II. Indication

  1. First line agent for Open Angle Glaucoma

III. Contraindications

  1. Active Uveitis

IV. Mechanism

  1. Prostaglandin analogs that increase uveoscleral aqueous outflow (lowers IOP 25 to 35%)

V. Medications (Teal Caps)

  1. Latanoprost (Xalatan) 0.005% one drop daily
  2. Bimatoprost (Lumigan) 0.03% one drop daily
  3. Travoprost (Travatan) 0.004% one drop daily
  4. Unoprostone (Rescula) 0.15% one drop daily
  5. Tafluprost (Zioptan) 0.0015% one drop daily
  6. Latanoprostene bunod (Vyzulta)
    1. Breaks down to Latanoprost and nitric oxide, but with no significant benefit over Latanoprost alone
    2. Released in 2018, costing 10x the cost of Latanoprost alone (which is $12 per bottle)
    3. (2018) Presc Lett 25(5): 28

VI. Efficacy: Latanoprost

  1. Highly effective, low side effect agent
  2. Currently most prescribed Glaucoma agent worldwide
  3. References
    1. Hedman (2000) Eur J Ophthalmol 10:95-104 [PubMed]

VII. Adverse Effects

  1. Increased eyelash growth
  2. Eyelid fat atrophy (with secondary Eyelid droop or Ptosis)
  3. Increased pigmentation (Hyperpigmentation) of iris, eyelashes or periocular skin including Eyelids
  4. Hyperemia
  5. Local irritation
    1. Burning, stinging, itching, Eye Pain or foreign body Sensation

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Related Studies

Cost: Medications

latanoprost (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
LATANOPROST 0.005% EYE DROPS Generic $1.75 per ml
xalatan (on 8/17/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
XALATAN 0.005% EYE DROPS Generic $1.75 per ml
bimatoprost (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
BIMATOPROST 0.03% EYE DROPS Generic $31.11 per ml
BIMATOPROST 0.03% EYELASH SOLN Generic $26.03 per ml
lumigan (on 1/14/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
LUMIGAN 0.01% EYE DROPS $87.53 per ml
travoprost (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
TRAVOPROST 0.004% EYE DROP Generic $26.10 per ml
travatan (on 7/27/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
TRAVATAN Z 0.004% EYE DROP Generic $22.25 per ml
tafluprost (on 2/22/2023 at Medicaid.Gov Survey of pharmacy drug pricing)
TAFLUPROST 0.0015% EYE DROP Generic $4.29 each
zioptan (on 10/19/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
ZIOPTAN 0.0015% EYE DROP Generic $4.78 each
ZIOPTAN 0.0015% EYE DROPS $7.39 each
vyzulta (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
VYZULTA 0.024% OPHTH SOLUTION $87.46 per ml

Ontology: latanoprost (C0090306)

Definition (NCI) A prostaglandin F2alpha analogue and a prostanoid selective FP receptor agonist with an ocular hypertensive effect. Latanoprost increases uveoscleral outflow and thereby reduces intraocular pressure.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C072042
SnomedCT 330728002, 108838001, 386926002
English latanoprost, Latanoprost [eye], latanoprost (ophthalmic) (medication), latanoprost (ophthalmic), latanoprost ophthalmic, latanoprost [Chemical/Ingredient], Isopropyl (Z)-7-((1R,2R,3R,5S)-3,5-dihydroxy-2-((3R)-3-hydroxy-5-phenylpentyl)cyclopentyl)-5-heptenoate, LATANOPROST, Latanoprost Ophthalmic, Latanoprost [eye] (product), Latanoprost, Latanoprost (product), Latanoprost (substance), Latanoprost [eye] (substance)
Spanish latanoprost (ocular) (producto), latanoprost (ocular), latanoprost (producto), latanoprost (sustancia), latanoprost

Ontology: Xalatan (C0593887)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C072042
LNC LA14718-3
English Pfizer brand of latanoprost, xalatan, Xalatan®, Xalatan

Ontology: UNOPROSTONE (C0772319)

Concepts Pharmacologic Substance (T121) , Hormone (T125) , Eicosanoid (T111)
English unoprostone, UNOPROSTONE, Unoprostone

Ontology: travoprost (C0937916)

