaglandin analog in patients with ocular hypertension or open-angle glaucoma. Abstract presented at Third International Glaucoma Symposium. Prague, Czech Republic: 2001 Mar 21-5. From .
5. Anon. Travoprost. Drugs Future. 2000; 25:41-5.
6. Pharmacia & Upjohn. Xalatan (latanoprost) ophthalmic solution 0.005% prescribing information. Kalamazoo, MI; 2000 Nov.
7. Alcon, Fort Worth, TX: Personal communication.
8. Ratliff M, Fellman RL, Sullivan EK et al. Travoprost, a new prostaglandin analogue, is superior to timolol in lowering IOP in patients with open-angle glaucoma or ocular hypertension. Invest Ophthalmol Vis Sci. 2001; 42:S557.
9. Netland PA, Landry T, Silver LH et al. IOP-lowering efficacy and safety of travoprost compared to latanoprost and timolol in patients with open-angle glaucoma or ocular hypertension. Invest Ophthalmol Vis Sci. 2001; 42:S556.
10. Orengo-Nania SD, Landry T, Von Tress M et al. Travoprost significantly decreased IOP in patients with open-angle glaucoma or ocular hypertension when used adjunctively with timolol. Invest Ophthalmol Vis Sci. 2001; 42:S820.
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