Drugs List

Therapeutic Indications

Uses

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

Contraindications

Breastfeeding
Herpetic keratitis
Pregnancy

Precautions and Warnings

Predisposition to iritis
Predisposition to uveitis
Risk factors for cystoid macular oedema
Wearing of contact lenses
Anterior chamber lens
Aphakia
Asthma
History of herpes simplex keratitis
Inflammatory glaucoma
Narrow angle glaucoma
Neovascular glaucoma
Ocular inflammation
Peri-operative period in cataract surgery
Pigmentary glaucoma
Pseudophakia
Pseudophakia with open angle glaucoma
Pseudophakia with torn posterior lens capsule

Advise patient blurred vision may affect ability to drive/operate machinery
Contains benzalkonium chloride
In combined therapy, administer eye products at least five minutes apart
To reduce systemic absorption compress lacrimal sac during administration
Review treatment if severe ocular irritation occurs
Advise patient that some eye changes may be permanent
Advise patient to seek medical advice if severe ocular irritation occurs
May cause periorbital/eyelid skin darkening
Not licensed for use in children under 18 years
Advise patient to avoid touching the eye/other surfaces with container tip
Before initiating treatment inform patient of possibility of eyelash growth
Before starting treatment inform patient of risk of increased iris pigment
Remove contact lenses before use and re-insert 15 minutes after use

Latanoprost eye drops may gradually and permanently change eye colour by increasing the amount of brown pigment in the iris. A change in eye colour has predominately been seen in patients with mixed coloured irises, the onset of changes usually occurring within the first 8 months of treatment. Unilateral treatment may result in heterochromia. Patients should be warned of this possibility before treatment and should be monitored regularly and treatment discontinued if necessary.

Preserved formulations contain benzalkonium chloride.

Pregnancy and Lactation

Pregnancy

Latanoprost is contraindicated in pregnancy.

Latanoprost is a prostaglandin F2 alpha analogue. Prostaglandin derivatives may increase uterine tone and may cause reduced perfusion to the foetus. There is limited published evidence concerning latanoprost for use in human pregnancy. One series of 10 pregnancies exposed to latanoprost, showed 9 successful outcomes and one miscarriage. Latanoprost is reported to have a short half life (under 30 minutes). Animal studies in rabbits showed embryo/foetal toxicity at doses approximately one hundred times the clinical dose.

There is limited data on its use and concerns remain about potential hazardous pharmacological effects with respect to the course of pregnancy, to the unborn child or the neonate. Schaefer, however, concludes that if there are compelling indications such as severe glaucoma, then it should not withheld provided the dose is kept as low as possible (Schaefer 2015). It is advisable to consider lacrimal sac compression and removal of any excess on the skin with a tissue.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Latanoprost is contraindicated in breastfeeding.

Latanoprost and its metabolites may pass into breast milk. Latanoprost is reported to have a short half life (under 30 minutes) and some authorities consider that this, together with limited oral absorption in the infant, suggests that the amount of drug reaching the infant is unlikely to cause untoward effects. Schaefer concludes that if severe glaucoma requires treatment, breastfeeding can continue provided the infant can be monitored (Schaefer 2015). It is advisable to consider lacrimal sac compression and removal of any excess on the skin with a tissue.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Aggravation of angina
Arthralgia
Asthma
Blepharitis
Blurred vision (transient)
Brown pigmentation of iris
Burning and stinging of the eyes
Chest pain
Conjunctival hyperaemia
Conjunctivitis
Corneal erosion
Corneal oedema
Darkening of the palpebral skin
Darkening, thickening and lengthening of eye lashes
Darkening, thickening and lengthening of vellus hair
Distichiasis
Dizziness
Dry eyes
Dyspnoea
Exacerbation of pre-existing asthma
Eyelid oedema
Eyelid reaction
Headache
Iris cyst
Iritis
Keratitis
Macular oedema
Misdirected eyelash growth
Myalgia
Nasopharyngitis
Ocular grittiness
Ocular irritation
Ocular itching
Ocular pain
Palpitations
Periorbital oedema
Photophobia
Punctate epithelial erosions of eye (transient)
Pyrexia
Rash
Sensation of foreign body in eye
Uveitis

Presentation

Eye drops containing latanoprost (preservative containing and preservative-free).

