Elevated IOP in open-angle glaucoma or ocular hypertension
1 drop in the affected eye(s) once daily in the evening, not to exceed once daily
Nearly a third reach a 40% or greater IOP reduction, versus under 10% on either component alone.
Contraindications
None listed on the FDA label.
Available Forms
0.02%/0.005% ophthalmic solution (netarsudil 0.2 mg/mL, latanoprost 0.05 mg/mL), 2.5 mL fill in a 4 mL bottle
Mechanism of Action
Fixed combination of netarsudil, a Rho kinase inhibitor, and latanoprost, a prostaglandin F2alpha analogue; each component lowers elevated IOP and the label attributes the combined effect to increased aqueous outflow. The routes are complementary, the Rho kinase inhibitor acting primarily on trabecular (conventional) outflow and the prostaglandin primarily on uveoscleral outflow.
Warnings & Precautions
Epithelial corneal edema: Netarsudil component, honeycomb or bullous, in eyes with pre-existing corneal stromal edema or after procedures that could affect corneal endothelial function; typically resolves after discontinuation.
Iris and periorbital pigmentation: Latanoprost component; brown iris pigmentation spreads concentrically from the pupil, increases for as long as treatment continues, and is likely permanent, while periorbital tissue and eyelash pigmentation are reversible in some patients. Nevi and freckles appear unaffected, and treatment may continue with regular examination.
Eyelash changes: Increased length, thickness, pigmentation, and number of lashes and vellus hair plus misdirected growth in the treated eye; usually reversible after discontinuation.
Intraocular inflammation: Caution with a history of iritis or uveitis, and generally not for use with active intraocular inflammation, which may be exacerbated.
Macular edema: Macular edema including cystoid macular edema has been reported with latanoprost; caution in aphakia, in pseudophakia with a torn posterior lens capsule, and with other known risk factors.
Herpetic keratitis: Reactivation of herpes simplex keratitis has been reported with latanoprost; caution with a history of it and avoid in active herpes simplex keratitis, which may be exacerbated.
Prostaglandin duplication: Combining two or more prostaglandins or prostaglandin analogs is not recommended, and dosing more than once daily may decrease the IOP lowering effect or cause paradoxical IOP elevation.
Thimerosal-containing drops: Precipitation occurred in vitro when thimerosal drops were mixed with this product; separate concurrent topical drops by at least 5 minutes.
Bacterial keratitis: Reported with contaminated multidose containers, in most cases in eyes with concurrent corneal disease or a disrupted epithelial surface.
Soft contact lenses: Benzalkonium chloride 0.02% may be absorbed by soft lenses; remove before instillation and reinsert after 15 minutes.
Common Side Effects
Ocular: Conjunctival hyperemia 59%, the most common reaction, with 5% of patients discontinuing therapy for it; instillation site pain 20%, corneal verticillata 15%, and conjunctival hemorrhage 11%; eye pruritus, reduced visual acuity, increased lacrimation, instillation site discomfort, and blurred vision in 5% to 8%.
Netarsudil component: Instillation site erythema, corneal staining, increased lacrimation, and eyelid erythema.
Systemic, latanoprost component: Upper respiratory tract infection, nasopharyngitis, influenza, myalgia, arthralgia, back pain, and rash or allergic reactions.
Postmarketing: Epithelial corneal edema from the netarsudil component in patients with pre-existing corneal stromal edema or after ocular procedures that could affect corneal endothelial function; frequency not estimable.
Pregnancy & Lactation
Pregnancy: No adequate and well-controlled studies of the combination or either component in pregnant women; use only if the potential benefit justifies the potential risk to the fetus. Latanoprost caused embryofetal lethality in rabbits at approximately 80 times the recommended human ophthalmic dose (no viable fetuses in 4 of 16 pregnant rabbits) but not at approximately 15 times, while IV netarsudil in pregnant rats and rabbits produced no adverse embryofetal effects at clinically relevant systemic exposures.
Lactation: No data on the presence of either component in human milk, effects on the breastfed infant, or effects on milk production; systemic exposure to netarsudil after ocular dosing is low.
Pediatric Use
Safety and effectiveness in pediatric patients not established.
Available Forms
Mechanism of Action
Pregnancy & Lactation
Pediatric Use