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Travoprost

Medically reviewed by Drugs.com. Last updated on May 27, 2020.

Pronunciation

(TRA voe prost)

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Ophthalmic:

Travatan Z: 0.004% (5 mL) [contains propylene glycol]

Travatan Z: 0.004% (2.5 mL, 5 mL [DSC]) [benzalkonium free; contains cremophor el, propylene glycol]

Generic: 0.004% (2.5 mL, 5 mL)

Brand Names: U.S.

  • Travatan Z

Pharmacologic Category

  • Ophthalmic Agent, Antiglaucoma
  • Prostaglandin, Ophthalmic

Pharmacology

A selective FP prostanoid receptor agonist which lowers intraocular pressure by increasing trabecular meshwork and outflow

Absorption

Absorbed via cornea; plasma levels <10 pg/mL within 1 hour

Metabolism

Hydrolyzed by esterases in the cornea to active free acid; systemically; the free acid is metabolized to inactive metabolites

Excretion

Urine (<2% as metabolites).

Onset of Action

~2 hours; Peak effect: 12 hours

Half-Life Elimination

45 minutes (range:17 to 86 minutes)

Special Populations: Race

The IOP-lowering effect was shown to be 7 to 8 mm Hg in clinical studies. The mean IOP reduction in African-American patients was up to 1.8 mm Hg greater than in non-African-American patients. The reason for this effect is unknown.

Use: Labeled Indications

Ocular hypertension/glaucoma (open-angle): Reduction of elevated intraocular pressure in patients ≥16 years of age.

Contraindications

There are no contraindications listed in the US manufacturer’s labeling.

Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to travoprost or any component of the formulation; pregnancy or women attempting to become pregnant.

Dosing: Adult

Ocular hypertension/glaucoma (open-angle): Ophthalmic: Instill 1 drop into affected eye(s) once daily in the evening; do not exceed once-daily dosing (may decrease intraocular pressure-lowering effect).

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Elevated intraocular pressure (IOP): Ophthalmic: Infants ≥2 months, Children, and Adolescents: Limited data available: 1 drop into affected eye(s) once daily in the evening (Dixon 2017; Yanovitch 2008). Note: Do not exceed once-daily dosing (may decrease IOP-lowering effect).

Administration

Ophthalmic: 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 (after administration) before reinserting. Minimize contamination by not touching the eyelids or surrounding areas with the dropper tip; keep bottle tightly closed when not in use. Use eyelid closure or nasolacrimal occlusion when applying topical medications to reduce systemic absorption.

Storage

Store between 2°C and 25°C (36°F and 77°F).

Drug Interactions

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

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%: Ophthalmic: Ocular hyperemia (30% to 50%)

1% to 10%:

Cardiovascular: Angina pectoris (1% to 5%), bradycardia (1% to 5%), chest pain (1% to 5%), hypertension (1% to 5%), hypotension (1% to 5%)

Central nervous system: Foreign body sensation of eye (5% to 10%), anxiety (1% to 5%), depression (1% to 5%), headache (1% to 5%), pain (1% to 5%)

Dermatologic: Hyperpigmentation of eyelashes, increased growth in number of eyelashes

Endocrine & metabolic: Hypercholesterolemia (1% to 5%)

Gastrointestinal: Dyspepsia (1% to 5%), gastrointestinal distress (1% to 5%)

Genitourinary: Prostatic disease (1% to 5%), urinary incontinence (1% to 5%), urinary tract infection (1% to 5%)

Hypersensitivity: Hypersensitivity reaction (1% to 5%)

Infection: Infection (1% to 5%)

Neuromuscular & skeletal: Arthritis (1% to 5%), back pain (1% to 5%)

Ophthalmic: Decreased visual acuity (5% to 10%), eye discomfort (5% to 10%), eye pain (5% to 10%), eye pruritus (5% to 10%), blepharitis (1% to 4%), blurred vision (1% to 4%), cataract (1% to 4%), conjunctivitis (1% to 4%), corneal staining (1% to 4%), crusting of eyelid (1% to 4%), dry eye syndrome (1% to 4%), hyperpigmentation of eyelids (periorbital; 1% to 4%), iris discoloration (1% to 4%), keratitis (1% to 4%), lacrimation (1% to 4%), ophthalmic inflammation (1% to 4%), photophobia (1% to 4%), subconjunctival hemorrhage (1% to 4%), visual disturbance (1% to 4%), increased eyelash length, increased eyelash thickness

Respiratory: Bronchitis (1% to 5%), flu-like symptoms (1% to 5%), sinusitis (1% to 5%)

<1%, postmarketing, and/or case reports: Abdominal pain, arthralgia, asthma, bacterial keratitis (due to solution contamination), cardiac arrhythmia, chest discomfort, corneal edema, cystoid macular edema, diarrhea, dyspnea, dysuria, enophthalmos, epistaxis, erythema of skin, insomnia, iritis, macular edema, musculoskeletal pain, nausea, prostate specific antigen increase, pruritus, tachycardia, tinnitus, uveitis, vomiting

Warnings/Precautions

Concerns related to adverse effects:

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

• Eye color changes: 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:

• Aphakia or pseudoaphakia: Topical prostaglandin analogues have been associated with the occurrence/exacerbation of macular edema. Carefully examine the macula in these patients especially those with an open posterior capsule.

• 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.

• Uveitis: Use cautiously in patients with intraocular inflammation as topical prostaglandins may worsen inflammation.

Special populations:

• Contact lens wearers: Remove contact lens prior to instillation; may reinsert 15 minutes following administration.

• Pediatric: Use in pediatric patients (<16 years of age) is not recommended by the manufacturer due to possible safety issues of increased pigmentation following long-term chronic use.

Monitoring Parameters

Ophthalmic exams (optic nerve and visual field assessment), serial measurement of intraocular pressure (IOP). Frequency of follow up based upon whether target IOP achieved, if there is any progression of damage, and how long disease has been controlled (AAO 2019).

Reproductive Considerations

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

Pregnancy Considerations

Ophthalmic prostaglandins, such as travoprost, are generally avoided during pregnancy due to a theoretical risk of miscarriage and premature labor. Agents other than travoprost 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.

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:

• Itching

• Foreign body sensation of eye

• 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

• 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.