Bimatoprost

Trade Names:Latisse- Solution, ophthalmic 0.03%

Trade Names:Lumigan- Solution, ophthalmic 0.03%

Pharmacology

Mechanism of action in treating hypotrichosis of the eyelids is unknown.

May lower IOP by increasing outflow of aqueous humor through the trabecular meshwork and uveoscleral routes.

Pharmacokinetics

Absorption

T _max is within 10 min. Mean C _max is about 0.08 ng/mL. Within 1.5 h after dosing, bimatoprost levels are below the lower limit of detection in most subjects. There is no systemic drug accumulation over time.

Distribution

Moderately distributed to body tissues. Vd is 0.67 L/kg. Protein binding is about 88%.

Metabolism

Metabolism is via oxidation and glucuronidation to various metabolites.

Elimination

Elimination half-life is approximately 45 min. Total blood Cl is 1.5 L/h/kg. Up to 67% is excreted by the kidneys and 25% is eliminated in the feces.

Indications and Usage

Treatment of hypotrichosis of the eyelashes by increasing their growth, including length, thickness, and darkness.

Reduction of IOP in patients with open-angle glaucoma or ocular hypertension.

Contraindications

Standard considerations.

Dosage and Administration

Ophthalmic Instill 1 drop in affected eye(s) in the evening.

Topical Once nightly, place 1 drop on the disposable sterile applicator and apply evenly along the skin of the upper eyelid margin at the base of the eyelashes. Use separate applicators for each eyelid.

General Advice

• Latisse
• Before application, ensure face is clean, all makeup is removed, and contact lenses are removed.
• After application, the upper eyelid margin should feel lightly moist without runoff.
• Blot excess solution runoff outside the upper eyelid margin with a tissue or absorbent cloth.
• Dispose of the applicator after 1 use. A new sterile applicator should be used for the opposite eyelid.
• Do not use any other brush/applicator to apply.

Storage/Stability

Store at 36° to 77°F.

Drug Interactions

None well documented.

Laboratory Test Interactions

None well documented.

Adverse Reactions

CNS

Asthenia, headaches (1% to 5%).

Dermatologic

Skin hyperpigmentation (less than 4%).

Abnormal hair growth (1% to 5%).

EENT

Conjunctival hyperemia, dry eye symptoms, erythema of the eyelid, eye pruritus, ocular irritation (less than 4%).

Conjunctival hyperemia, growth of eyelashes, ocular pruritus (at least 15%); blepharitis, cataract, eye pain, eyelash darkening, eyelid erythema, foreign body sensation, ocular burning, ocular dryness, ocular irritation, pigmentation of the periorbital skin, superficial punctuate keratitis, visual disturbances (3% to 10%); allergic conjunctivitis, conjunctival edema, eye discharge, eye stain, increased iris pigmentation; photophobia, tearing (1% to 3%).

Hepatic

Abnormal LFTs (1% to 5%).

Respiratory

Upper respiratory tract infections (approximately 10%).

Miscellaneous

Infections.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy not established.

Elderly

No overall differences in safety and efficacy have been observed between elderly and other adult patients.

Active intraocular inflammation

Use with caution in patients with iritis/uveitis.

Bacterial keratitis

Bacterial keratitis has been reported with multiple-dose containers as a result of patient contamination.

Contact lenses

Instruct patients to remove contact lenses prior to administration and not to wear for 15 min following administration.

Eyelash growth

Upon discontinuation of treatment, eyelash growth is expected to return to the pretreatment level.

Hair growth

There is the potential for hair growth to occur in areas were bimatoprost solution comes in repeated contact with the skin surface. When applying bimatoprost topically, it is important to carefully blot any excess drug from the eyelid margin to avoid it running onto the cheek or other skin areas.

IOP

When instilled directly into the eye, IOP is lowered. Patients using prostaglandin analogs, including Lumigan to lower IOP should only use Latisse after consulting with their health care provider.

Macular edema

Use with caution in aphakic patients, pseudophakic patients with a risk of torn posterior lens capsule, or in patients with risk factors for macular edema.

Pigmentation changes

Permanent changes to pigmented tissue may occur, most frequently involving pigmentation of the iris and eyelid and increased pigmentation and growth of eyelashes. Gradual change in eye color (ie, increased amount of brown pigmentation in the iris) may occur.

Overdosage

Symptoms

No information is available.

Patient Information

• Remind patient that eye examinations and measurement of IOP are necessary while using this medication; advise patient to keep appointments.

• Latisse
• Instruct patients on the proper means of application.
• Instruct patients to ensure face is clean, all makeup is removed, and their contact lenses are removed.
• Instruct patients to blot excess solution runoff outside the upper eyelid margin with a tissue or absorbent cloth.
• Instruct patients to dispose of the applicator after one use. A new sterile applicator should be used for the opposite eyelid.
• Instruct patients not to use any other brush or applicator to apply product.
• Inform patients not to apply to the lower eyelash line.
• Inform patients that if solution gets into the eye, it will not cause harm and they should not rinse the eye.
• Warn patients that additional applications will not increase eyelash growth.

• Lumigan
• Warn patient not to instill more often than once a day in the evening. More frequent use may decrease efficacy of the medication.
• Teach patient proper technique for instilling eye drops. Wash hands; do not allow dropper to touch eye. Tilt head back, look up; pull lower eyelid down; instill drop. Close eye for 1 to 2 min and apply gentle pressure to bridge of nose. Do not rub eye.
• Advise patient that if more than 1 topical ophthalmic drug is used, to administer the drugs at least 5 min apart.
• Inform patient that medication may cause increases in length, thickness, color, and number of eyelashes.
• Advise patient to contact the eye doctor if eye or eyelid inflammation is noted, if eye is injured, or if eye surgery is planned.

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