Elevated intraocular pressure: Ophthalmic: One drop in the affected eye(s) once daily in the evening; do not exceed the once daily dosage (may decrease the IOP-lowering effect)
There is no dosage adjustment provided in manufacturer’s labeling. However, dosage adjustment unlikely due to low systemic absorption.
There is no dosage adjustment provided in manufacturer’s labeling. However, dosage adjustment unlikely due to low systemic absorption.
(For additional information see "Latanoprost: Pediatric drug information")
Reduction of intraocular pressure: Limited data available: Infants, Children, and Adolescents: Ophthalmic solution (eg, Xalatan): Ophthalmic: 1 drop to affected eye(s) once daily in the evening (Maeda-Chubachi 2013; Quaranta 2017).
There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely due to low systemic absorption.
There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely due to low systemic absorption.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Emulsion, Ophthalmic:
Xelpros: 0.005% (2.5 mL) [contains edetate (edta) disodium, propylene glycol]
Solution, Ophthalmic:
Xalatan: 0.005% (2.5 mL) [contains benzalkonium chloride]
Generic: 0.005% (2.5 mL)
May be product dependent
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Ophthalmic:
Monoprost: 0.005% (0.2 mL) [contains edetate (edta) disodium]
Xalatan: 0.005% (2.5 mL) [contains benzalkonium chloride]
Generic: 0.005% (2.5 mL, 5 mL)
Iyuzeh (latanoprost 0.005% ophthalmic solution): FDA approved December 2022; availability anticipated in the second half of 2023. Information pertaining to this product within the monograph is pending revision. Iyuzeh is a preservative-free formulation that is indicated for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension. Consult the prescribing information for additional information.
Ophthalmic: Wash hands prior to use. May be used with other eye drops to lower intraocular pressure. If more than 1 topical ophthalmic drug is being used, administer the drugs at least 5 minutes apart. Remove contact lenses prior to administration and wait 15 minutes before reinserting.
Ophthalmic: Wash hands before use.
Solution: Unscrew the cap by turning in the direction of the arrows on top of the cap. Pull lower eyelid down slightly to form a pocket for the eye drop and tilt head back; administer 1 drop. Apply gentle pressure to lacrimal sac immediately following instillation (1 minute) or instruct patient to gently close eyelid after administration to decrease systemic absorption of ophthalmic drops (Urtti 1993; Zimmerman 1984). Avoid contact of bottle tip with skin or eye; remove contact lenses prior to administration and wait at least 15 minutes after instillation before reinserting soft contact lenses. If more than one topical ophthalmic drug is being used, separate administration by at least 5 minutes.
Elevated intraocular pressure: Reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma and ocular hypertension.
Latanoprost may be confused with Lantus
Xalatan may be confused with Lantus, Travatan, Xalacom, Zarontin
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Central nervous system: Foreign body sensation of eye (2% to 13%)
Ophthalmic: Eye pain (≤55%), stinging of eyes (≤55%), ocular hyperemia (41%), conjunctival hyperemia (8% to 15%), eye discharge (12%), increased eyelash length (11%)
1% to 10%:
Dermatologic: Erythema of eyelid (3%), hyperpigmentation of eyelashes (1%), allergic skin reaction (≤1%, including eyelid), skin rash (≤1%)
Infection: Influenza (≤3%)
Neuromuscular & skeletal: Arthralgia (≤1%), back pain (≤1%), myalgia (≤1%)
Ophthalmic: Punctate keratitis (1% to 10%), blurred vision (8%), increased eyelash thickness (8%), eye pruritus (5% to 8%), burning sensation of eyes (7%), iris hyperpigmentation (7%), decreased visual acuity (4%), eyelid pain (4%), lacrimation (4%), crusting of eyelid (3%), dry eye syndrome (3%), photophobia (2%), eyelid edema (1% to 2%), conjunctival edema (1%)
Respiratory: Nasopharyngitis (≤3%), upper respiratory tract infection (≤3%)
<1%, postmarketing, and/or case reports: Angina pectoris, asthma, bacterial keratitis, chest pain, conjunctivitis (including pseudopemphigoid of the ocular conjunctiva), corneal edema, corneal erosion, dizziness, dyspnea, exacerbation of asthma, eye disease (periorbital and lid changes resulting in deepening of the eyelid sulcus), headache, herpes simplex keratitis, hyperpigmentation of eyelids, increased growth in number of eyelashes, iris cyst, iritis, keratitis, macular edema (including cystoid macular edema), misdirected growth of eyelashes (including trichiasis), palpitations, pruritus, toxic epidermal necrolysis, unstable angina pectoris, uveitis
Hypersensitivity to latanoprost, benzalkonium chloride, or any component of the formulation
Concerns related to adverse effects:
• Bacterial keratitis: Inadvertent contamination of multiple-dose ophthalmic solutions, has caused bacterial keratitis.
• Ocular effects: 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:
• 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.
• Ocular disease: Use with caution in aphakic patients, pseudophakic patients with a torn posterior lens capsule, or patients with risk factors for macular edema. Safety and efficacy have not been determined for use in patients with angle-closure, inflammatory, or neovascular glaucoma.
Special populations:
• Contact lens wearers: Solution contains benzalkonium chloride which may be absorbed by contact lenses; remove contacts prior to administration and wait 15 minutes before reinserting.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Bimatoprost: The concomitant use of Latanoprost and Bimatoprost may result in increased intraocular pressure. Risk C: Monitor therapy
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). Risk C: 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). Risk C: Monitor therapy
Ophthalmic prostaglandins, such as latanoprost, have a theoretical risk of miscarriage. To decrease this risk, agents other than latanoprost may be preferred for the treatment of glaucoma in patients planning to become pregnant (Strelow 2020).
Information related to latanoprost use in pregnancy is limited (DeSantis 2004).
Ophthalmic prostaglandins, such as latanoprost, are generally avoided during pregnancy due to a theoretical risk of miscarriage and premature labor. Agents other than latanoprost 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).
It is not known if latanoprost is present in breast milk.
According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother. Due to their short half-lives, ophthalmic prostaglandins, such as latanoprost, are considered compatible with breastfeeding; administering after breastfeeding may help decrease potential exposure to the infant via breast milk (Belkin 2020; Prum 2016; Strelow 2020).
Monitor IOP; regularly examine patients who develop increased iris pigmentation.
Latanoprost is a prostaglandin F2-alpha analog believed to reduce intraocular pressure by increasing the outflow of the aqueous humor
Onset of action: 3 to 4 hours
Peak effect: Maximum: 8 to 12 hours
Absorption: Through the cornea where the isopropyl ester prodrug is hydrolyzed by esterases to the biologically active acid. Peak concentration is reached in 2 hours after topical administration in the aqueous humor.
Distribution: Vd: 0.16 ± 0.02 L/kg
Metabolism: Primarily hepatic via fatty acid beta-oxidation
Half-life elimination: 17 minutes
Excretion: Urine (as metabolites)
Emulsion (Xelpros Ophthalmic)
0.005% (per mL): $28.80
Solution (Latanoprost Ophthalmic)
0.005% (per mL): $3.63 - $38.11
Solution (Xalatan Ophthalmic)
0.005% (per mL): $112.91
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