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Pronunciation:

(la TA noe prost)

U.S. Brand Names:

Xalatan®

Generic Available:

Canadian Brand Names:

Xalatan®

Use:

Reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension

Pregnancy Risk Factor:

Contraindications:

Hypersensitivity to latanoprost or any component of the formulation

Warnings/Precautions:

Latanoprost may gradually change eye color, increasing the amount of brown pigment in the iris by increasing the number of melanosome in melanocytes. The long-term effects on the melanocytes and the consequences of potential injury to the melanocytes or deposition of pigment granules to other areas of the eye is currently unknown. Patients should be examined regularly, and depending on the clinical situation, treatment may be stopped if increased pigmentation ensues.

There have been reports of bacterial keratitis associated with the use of multiple-dose containers of topical ophthalmic products. Do not administer while wearing contact lenses.

Adverse Reactions:

>10%: Ocular: Blurred vision, burning and stinging, conjunctival hyperemia, foreign body sensation, itching, increased pigmentation of the iris, and punctate epithelial keratopathy

1% to 10%:

Cardiovascular: Chest pain, angina pectoris

Dermatologic: Rash, allergic skin reaction

Neuromuscular & skeletal: Myalgia, arthralgia, back pain

Ocular: Dry eye, excessive tearing, eye pain, lid crusting, lid edema, lid erythema, lid discomfort/pain, photophobia

Respiratory: Upper respiratory tract infection, cold, flu

<1%: Conjunctivitis, diplopia, discharge from the eye, retinal artery embolus, retinal detachment, vitreous hemorrhage from diabetic retinopathy

Postmarketing and/or case reports: Asthma, corneal edema, corneal erosion, dyspnea, eyelash change, eyelid skin darkening, herpes keratitis, iritis, keratitis, macular edema, toxic epidermal necrolysis, uveitis

Overdosage/Toxicology:

Symptoms include ocular irritation and conjunctival or episcleral hyperemia

Treatment should be symptomatic

Drug Interactions:

Decreased effect: In vitro studies have shown that precipitation occurs when eye drops containing thimerosal are mixed with latanoprost. If such drugs are used, administer with an interval of at least 5 minutes between applications. May be used concomitantly with other topical ophthalmic drugs if administration is separated by at least 5 minutes.

Stability:

Protect from light; store intact bottles under refrigeration (2°C to 8°C/36°F to 46°F). Once opened, the container may be stored at room temperature up to 25°C (77°F) for 6 weeks.

Mechanism of Action:

Latanoprost is a prostaglandin F2-alpha analog believed to reduce intraocular pressure by increasing the outflow of the aqueous humor

Pharmacodynamics/Kinetics:

Onset of action: 3-4 hours

Peak effect: Maximum: 8-12 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 L/kg

Metabolism: Primarily hepatic via fatty acid beta-oxidation

Half-life elimination: 17 minutes

Excretion: Urine (as metabolites)

Dosage:

Adults: Ophthalmic: 1 drop (1.5 mcg) in the affected eye(s) once daily in the evening; do not exceed the once daily dosage because it has been shown that more frequent administration may decrease the IOP lowering effect

Note: A medication delivery device (Xal-Ease™) is available for use with Xalatan®.

Administration:

If more than one topical ophthalmic drug is being used, administer the drugs at least 5 minutes apart. A delivery aid, Xal-Ease™, is available for administering Xalatan®.

Patient Education:

For use in eyes only. Iris color may change because of an increase of the brown pigment (cosmetically different eye coloration that may occur). Iris pigmentation changes may be more noticeable in patients with green-brown, blue/gray-brown, or yellow-brown irides. If any ocular reaction develops, particularly conjunctivitis and lid reactions, immediately notify prescriber. If more than one topical ophthalmic drug is being used, administer the drugs at least 5 minutes apart. Latanoprost contains benzalkonium chloride, which may be absorbed by contact lenses. Remove contact lenses prior to administration; lenses may be reinserted after 15 minutes. Do not let tip of applicator touch eye; do not contaminate tip of applicator (may cause eye infection, eye damage, or vision loss). Serious damage to the eye and subsequent loss of vision may result from using contaminated solutions. A delivery aid, Xal-Ease™, is available for administering Xalatan®. Pregnancy precaution: Inform prescriber if you are pregnant.

Dental Health: Effects on Dental Treatment:

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

No information available to require special precautions

Mental Health: Effects on Mental Status:

None reported

Mental Health: Effects on Psychiatric Treatment:

None reported

Dosage Forms:

Solution, ophthalmic: 0.005% (2.5 mL) [contains benzalkonium chloride]

International Brand Names:

Louten® (AR, CO); Xalatan® (AR, AT, AU, BE, BG, CA, CH, CL, CO, CR, CZ, DE, DK, ES, FI, FR, GB, GT, HN, HR, HU, ID, IE, IL, IT, MX, NL, NO, NZ, PA, PL, PT, RO, RU, SE, SG, SI, SV, TH, TR, YU, ZA)

References

Patel SS and Spencer CM, "Latanoprost: A Review of Its Pharmacological Properties, Clinical Efficacy and Tolerability in the Management of Primary Open-Angle Glaucoma and Ocular Hypertension,"Drugs Aging, 1996, 9(5):363-78.

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