Xalatan 0.005%

Xalatan 0.005% is an antiglaucoma drug, an analog of prostaglandin F2α. It is a selective agonist of FP (prostaglandin F) receptors and decreases intraocular pressure (IOP) by magnifying the aqueous humor outflow, mainly by the uveoscleral route, and also through the trabecular network. It was found that latanoprost has no visiable effect on the aqueous humor production  and on the blood-ophthalmic barrier.

Indications

Decrease in increased IOP in adults and children (over the age of 1 year) with open-angle glaucoma or increased ophthalmotonus.

Dosage regimen

Adults and children over 1 year old – 1 drop in the affected eye (s) 1 time/day. The optimal effect is achieved when applying the drug in the evening.

As with the use of any eye drops, in order to reduce the possible systemic drug effect, immediately after putting of each drop on, it is recommended to press on the lower lacrimal opening located at the inner eye corner on the lower eyelid. This must be done within 1 minute.

Side effects

The following side effects in relation to the drug use have been described:

  • the organ of vision: eye irritation; hyperemia of the conjunctiva; blepharitis; eye pain; increased iris pigmentation; eyelid edema, periorbital edema, corneal erosion; conjunctivitis; iritis/uveitis; keratitis; macular edema (including cystoid); a change in the direction of eyelash growth, sometimes provoking eye irritation; the growth of an additional row of eyelashes over the meibomian glands, changes in the periorbital region and in the eyelash region, resulting in  a deepening of the upper eyelid groove; dryness of the eyes’ mucous membrane, blurred vision, photophobia.
  • the skin: rash, darkening of the eyelid skin and local skin reactions on the eyelids, toxic epidermal necrolysis.
  • the nervous system: dizziness, headache.
  • the respiratory system: bronchospasm (including acute attacks or exacerbation of the disease in patients with a history of bronchial asthma), shortness of breath.
  • the musculoskeletal system: muscle pain, joint pain.
  • infections and invasions: herpetic keratitis.
  • others: nonspecific chest pain.

Cases of retinal artery embolism, retinal detachment and vitreous hemorrhage have also been reported in patients with diabetic retinopathy.

In some patients with visiable corneal damage, very rare cases of corneal calcification have been reported due to the use of phosphate-containing eye drops.

The safety profile of Xalatan in children did not differ from that in adults. Compared to the adult population, nasopharyngitis and fever were most common in children.

Contraindications for use

  • Age up to 1 year (efficacy and safety have not been established);
  • Hypersensitivity to latanoprost or other components of the drug.

The drug should be used with caution in patients with aphakia, pseudoaphakia with rupture of the posterior lens capsule, in patients with risk factors for macular edema (when treating with latanoprost, cases of macular edema, including cystoid edema, have been described; in patients with inflammatory, neovascular glaucoma (due to lack of sufficient experience with the drug); with bronchial asthma, herpetic keratitis in medical history.

The use of Xalatan should be avoided in patients with active herpetic keratitis and recurrent herpetic keratitis, especially related to the use of prostaglandin F2α analogs.

Xalatan should be used with caution in patients with risk factors for iritis/uveitis.

There are limited data on the use of Xalatan eye drops in patients who are planned for surgery for cataracts. In this regard, it should be used with caution in this group of patients.

Pregnancy and lactation

There have been no adequate controlled studies in pregnant women. The drug should be prescribed during pregnancy only in cases where the expected benefit to the mother outweighs the possible risk to the fetus.

Latanoprost and its metabolites can be excreted in breast milk, therefore, the drug should be used with caution during breastfeeding.

Application in children

Contraindicated for use in children under 1 year of age.

Overdose

Symptoms: in addition to irritation of the eyes’ mucous membrane, hyperemia of the conjunctiva or episclera, there were no other ambiguous swings on the part of the organ of vision with an overdose of latanoprost.

In case of accidental ingestion of latanoprost orally, the following information should be taken into account: one bottle with 2.5 ml of solution contains 125 mcg of latanoprost. More than 90% of the drug is metabolized during the “first pass” through the liver. Intravenous infusion at a dose of 3 μg / kg did not cause any symptoms in healthy volunteers, however, when a dose of 5.5-10 μg / kg was administered, nausea, abdominal pain, dizziness, fatigue, hot flashes and sweating were observed. In patients with moderate bronchial asthma, the introduction of latanoprost into the eyes at a dose 7 times higher than the therapeutic dose did not cause bronchospasm.

Treatment: symptomatic therapy.

Drug interactions

With the simultaneous putting on two prostaglandin analogs into the eyes, a paradoxical increase in IOP has been described, therefore the simultaneous use of two or more prostaglandins, their analogs or derivatives is not recommended.

Pharmaceutical interactions

Xalatan is incompatible with eye drops containing thiomersal (precipitation occurs).