Drugs List

Therapeutic Indications

Uses

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

Dosage

Adults

Children

Contraindications

Breastfeeding
Herpetic keratitis
Pregnancy

Precautions and Warnings

Predisposition to iritis
Predisposition to uveitis
Risk factors for cystoid macular oedema
Wearing of contact lenses
Anterior chamber lens
Aphakia
Asthma
History of herpes simplex keratitis
Inflammatory glaucoma
Narrow angle glaucoma
Neovascular glaucoma
Ocular inflammation
Peri-operative period in cataract surgery
Pigmentary glaucoma
Pseudophakia
Pseudophakia with open angle glaucoma
Pseudophakia with torn posterior lens capsule

Advise patient blurred vision may affect ability to drive/operate machinery
Contains benzalkonium chloride
In combined therapy, administer eye products at least five minutes apart
To reduce systemic absorption compress lacrimal sac during administration
Review treatment if severe ocular irritation occurs
Advise patient that some eye changes may be permanent
Advise patient to seek medical advice if severe ocular irritation occurs
May cause periorbital/eyelid skin darkening
Not licensed for use in children under 18 years
Advise patient to avoid touching the eye/other surfaces with container tip
Before initiating treatment inform patient of possibility of eyelash growth
Before starting treatment inform patient of risk of increased iris pigment
Remove contact lenses before use and re-insert 15 minutes after use

Latanoprost eye drops may gradually and permanently change eye colour by increasing the amount of brown pigment in the iris. A change in eye colour has predominately been seen in patients with mixed coloured irises, the onset of changes usually occurring within the first 8 months of treatment. Unilateral treatment may result in heterochromia. Patients should be warned of this possibility before treatment and should be monitored regularly and treatment discontinued if necessary.

Preserved formulations contain benzalkonium chloride.

Pregnancy and Lactation

Pregnancy

Latanoprost is contraindicated in pregnancy.

Latanoprost is a prostaglandin F2 alpha analogue. Prostaglandin derivatives may increase uterine tone and may cause reduced perfusion to the foetus. There is limited published evidence concerning latanoprost for use in human pregnancy. One series of 10 pregnancies exposed to latanoprost, showed 9 successful outcomes and one miscarriage. Latanoprost is reported to have a short half life (under 30 minutes). Animal studies in rabbits showed embryo/foetal toxicity at doses approximately one hundred times the clinical dose.

There is limited data on its use and concerns remain about potential hazardous pharmacological effects with respect to the course of pregnancy, to the unborn child or the neonate. Schaefer, however, concludes that if there are compelling indications such as severe glaucoma, then it should not withheld provided the dose is kept as low as possible (Schaefer 2015). It is advisable to consider lacrimal sac compression and removal of any excess on the skin with a tissue.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Latanoprost is contraindicated in breastfeeding.

Latanoprost and its metabolites may pass into breast milk. Latanoprost is reported to have a short half life (under 30 minutes) and some authorities consider that this, together with limited oral absorption in the infant, suggests that the amount of drug reaching the infant is unlikely to cause untoward effects. Schaefer concludes that if severe glaucoma requires treatment, breastfeeding can continue provided the infant can be monitored (Schaefer 2015). It is advisable to consider lacrimal sac compression and removal of any excess on the skin with a tissue.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Counselling

If a dose is missed, continue the treatment with the next dose.
In combined therapy, administer eye products at least five minutes apart. Advise patient that some eye changes may be permanent. May cause periorbital/eyelid skin darkening. Remove contact lenses before use and re-insert 15 minutes after use. Before starting treatment inform patient of risk of increased iris pigment. Before initiating treatment inform patient of possibility of eyelash growth. Advise patient to avoid touching the eye/other surfaces with container tip. Advise patient to seek medical advice if severe ocular irritation occurs. To reduce systemic absorption compress lacrimal sac during administration. Advise patient blurred vision may affect ability to drive/operate machinery.

Side Effects

Aggravation of angina
Arthralgia
Asthma
Blepharitis
Blurred vision (transient)
Brown pigmentation of iris
Burning and stinging of the eyes
Chest pain
Conjunctival hyperaemia
Conjunctivitis
Corneal erosion
Corneal oedema
Darkening of the palpebral skin
Darkening, thickening and lengthening of eye lashes
Darkening, thickening and lengthening of vellus hair
Distichiasis
Dizziness
Dry eyes
Dyspnoea
Exacerbation of pre-existing asthma
Eyelid oedema
Eyelid reaction
Headache
Iris cyst
Iritis
Keratitis
Macular oedema
Misdirected eyelash growth
Myalgia
Nasopharyngitis
Ocular grittiness
Ocular irritation
Ocular itching
Ocular pain
Palpitations
Periorbital oedema
Photophobia
Punctate epithelial erosions of eye (transient)
Pyrexia
Rash
Sensation of foreign body in eye
Uveitis

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: April 2018

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

Summary of Product Characteristics: Medizol 0.005% w/v eye drops, solution. Medicom Healthcare Ltd. Revised August 2017.

Summary of Product Characteristics: Monopost 50mcg/ml eye drops, solution in single-dose container. Thea Pharmaceuticals Ltd. Revised January 2017.

Summary of Product Characteristics: Xalatan 50micrograms/ml eye drops solution. Pfizer Ltd. Revised April 2018.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 12 April 2018

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Latanoprost, Last revised: March 10, 2015
Last accessed: April 12, 2018