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Netarsudil

Medically reviewed on August 12, 2018

Pronunciation

(ne TAR soo dil)

Dosage Forms

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

Solution, Ophthalmic:

Rhopressa: 0.02% (2.5 mL) [contains benzalkonium chloride]

Brand Names: U.S.

  • Rhopressa

Pharmacologic Category

  • Rho Kinase Inhibitor

Pharmacology

Although the exact mechanism of action of netarsudil, a rho kinase inhibitor, is unknown, it may reduce IOP by increasing the outflow of aqueous humor through the trabecular meshwork route.

Metabolism

Metabolized by esterases in the eye to active metabolite AR-13503.

Use: Labeled Indications

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

Contraindications

There are no contraindications listed in the manufacturer's labeling

Dosing: Adult

Elevated intraocular pressure: Ophthalmic: Instill 1 drop into affected eye(s) once daily in the evening (maximum: 1 drop into affected eye(s) once daily).

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer's labeling; dosage adjustments are unlikely due to low systemic absorption.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer's labeling; dosage adjustments are unlikely due to low systemic absorption.

Administration

Ophthalmic: For ophthalmic use only. May be used with other eye drops to lower intraocular pressure. If using more than 1 ophthalmic product, wait at least 5 minutes in between application of each medication. Remove contact lenses prior to administration and wait at least 15 minutes (after administration) before reinserting. Avoid touching the dropper tip with fingers, eyes, eyelids, or surrounding areas to minimize contamination of the dropper tip.

Storage

Store at 2°C to 8°C (36°F to 46°F) until opened. After opening, may store at 2°C to 25°C (36°F to 77°F) for ≤6 weeks. During shipment, may maintain at temperatures ≤40°C (≤104°F) for ≤14 days.

Drug Interactions

There are no known significant interactions.

Adverse Reactions

>10%:

Local: Application site pain (20%)

Ophthalmic: Conjunctival hyperemia (53%), conjunctival hemorrhage (20%), corneal disease (20%)

1% to 10%:

Dermatologic: Erythema of eyelid (5% to 10%)

Local: Application site erythema (5% to 10%)

Ophthalmic: Blurred vision (5% to 10%), corneal staining (5% to 10%), decreased visual acuity (5% to 10%), increased lacrimation (5% to 10%)

Warnings/Precautions

Concerns related to adverse effects:

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

Special populations:

• Contact lens wearers: Contains benzalkonium chloride, which may be absorbed by soft contact lenses. Remove contact lens prior to instillation; may reinsert 15 minutes following administration.

Monitoring Parameters

Intraocular pressure

Pregnancy Considerations

Adverse events were not observed in animal reproduction studies following clinically relevant systemic exposure. Systemic absorption is minimal following ophthalmic application. If ophthalmic agents are needed during pregnancy, the minimum effective dose should be used in combination with punctual occlusion to decrease potential exposure to the fetus (Samples 1988).

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 or watery eyes. Have patient report immediately to prescriber vision changes, eye pain, or severe eye irritation (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 health care 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.

Further information

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

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