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Latanoprost

Pronunciation

Pronunciation

(la TA noe prost)

Dosage Forms

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

Solution, Ophthalmic:

Xalatan: 0.005% (2.5 mL) [contains benzalkonium chloride]

Generic: 0.005% (2.5 mL)

Brand Names: U.S.

  • Xalatan

Pharmacologic Category

  • Ophthalmic Agent, Antiglaucoma
  • Prostaglandin, Ophthalmic

Pharmacology

Latanoprost is a prostaglandin F2-alpha analog believed to reduce intraocular pressure by increasing the outflow of the aqueous humor

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 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

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: Renal Impairment

There is no dosage adjustment provided in manufacturer’s labeling. However, dosage adjustment unlikely due to low systemic absorption.

Dosing: Hepatic Impairment

There is no dosage adjustment provided in manufacturer’s labeling. However, dosage adjustment unlikely due to low systemic absorption.

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

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. 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

>10%: Central nervous system: Foreign body sensation of eye (13%)

1% to 10%:

Cardiovascular: Angina pectoris (≥1% to ≤2%), chest pain (≥1% to ≤2%)

Dermatologic: Erythema of eyelid (3%), allergic skin reaction (≤1%), skin rash (≤1%)

Infection: Influenza (≤3%)

Neuromuscular & skeletal: Arthralgia (≤1%), back pain (≤1%), myalgia (≤1%)

Ophthalmic: Epithelial keratopathy (punctate; 10%), stinging of eyes (9%), blurred vision (8%), conjunctival hyperemia (8%), eye pruritus (8%), burning sensation of eyes (7%), iris hyperpigmentation (7%), eyelid pain (4%), lacrimation (4%), crusting of eyelid (3%), dry eye syndrome (3%), eye pain (3%), photophobia (2%), eyelid edema (1%)

Respiratory: Nasopharyngitis (≤3%), upper respiratory tract infection (≤3%)

<1%, postmarketing, and/or case reports: Asthma, 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 eyelashes, hyperpigmentation of eyelids, increased eyelash length, increased eyelash thickness, increased growth in number of eyelashes, iris cyst, iritis, keratitis, macular edema (including cystoid macular edema), misdirected growth of eyelashes, 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: 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 Risk Factor

C

Pregnancy Considerations

Adverse events were observed in animal reproduction studies at maternally toxic doses.

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 blurred vision, burning, stinging, eyelash changes, or foreign body sensation in eye. Have patient report immediately to prescriber vision changes, eye pain, severe eye irritation, 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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