One drop in the affected eye(s) once daily in the evening; not to exceed once daily.
IOP begins to fall 3 to 4 hours after dosing, peaks at 8 to 12 hours, and lasts at least 24 hours.
Contraindications
Known hypersensitivity to latanoprost or any other ingredient in this product.
Available Forms
0.005% (50 mcg/mL) ophthalmic emulsion, 2.5 mL fill in a 5 mL bottle, package of 1 bottle, multi-pack of 3 bottles
Mechanism of Action
Prostaglandin F2alpha analogue supplied as an isopropyl ester prodrug that corneal esterases hydrolyze to the active acid; IOP falls mainly through increased uveoscleral outflow, which class reviews attribute to matrix metalloproteinase remodeling that widens the spaces between ciliary muscle fibers. Onset is 3 to 4 hours after instillation, maximum effect at 8 to 12 hours, and IOP reduction persists at least 24 hours.
Warnings & Precautions
Iris pigmentation: Brown pigmentation spreads concentrically from the pupil and increases as long as dosing continues, from increased melanin content in melanocytes rather than more melanocytes; it is likely permanent after discontinuation, so examine these patients regularly. Nevi and freckles of the iris appear unaffected, and the long-term effects of increased pigmentation are not known.
Periorbital and lash changes: Eyelid skin darkening plus increased eyelash and vellus hair length, thickness, pigmentation, number, and misdirected growth in the treated eye; reported reversible in some patients 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 products; 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.
Bacterial keratitis: Reported with inadvertently contaminated multiple-dose containers, in most cases in patients with concurrent corneal disease or a disrupted ocular epithelial surface.
Contact lens wear: Remove lenses before instillation and reinsert 15 minutes after.
Prostaglandin duplication: Dosing more than once daily, or combining two or more prostaglandins or prostaglandin analogs, may decrease the IOP lowering effect or cause paradoxical IOP elevation.
Thimerosal-containing drops: Precipitation occurs in vitro when thimerosal drops are mixed with this emulsion; separate concurrent topical drops by at least 5 minutes.
Common Side Effects
Ocular, 5% or more: eye pain or stinging on instillation 55%, ocular hyperemia 41%, conjunctival hyperemia 15%, eye discharge 12%, growth of eyelashes 11%, eyelash thickening 8%, ocular itching 5% (N=448; any eye disorder 73%).
Discontinuation: fewer than 1% stopped therapy for intolerance to eye pain or stinging or to ocular hyperemia.
Ocular, latanoprost class postmarketing: intraocular inflammation (iritis/uveitis), macular edema including cystoid macular edema, herpes keratitis, corneal edema and erosions, deepening of the eyelid sulcus, trichiasis, iris cyst, eyelid skin darkening, conjunctivitis, pseudopemphigoid of the conjunctiva.
Systemic, latanoprost class postmarketing: asthma and exacerbation of asthma, dyspnea, headache, dizziness, angina including unstable angina, palpitations, chest pain, nausea, vomiting, pruritus, toxic epidermal necrolysis.
Pregnancy & Lactation
Pregnancy: No adequate and well-controlled studies in pregnant women. IV latanoprost given to pregnant rabbits and rats through organogenesis produced malformations, embryofetal lethality, and spontaneous abortion at clinically relevant doses, with post-implantation loss in rabbits at 1.3 times the maximum recommended human ophthalmic dose and cleft palate in rats at 3.2 times.
Lactation: Excretion in human milk is unknown; weigh the benefits of breastfeeding against maternal need and potential effects on the breastfed child.
Pediatric Use
Safety and effectiveness not established in pediatric patients.
Available Forms
Mechanism of Action
Pregnancy & Lactation
Pediatric Use