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Drug Reference

latanoprost

Prostaglandin analog· Brands: Xalatan, MonoprostTOP

Mechanism of action
Latanoprost is a prostaglandin F2alpha analogue that increases uveoscleral outflow of aqueous humour, thereby reducing intraocular pressure. It binds to prostaglandin FP receptors in the ciliary muscle, leading to relaxation and increased drainage.
Pharmacokinetics
After topical application, latanoprost is absorbed through the cornea and hydrolysed to its active acid form. Peak concentrations in aqueous humour occur about 2 hours after administration. Systemic absorption is low, and the drug is metabolised in the liver and excreted primarily in urine. The half-life in aqueous humour is about 3 hours.
Indications & dosing

Open-angle glaucoma

First-line topical treatment; apply one drop to affected eye(s) in the evening.

  • adult · TOP: 1 drop ONCE DAILY · First-line topical treatment; apply one drop to affected eye(s) in the evening.

Ocular hypertension

Used to reduce elevated intraocular pressure; same dosing as glaucoma.

  • adult · TOP: 1 drop ONCE DAILY · Used to reduce elevated intraocular pressure; same dosing as glaucoma.

Paediatric glaucoma (off-label)off-label

Off-label use in paediatric glaucoma; monitor for adverse effects and effectiveness.

  • pediatric · TOP: 1 drop ONCE DAILY · Off-label use in paediatric glaucoma; monitor for adverse effects and effectiveness.
Contraindications & precautions
  • Hypersensitivity to latanoprost or any component of the formulation · Avoid use in patients with a known allergy.
  • Pregnancy (especially near term) · Use only if potential benefit justifies risk; prostaglandin analogs may stimulate uterine contractions.
  • Remove contact lenses before instillation; wait at least 15 minutes before reinsertion.
  • Use with caution in patients with risk factors for cystoid macular edema (e.g., aphakia, pseudophakia with torn posterior capsule).
  • Use with caution in patients with a history of herpes simplex keratitis or uveitis.
  • Use with caution in patients with asthma or other obstructive pulmonary diseases.
  • If using other topical ophthalmic drugs, allow at least 5 minutes between applications.
Adverse effects
  • Conjunctival hyperemia
  • Increased iris pigmentation
  • Ocular irritation (e.g., burning, stinging)
  • Blurred vision
  • Cystoid macular edemaserious
  • Uveitis/iritisserious
  • Reactivation of herpes simplex keratitisserious
  • Exacerbation of asthmaserious
Monitoring, pregnancy & toxicity
  • Intraocular pressure · Regularly as determined by clinician
  • Ocular examination for iris pigmentation, eyelash changes, and conjunctival hyperemia · At baseline and periodically
  • Pregnancy: Avoid during pregnancy, especially in the third trimester. Prostaglandin analogues may increase uterine tone and cause premature labour or miscarriage. Use only if the potential benefit justifies the potential risk to the fetus.
Clinical notes
It is contraindicated in patients with active intraocular inflammation (uveitis), and should be used with caution in those at risk of macular oedema.

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BNF; local formulary