Netarsudil + Latanoprost eye prep

Indications

Netarsudil + Latanoprost eye prep is used for: Elevated Intraocular Pressure

Adult Dose

Elevated Intraocular Pressure Indicated for reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension Instill 1 drop in affected eye(s) qDay in evening; not to exceed 1 dose/day

Child Dose

Renal Dose

Administration

Instruct patient on proper technique of administering ophthalmic drops and how to avoid contaminating the container Concomitant use with other ophthalmics: Administer at least 5 minutes apart Contact lenses: Remove contacts before administering ophthalmic drops; may reinsert 15 minutes afterwards; contains benzalkonium chloride, which may be absorbed by soft contact lenses

Contra Indications

Precautions

Latanoprost reported to cause changes to pigmented tissues (owing to increased melanin content in melanocytes), including increased pigmentation of the iris, periorbital tissue, and eyelashes; pigmentation is expected to increase as long as latanoprost is administered; inform patients of possibility of increased pigmentation Latanoprost may gradually change eyelashes and vellus hair in the treated eye; changes include increased length, thickness, pigmentation, number of lashes or hairs, and misdirected growth of eyelashes; eyelash changes are usually reversible when treatment discontinued Caution with history of intraocular inflammation (iritis/uveitis); should generally not be used with active intraocular inflammation because latanoprost may exacerbate inflammation Macular edema, including cystoid macular edema, reported with latanoprost; caution in aphakic patients, pseudophakic patients with a torn posterior lens capsule, or those with known risk factors for macular edema Reactivation of herpes simplex keratitis reported with latanoprost; caution with history of herpetic keratitis; avoid with active herpes simplex keratitis as administration may exacerbate inflammation Risk of bacterial keratitis associated with use of multiple-dose containers of topical ophthalmic products

Pregnancy-Lactation

Pregnancy There are no available data regarding ophthalmic use in pregnant women Animal studies Reproduction studies of latanoprost showed embryofetal lethality in rabbits; no embryofetal lethality was observed at a dose ~15 times higher than the recommended human ophthalmic dose (RHOD); in 4 of 16 pregnant rabbits, no viable fetuses were present at a dose ~80 times RHOD IV administration of netarsudil to pregnant rats and rabbits during organogenesis did not produce adverse embryofetal effects at clinically relevant systemic exposures Lactation No data are available regarding the presence of netarsudil or latanoprost in human milk, the effects on the breastfed infant, or the effects on milk production Systemic exposure to netarsudil following topical ocular administration is low, and it is not known whether measurable levels of netarsudil would be present in maternal milk following topical ocular administration Consider the development and health benefits of breastfeeding along with the mother’s clinical need for the drug and any potential adverse effects on the breastfed child or from the underlying maternal condition

Interactions

In vitro studies show precipitation of latanoprost solution occurs when mixed with thimerosal-containing ophthalmic drops Combining 2 or more prostaglandins or prostaglandin analogues is not recommended; administration of prostaglandin drug products more than once daily may mitigate the IOP-lowering effect or cause paradoxical elevations in IOP

Side Effects

Side effects of Netarsudil + Latanoprost eye prep : >10% Conjunctival hyperemia (59%) Instillation site pain (20%) Corneal verticillata (15%) Conjunctival hemorrhage (11%) 1-10% Eye pruritus (5-8%) Reduced visual acuity (5-8%) Increased lacrimation (5-8%) Instillation site discomfort (5-8%) Blurred vision (5-8%)

Mode of Action

Latanoprost: Prostaglandin F2-alpha analog; increases outflow of aqueous humor Netarsudil: Dual inhibitor of Rho-kinase and the norepinephrine plasma membrane transport protein; increases trabecular outflow