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Bimatoprost

Medically reviewed by Drugs.com. Last updated on Jul 22, 2020.

Pronunciation

(bi MAT oh prost)

Dosage Forms

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

Implant, Intraocular:

Durysta: 10 mcg (1 ea) [contains polyethylene glycol]

Solution, External:

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

Generic: 0.03% (3 mL, 5 mL)

Solution, Ophthalmic:

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

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

Brand Names: U.S.

  • Durysta
  • 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 (Durysta; Lumigan; Vistitan [Canadian product]): Reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension.

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

Contraindications

Hypersensitivity to bimatoprost or any component of the formulation.

Additional product-specific contraindications: Implant (Durysta): Active or suspected ocular or periocular infection; corneal endothelial cell dystrophy (eg, Fuchs dystrophy); prior corneal transplantation or endothelial cell transplant (eg, Descemet stripping automated endothelial keratoplasty); absent or ruptured posterior lens capsule (Note: Laser posterior capsulotomy in pseudophakic patients is not a contraindication if the intraocular lens fully covers the opening in the posterior capsule).

Dosing: Adult

Elevated intraocular pressure:

Implant (Durysta): Intracameral: Insert 1 implant (10 mcg) in anterior chamber of affected eye. Limit to a single implant per eye; do not readminister to an eye that has received a prior implant.

Solution (Lumigan; Vistitan [Canadian product]): Ophthalmic, topical: 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). Note: Onset of effect is gradual but is not significant in the majority of patients until 2 months.

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.

Administration

Intracameral (Durysta): Insert implant under aseptic conditions. Use immediately after foil pouch is opened. Affected eye should not be dilated prior to procedure. Patient should remain upright for ≥1 hour after procedure. Refer to manufacturer's labeling for detailed administration instructions.

Ophthalmic, topical:

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; Vistitan [Canadian product]: 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

Implant: Store between 2°C to 8°C (36°F to 46°F).

Solution: 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. Monitor therapy

Latanoprostene Bunod: The concomitant use of Bimatoprost and Latanoprostene Bunod 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%: Ophthalmic: Conjunctival hyperemia (Durysta and Lumigan: 27% to 31%; Latisse: <4%)

1% to 10%:

Dermatologic: Erythema of eyelid (Latisse and Lumigan: ≤4%), hypertrichosis (Latisse and Lumigan: ≤4%), hypertrichosis of eyelid (Lumigan: 1% to 4%), local skin hyperpigmentation (Latisse and Lumigan: ≤4%)

Local: Application site irritation (Lumigan: 1% to 4%)

Nervous system: Headache (Durysta: 5%; Lumigan)

Ophthalmic: Anterior chamber inflammation (Durysta: 1% to 5%), blurred vision (≤10%), conjunctival edema (Lumigan: 1% to 4%), conjunctival hemorrhage (Durysta and Lumigan: 1% to 10%), corneal edema (Durysta: 1% to 5%), corneal erosion (endothelial cell loss: Durysta: 5% to 10%), corneal sensitivity (Durysta: 1% to 5%), decreased visual acuity (Lumigan: 1% to 4%), dry eye syndrome (≤10%), eye discharge (Lumigan; aqueous humor leakage: Durysta: 1% to 5%), eye discomfort (Durysta: 1% to 5%), eye irritation (≤10%), eyelid pruritus (Latisse and Lumigan: ≤4%), eye pain (Durysta and Lumigan: 1% to 10%), eye pruritus (Latisse and Lumigan: ≤4%), foreign body sensation of eye (≤10%), increased intraocular pressure (Durysta: 5% to 10%), increased lacrimation (≤5%), iris hyperpigmentation (≤5%), iritis (Durysta and Lumigan: ≤10%), lacrimation (≤5%), macular edema (Durysta and Lumigan: ≤5%), photophobia (Durysta and Lumigan: ≤10%), punctate keratitis (Lumigan: 1% to 4%), synechiae of iris (Durysta: 1% to 5%)

<1%:

Hypersensitivity: Local hypersensitivity reaction

Ophthalmic: Anterior chamber eye hemorrhage (hyphema: Durysta), corneal decompensation (Durysta), corneal opacity (Durysta), cystoid macular edema (Durysta and Lumigan), iridocyclitis (Durysta), uveitis

Frequency not defined:

Neuromuscular & skeletal: Asthenia (Lumigan)

Ophthalmic: Allergic conjunctivitis (Lumigan), asthenopia (Lumigan), blepharitis (Lumigan), burning sensation of eyes (Lumigan), cataract (Lumigan), hyperpigmentation of eyelashes (Latisse and Lumigan), hypotony of eye (Latisse), visual disturbance (Lumigan)

Postmarketing:

Dermatologic: Erythematous rash (Latisse), local dryness of skin (periocular: Latisse), macular eruption (Latisse), madarosis of eyebrow (Latisse), skin discoloration (periorbital: Latisse), trichorrhexis (Latisse)

Hypersensitivity: Hypersensitivity reaction (Lumigan)

Ophthalmic: Deepening of the eyelid sulcus (Latisse and Lumigan), eyelid edema (Latisse), ocular edema (Lumigan), periorbital swelling (Latisse)

Respiratory: Dyspnea (Lumigan), pulmonary signs and symptoms (asthma-like: Lumigan)

Warnings/Precautions

Concerns related to adverse effects:

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

• Corneal effects: Intracameral implant may cause corneal adverse effects and increased risk of corneal endothelial cell loss; use with caution in patients with limited corneal endothelial cell reserve. Limit administration to a single implant per eye without retreatment.

• Endophthalmitis: Intraocular surgical procedures and injections are associated with endophthalmitis. Use proper aseptic injection technique and monitor patients appropriately.

• Macular edema: Macular edema, including cystoid macular edema, has been reported; use with caution in aphakic patients, pseudophakic patients with a torn posterior lens capsule, or patients with risk factors for macular edema.

• Ocular effects: May permanently change/increase brown pigmentation of the iris, the eyelid skin, periorbital tissue, and eyelashes; area(s) affected may vary based on bimatoprost formulation used. 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:

• Iridocorneal angle: Use intracameral implant with caution in patients with narrow iridocorneal angles (Shaffer grade <3) or anatomical obstruction (eg, scarring) that may prohibit the implant from settling in the inferior angle.

Special populations:

• Contact lens wearers: Topical solution formulations contain 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.

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

Monitoring Parameters

Intraocular pressure, ocular pigmentation changes.

Reproductive Considerations

Ophthalmic prostaglandins, such as bimatoprost, have a theoretical risk of miscarriage. To decrease this risk, agents other than bimatoprost may be preferred for the treatment of glaucoma in patients planning to become pregnant (Strelow 2020).

Pregnancy Considerations

According to the manufacturer, an increased risk of major birth defects or miscarriages has not been observed following use of bimatoprost ophthalmic drops in pregnant patients. However, ophthalmic prostaglandins, such as bimatoprost, are generally avoided during pregnancy due to a theoretical risk of miscarriage and premature labor. Agents other than bimatoprost may be preferred for the treatment of glaucoma during pregnancy, especially during the first trimester. 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 (Belkin 2020; Prum 2016; Strelow 2020).

Patient Education

What is this drug used for?

• It is used to treat glaucoma.

• It is used to lower high eye pressure.

• It is used to help eyelashes grow. It may take 2 months to see the full effect.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Eyelid changes or eyelash changes

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Vision changes

• Eye pain

• Severe eye irritation

• Sensitivity to light

• Eye discharge

• Eye discoloration

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, 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 limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.