Definition (NCI) A synthetic lipophilic isopropyl ester prodrug of the active compound travoprost free acid, a prostaglandin F2alpha analog with anti-glaucoma property. Upon administration, travoprost is hydrolysed to a free acid by corneal esterases, and then selectively stimulating the prostaglandin F (FP prostanoid) receptor, thereby increasing the uveoscleral outflow which leads to a reduction in intra-ocular pressure.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C438103
SnomedCT 391664000, 129493000
English TRAVOPROST @ @ UNIDENTIFIED, TRAVOPROST UNIDENTIFIED, 5-Heptenoic Acid, 7-((1R,2R,3R,5S)-3,5-dihydroxy-2-((1E,3R)-3-hydroxy-4-(3-(trifluoromethyl)phenoxy)-1-butenyl)cyclopentyl)-, 1-methylethyl Ester,(5Z)-, travoprost (ophthalmic) (medication), travoprost (ophthalmic), travoprost [Chemical/Ingredient], TRAVOPROST, travoprost, travoprost ophthalmic, Travoprost (product), Travoprost (substance), Travoprost
Spanish travoprost (producto), travoprost (sustancia), travoprost

Ontology: bimatoprost (C0937917)

Definition (NCI_NCI-GLOSS) A drug used under the name Latisse to increase the length, thickness, and darkness of eyelashes. It is being studied as a way to increase the growth of eyelashes and eyebrows in patients given chemotherapy for cancer. Bimatoprost is also used under the name Lumigan to treat glaucoma (a build-up of fluid in the eye). It lowers pressure in the eye by increasing the flow of natural eye fluids out of the eye. It is a type of prostaglandin analog.
Definition (NCI) A synthetic prostamide and structural prostaglandin analogue with ocular hypotensive activity. Bimatoprost mimics the effects of the endogenous prostamides and reduces intraocular pressure by increasing outflow of aqueous humor through both the pressure-sensitive outflow pathway (the trabecular meshwork), and the pressure-insensitive outflow pathway (the uveoscleral routes). It is not clear whether bimatoprost lowers intraocular pressure by stimulating F-Prostanoid receptors or by acting on specific prostamide receptors.
Concepts Eicosanoid (T111) , Pharmacologic Substance (T121)
MSH C420823
SnomedCT 129492005, 395300006
English BIMATOPROST @ @ UNIDENTIFIED, BIMATOPROST UNIDENTIFIED, 5-Heptenamide, 7-((1R,2R,3R,5S)-3,5-dihydroxy-2-((1E,3S)-3-hydroxy-5-phenyl-1-pentenyl)cyclopentyl)-N-ethyl-,(5Z)-, 5-Heptenamide, 7-(3,5-dihydroxy-2-(3-hydrdoxy-5-phenyl-1-pentenyl)cyclopentyl)-N-ethyl-, (1R-(1alpha(Z),2beta(1E,3S*),3alpha,5alpha))-, bimatoprost (medication), bimatoprost [Chemical/Ingredient], bimatoprost, Bimatoprost, Bimatoprost (product), Bimatoprost (substance), BIMATOPROST
Spanish bimatoprost (producto), bimatoprost (sustancia), bimatoprost

Ontology: Lumigan (C0939372)

Concepts Eicosanoid (T111) , Pharmacologic Substance (T121)
MSH C420823
English Lumigan, lumigan, Pharm-Allergan brand of bimatoprost, Allergan brand of bimatoprost

Ontology: Eescula (C0939466)

Concepts Pharmacologic Substance (T121) , Eicosanoid (T111)
MSH C072630
English Eescula, rescula, Rescula, Ciba Vision brand of isopropyl unoprostone, Novartis brand of isopropyl unoprostone

Ontology: Travatan (C0939506)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C438103
English Travatan, travatan, Alcon brand of travoprost

Ontology: Prostaglandin analog antiglaucoma preparation (C1689940)

Concepts Eicosanoid (T111) , Pharmacologic Substance (T121)
SnomedCT 419886007
English Prostaglandin analog antiglaucoma preparation, Prostaglanding analogue anti glaucoma preparation, Prostaglanding analog anti glaucoma preparation (product), Prostaglandin analog antiglaucoma preparation (product), Prostaglandin analogue antiglaucoma preparation, Prostaglanding analog anti glaucoma preparation
Spanish preparación contra el glaucoma con análogo de prostaglandina (producto), preparación contra el glaucoma con análogo de prostaglandina, preparación contra el glaucoma con analógo de prostaglandina (producto), preparación contra el glaucoma con analógo de prostaglandina