Drugs List

Therapeutic Indications

Uses

Treatment of elevated intraocular pressure in chronic open-angle glaucoma
Treatment of elevated intraocular pressure in ocular hypertension

As monotherapy or as adjunctive therapy to beta-blockers in the treatment of elevated intraocular pressure in chronic open-angle glaucoma and ocular hypertension in adults.

Contraindications

Children under 18 years
Breastfeeding

Precautions and Warnings

Predisposition to hypotension
Predisposition to iritis
Predisposition to low heart rate
Predisposition to uveitis
Risk factors for cystoid macular oedema
Wearing of contact lenses
Aphakia
Asthma
Bradycardia
Chronic obstructive pulmonary disease
History of viral ocular infection
Hypotension
Moderate hepatic impairment
Ocular inflammation
Pregnancy
Pseudophakia with torn posterior lens capsule
Renal impairment
Respiratory impairment

Advise patient blurred vision may affect ability to drive/operate machinery
Some formulations may contain traces of silver - risk of hypersensitivity
Advise patient hair growth may occur on areas of skin repeatedly exposed
In combined therapy, administer eye products at least five minutes apart
To reduce systemic absorption compress lacrimal sac during administration
Advise patient that some eye changes may be permanent
Contains phosphate: Risk of calcification in existing notable cornea damage
Advise patient to avoid touching the eye/other surfaces with container tip
Before initiating treatment inform patient of possibility of eyelash growth
Before initiating treatment inform patient of risk of eyelid skin darkening
Before starting treatment inform patient of risk of increased iris pigment
Remove contact lenses before use and re-insert 15 minutes after use

Before treatment begins, advise patients there is a risk of prostaglandin analogue periorbitopathy (PAP). Some changes may be permanent and lead to an impaired field of vision. In cases where only one eye is treated there might be differences in appearance between eyes.

Pregnancy and Lactation

Pregnancy

Use bimatoprost with caution during pregnancy.

The manufacturer notes that bimatoprost eye drops should only be used in pregnancy if necessary. There is limited data for the use of bimatoprost in pregnant women and it is unknown if bimatoprost crosses the human placenta. Animal studies indicate a low risk.

Lactation

Bimatoprost is contraindicated during breastfeeding.

The manufacturer notes that the decision must be taken to cease breastfeeding or to discontinue the medication. There is limited data for the use of bimatoprost eye drops during human breastfeeding. The molecular weight (around 416) and moderate plasma protein binding (around 88%) indicates that it will be excreted into breast milk, yet the very low blood concentration and short elimination half life indicates that notable exposure will not occur.

Side Effects

Abnormal liver function tests
Allergic conjunctivitis
Allergic dermatitis
Asthenia
Asthenopia
Asthma
Blepharal pigmentation
Blepharitis
Blepharospasm
Blurred vision (transient)
Bradycardia
Conjunctival hyperaemia
Conjunctival oedema
Corneal erosion
Cystoid macular oedema
Dizziness
Dry eyes
Dry skin
Dyspnoea
Exacerbation of obstructive pulmonary disease
Exacerbation of pre-existing asthma
Eye pain
Eyelash darkening
Eyelash growth
Eyelid changes
Eyelid erythema
Eyelid oedema
Eyelid pruritus
Eyelid retraction
Eyelid sulcus
Hair growth abnormal
Headache
Hirsutism
Hypersensitivity reactions
Hypertension
Hypotension
Increased iris pigmentation
Increased lacrimation
Iritis
Macular oedema
Madarosis
Nausea
Ocular allergy
Ocular burning
Ocular discharge
Ocular discomfort
Ocular irritation
Ocular pruritus
Periorbital changes
Periorbital erythema
Periorbital skin depigmentation
Periorbital skin pigmentation
Photophobia
Pruritus
Punctate keratitis
Reduced visual acuity
Retinal haemorrhage
Sensation of foreign body in eye
Tearing
Uveitis
Visual disturbances

Presentation

Eye drops containing bimatoprost preservative-free.

Drugs List

Therapeutic Indications

Uses

Treatment of elevated intraocular pressure in chronic open-angle glaucoma
Treatment of elevated intraocular pressure in ocular hypertension

As monotherapy or as adjunctive therapy to beta-blockers in the treatment of elevated intraocular pressure in chronic open-angle glaucoma and ocular hypertension in adults.

