Drugs List

Therapeutic Indications

Uses

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

Contraindications

Children under 2 months
Breastfeeding
Pregnancy

Precautions and Warnings

Children aged 2 months to 3 years
Females of childbearing potential
Predisposition to iritis
Predisposition to uveitis
Risk factors for cystoid macular oedema
Wearing of contact lenses
Anterior chamber lens
Aphakia
Congenital glaucoma
Inflammatory glaucoma
Narrow angle glaucoma
Neovascular glaucoma
Ocular inflammation
Pigmentary glaucoma
Pseudoexfoliative glaucoma
Pseudophakia with open angle glaucoma
Pseudophakia with torn posterior lens capsule
Respiratory impairment

Advise patient blurred vision may affect ability to drive/operate machinery
Contains polyoxyethylene hydrogenated castor oil; may cause skin reactions
Some brands contain benzalkonium chloride
Some formulations contain propylene glycol
Avoid contact of product with skin
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
Female: Ensure adequate contraception during treatment
Advise patient not to exceed stated dose
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

Pregnancy and Lactation

Pregnancy

Travoprost is contraindicated in pregnancy.

Travoprost is a prostaglandin F2 alpha analogue. Prostaglandin derivatives may increase uterine tone and may cause reduced perfusion to the foetus. Animal studies in rats and mice showed embryo/foetal toxicity/loss at doses close to the clinical dose. There is limited published evidence and it is not known if travoprost free acid crosses the human placenta.

Concerns remain about potential hazardous pharmacological effects with respect to the course of pregnancy and to the unborn baby 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 manufacturers note that this medication should not be used during pregnancy unless clearly necessary.

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

Travoprost is contraindicated in breastfeeding.

No data on the use of travoprost during breastfeeding has been located. The low molecular weight of the drug, short elimination half-life and very low plasma levels indicate that no clinically significant amount will be excreted into breastmilk.

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.

The manufacturers note that travoprost and its metabolites may pass into breast milk in animals and recommend that it should not be used in breastfeeding women.

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 peptic ulcer
Allergic dermatitis
Allergic reaction
Anterior chamber inflammation
Anterior chamber pigmentation
Anxiety
Asthenia
Asthenopia
Asthma
Blepharitis
Blood pressure changes
Blurred vision
Bradycardia
Breast enlargement
Brown pigmentation of iris
Cataracts
Changes in hair colour
Changes in hair texture
Chest pain
Conjunctival follicles
Conjunctival oedema
Conjunctivitis
Constipation
Contact dermatitis
Corneal erosion
Cough
Darkening of the palpebral skin
Darkening, thickening and lengthening of eye lashes
Decrease in heart rate
Depression
Dizziness
Dry eyes
Dry mouth
Dysgeusia
Dysphonia
Dyspnoea
Dysuria
Ectropion
Erythema
Exacerbation of pre-existing asthma
Eyelid eczema
Eyelid erythema
Eyelid pruritus
Eyelid sulcus
Gastro-intestinal disturbances
Hair growth abnormal
Headache
Herpes simplex
Hyperpigmentation of skin
Hypersensitivity reactions
Hypertension
Hypertrichosis
Hypoaesthesia
Hypoaesthesia eye
Hypotension
Increase in prostate specific antigen (PSA)
Increased iris pigmentation
Increased lacrimation
Insomnia
Iridocyclitis
Iritis
Keratitis
Lid margin crusting
Macular oedema
Madarosis
Malaise
Meibomianitis
Musculoskeletal pain
Mydriasis
Nasal congestion
Ocular discharge
Ocular discomfort
Ocular hyperaemia
Ocular inflammation
Ocular pain
Ocular pruritus
Oropharyngeal pain
Palpitations
Periorbital oedema
Photophobia
Photopsia
Rash
Reduced visual acuity
Respiratory disorders
Tachycardia
Throat irritation
Tinnitus
Urinary incontinence
Uveitis
Variation in heart rate
Vertigo
Visual field defects
Visual haloes

Presentation

Eye drops containing travoprost.

