Elevated IOP in open angle glaucoma or ocular hypertension
One drop in the affected eye(s) once daily in the evening
IOP lowering stays within 0.9 mmHg of bimatoprost 0.03% with a third the worsening hyperemia.
OFF-LABELNot in the FDA label for this product
Chronic primary angle closure glaucoma
One drop once daily; the trial used bimatoprost 0.03%, not the 0.01% strength of this label
Randomized crossover · n=60
Observer-masked randomized crossover trial, 60 patients with chronic primary angle closure glaucoma and 54 completers (80 eyes), 6 weeks per arm. Bimatoprost 0.03% lowered IOP by 8.9 mmHg and latanoprost 0.005% by 8.4 mmHg from a baseline of 25.2 mmHg, a difference that was not statistically significant (P=0.23); adverse events, mostly mild ocular irritation, were reported by 81% on bimatoprost vs 40% on latanoprost (P<0.01).
Prostaglandin analog that selectively mimics prostamides. Lowers IOP by increasing aqueous humor outflow through both the trabecular meshwork and the uveoscleral routes.
Warnings & Precautions
Iris pigmentation: Brown pigmentation spreads concentrically from the pupil and is likely permanent after discontinuation, from increased melanin content in melanocytes rather than more melanocytes. May not be noticeable for several months to years; treatment can be continued but examine these patients regularly.
Periorbital and lash pigmentation: Eyelid tissue and lashes darken, and pigmentation is expected to increase as long as dosing continues; reported reversible in some patients after discontinuation.
Eyelash changes: Gradual increase in length, thickness, and number of lashes and vellus hair in the treated eye, usually reversible after discontinuation. May result in disparity between eyes in length, thickness, pigmentation, number, or direction of lash growth.
Intraocular inflammation: Prostaglandin analogs including bimatoprost have been reported to cause intraocular inflammation; caution with active inflammation such as uveitis, which may be exacerbated.
Macular edema: Cystoid macular edema reported; caution in aphakia, pseudophakia with a torn posterior lens capsule, or other known risk factors for macular edema.
Bacterial keratitis: Reported with contaminated multiple-dose ophthalmic containers, in most cases in patients with concurrent corneal disease or a disrupted ocular epithelial surface.
Benzalkonium chloride: May be absorbed by and discolor soft contact lenses; remove lenses before instillation and reinsert 15 minutes after.
Common Side Effects
Ocular, most common: Conjunctival hyperemia 31% in a 12-month study, with approximately 1.6% discontinuing because of it.
Pregnancy: No adequate and well-controlled studies in pregnant women; postmarketing experience shows no increase in major birth defects or miscarriage. Oral dosing during organogenesis caused abortion and early delivery in mice and rats at oral doses at least 33 times (mice) and 94 times (rats) the human exposure to bimatoprost 0.03% dosed bilaterally once daily by AUC, and these effects were not seen at 2.6 times (mice) or 47 times (rats). Use only if the benefit justifies fetal risk.
Lactation: Unknown whether topical ocular use yields detectable quantities in human milk; present in rat milk at an IV dose 970 times the recommended human ophthalmic dose on a mg/m2 basis.
Pediatric Use
Not recommended below 16 years because of potential safety concerns related to increased pigmentation with long-term chronic use.
Available Forms
Mechanism of Action
Pregnancy & Lactation
Pediatric Use