Dosage

Adults

Contraindications

Children under 18 years
Breastfeeding

Precautions and Warnings

Predisposition to hypotension
Predisposition to iritis
Predisposition to low heart rate
Predisposition to uveitis
Risk factors for cystoid macular oedema
Wearing of contact lenses
Aphakia
Asthma
Bradycardia
Chronic obstructive pulmonary disease
History of viral ocular infection
Hypotension
Moderate hepatic impairment
Ocular inflammation
Pregnancy
Pseudophakia with torn posterior lens capsule
Renal impairment
Respiratory impairment

Advise patient blurred vision may affect ability to drive/operate machinery
Some formulations may contain traces of silver - risk of hypersensitivity
Advise patient hair growth may occur on areas of skin repeatedly exposed
In combined therapy, administer eye products at least five minutes apart
To reduce systemic absorption compress lacrimal sac during administration
Advise patient that some eye changes may be permanent
Contains phosphate: Risk of calcification in existing notable cornea damage
Advise patient to avoid touching the eye/other surfaces with container tip
Before initiating treatment inform patient of possibility of eyelash growth
Before initiating treatment inform patient of risk of eyelid skin darkening
Before starting treatment inform patient of risk of increased iris pigment
Remove contact lenses before use and re-insert 15 minutes after use

Before treatment begins, advise patients there is a risk of prostaglandin analogue periorbitopathy (PAP). Some changes may be permanent and lead to an impaired field of vision. In cases where only one eye is treated there might be differences in appearance between eyes.

Pregnancy and Lactation

Pregnancy

Use bimatoprost with caution during pregnancy.

The manufacturer notes that bimatoprost eye drops should only be used in pregnancy if necessary. There is limited data for the use of bimatoprost in pregnant women and it is unknown if bimatoprost crosses the human placenta. Animal studies indicate a low risk.

Lactation

Bimatoprost is contraindicated during breastfeeding.

The manufacturer notes that the decision must be taken to cease breastfeeding or to discontinue the medication. There is limited data for the use of bimatoprost eye drops during human breastfeeding. The molecular weight (around 416) and moderate plasma protein binding (around 88%) indicates that it will be excreted into breast milk, yet the very low blood concentration and short elimination half life indicates that notable exposure will not occur.

Side Effects

Abnormal liver function tests
Allergic conjunctivitis
Allergic dermatitis
Asthenia
Asthenopia
Asthma
Blepharal pigmentation
Blepharitis
Blepharospasm
Blurred vision (transient)
Bradycardia
Conjunctival hyperaemia
Conjunctival oedema
Corneal erosion
Cystoid macular oedema
Dizziness
Dry eyes
Dry skin
Dyspnoea
Exacerbation of obstructive pulmonary disease
Exacerbation of pre-existing asthma
Eye pain
Eyelash darkening
Eyelash growth
Eyelid changes
Eyelid erythema
Eyelid oedema
Eyelid pruritus
Eyelid retraction
Eyelid sulcus
Hair growth abnormal
Headache
Hirsutism
Hypersensitivity reactions
Hypertension
Hypotension
Increased iris pigmentation
Increased lacrimation
Iritis
Macular oedema
Madarosis
Nausea
Ocular allergy
Ocular burning
Ocular discharge
Ocular discomfort
Ocular irritation
Ocular pruritus
Periorbital changes
Periorbital erythema
Periorbital skin depigmentation
Periorbital skin pigmentation
Photophobia
Pruritus
Punctate keratitis
Reduced visual acuity
Retinal haemorrhage
Sensation of foreign body in eye
Tearing
Uveitis
Visual disturbances

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: June 2022

Reference Sources

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

Summary of Product Characteristics: Bimatoprost 0.3mg/ml eye drops, solution in a single container. Aspire Pharma Ltd. Revised February 2022.

Summary of Product Characteristics: Bimi 0.3mg/ml eye drops, solution. Zaklady Farmaceutyczne POLPHARMA S.A. Revised May 2022.

Summary of Product Characteristics: Eyreida 0.3mg/ml eye drops, solution. Aspire Pharma Ltd. Revised February 2022.

Summary of Product Characteristics: Lumigan 0.3mg/ml eye drops, solution, in single-dose container. AbbVie Ltd. Revised April 2022.

Summary of Product Characteristics: Vizibim 0.3mg/ml eye drops, solution. Bausch and Lomb UK Ltd. Revised October 2021.

Summary of Product Characteristics: Zimed Preservative Free 0.3mg/ml eye drops, solution. Medicom Healthcare Ltd. Revised March 2022.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 11 November 2022