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

Children under 2 months
Breastfeeding
Pregnancy

Precautions and Warnings

Children aged 2 months to 3 years
Females of childbearing potential
Predisposition to iritis
Predisposition to uveitis
Risk factors for cystoid macular oedema
Wearing of contact lenses
Anterior chamber lens
Aphakia
Congenital glaucoma
Inflammatory glaucoma
Narrow angle glaucoma
Neovascular glaucoma
Ocular inflammation
Pigmentary glaucoma
Pseudoexfoliative glaucoma
Pseudophakia with open angle glaucoma
Pseudophakia with torn posterior lens capsule
Respiratory impairment

Advise patient blurred vision may affect ability to drive/operate machinery
Contains polyoxyethylene hydrogenated castor oil; may cause skin reactions
Some brands contain benzalkonium chloride
Some formulations contain propylene glycol
Avoid contact of product with skin
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
Female: Ensure adequate contraception during treatment
Advise patient not to exceed stated dose
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

Pregnancy and Lactation

Pregnancy

Travoprost is contraindicated in pregnancy.

Travoprost is a prostaglandin F2 alpha analogue. Prostaglandin derivatives may increase uterine tone and may cause reduced perfusion to the foetus. Animal studies in rats and mice showed embryo/foetal toxicity/loss at doses close to the clinical dose. There is limited published evidence and it is not known if travoprost free acid crosses the human placenta.

Concerns remain about potential hazardous pharmacological effects with respect to the course of pregnancy and to the unborn baby 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 manufacturers note that this medication should not be used during pregnancy unless clearly necessary.

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

Travoprost is contraindicated in breastfeeding.

No data on the use of travoprost during breastfeeding has been located. The low molecular weight of the drug, short elimination half-life and very low plasma levels indicate that no clinically significant amount will be excreted into breastmilk.

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.

The manufacturers note that travoprost and its metabolites may pass into breast milk in animals and recommend that it should not be used in breastfeeding women.

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 peptic ulcer
Allergic dermatitis
Allergic reaction
Anterior chamber inflammation
Anterior chamber pigmentation
Anxiety
Asthenia
Asthenopia
Asthma
Blepharitis
Blood pressure changes
Blurred vision
Bradycardia
Breast enlargement
Brown pigmentation of iris
Cataracts
Changes in hair colour
Changes in hair texture
Chest pain
Conjunctival follicles
Conjunctival oedema
Conjunctivitis
Constipation
Contact dermatitis
Corneal erosion
Cough
Darkening of the palpebral skin
Darkening, thickening and lengthening of eye lashes
Decrease in heart rate
Depression
Dizziness
Dry eyes
Dry mouth
Dysgeusia
Dysphonia
Dyspnoea
Dysuria
Ectropion
Erythema
Exacerbation of pre-existing asthma
Eyelid eczema
Eyelid erythema
Eyelid pruritus
Eyelid sulcus
Gastro-intestinal disturbances
Hair growth abnormal
Headache
Herpes simplex
Hyperpigmentation of skin
Hypersensitivity reactions
Hypertension
Hypertrichosis
Hypoaesthesia
Hypoaesthesia eye
Hypotension
Increase in prostate specific antigen (PSA)
Increased iris pigmentation
Increased lacrimation
Insomnia
Iridocyclitis
Iritis
Keratitis
Lid margin crusting
Macular oedema
Madarosis
Malaise
Meibomianitis
Musculoskeletal pain
Mydriasis
Nasal congestion
Ocular discharge
Ocular discomfort
Ocular hyperaemia
Ocular inflammation
Ocular pain
Ocular pruritus
Oropharyngeal pain
Palpitations
Periorbital oedema
Photophobia
Photopsia
Rash
Reduced visual acuity
Respiratory disorders
Tachycardia
Throat irritation
Tinnitus
Urinary incontinence
Uveitis
Variation in heart rate
Vertigo
Visual field defects
Visual haloes

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 2017.

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.

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.

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

Summary of Product Characteristics: Travatan eye drops. Novartis Pharmaceuticals UK Ltd - Alcon Laboratories is a subsidiary. Revised April 2017.

Summary of Product Characteristics: Bondulc 40micrograms/ml Eye Drops, Solution. Actavise UK Ltd. Revised October 2015.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 13 June 2017.

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
Travoprost Last revised: September 2013.
Last accessed: June 2017.