terminology and guidelines for glaucoma ii - Kwaliteitskoepel

adrenergic antagonists. Based on preliminary clinical data, bimatoprost, latanoprost, and travoprost appear to be at
least as effective on IOP as timolol, while the effectiveness of unoprostone is similar or slightly less.
Prostaglandin analogues/prostamide may be used in conjunction with other antiglaucoma medications, although
further studies must establish the optimal combinations. Whether clinical experience will yield outcomes in favour of
one of these products remains to be determined. Patients should be educated on associated adverse events especially
pigmentation of the iris and eyelashes.
Major contraindications
Known hypersensitivity to bimatoprost / latanoprost / travoprost / unoprostone, benzalkonium chloride, or any
other product ingredient.
Patients should not administer these drugs while wearing contact lenses, but contact lenses can be reinserted 15
minutes following administration of the drugs.
Precautions Cystoid macular edema in aphakes/pseudophakes has been reported in few cases, most occurring in
aphakic patients, in pseudophakic patients with a posterior lens capsule rupture, or in patients with
known risk factors for macular edema 69,70 .
Bimatoprost, latanoprost, travoprost and unoprostone should be used with caution in these patients
although con current administration of nonsteroidal anti-inflammatory agents, such as diclofenac,
might decrease this side effect
Unilateral treatment may cause a difference in iris colour and in length, thickness, pigmentation, and
number of lashes between the eyes.
Patients with uveitis.
Side effects
Local:
Conjunctival hyperemia (Bimatoprost up to 44.7% 53 ,Latanoprost up to 27.6% 55 , Travoprost up to
49.5% 55 , Unoprostone up to 9% 61 ), burning and stinging, foreign body sensation and itching.
Hyperemia is often transient and usually mild, without associated symptoms.
Eyelash changes (increased length, thickness, pigmentation, and number of lashes), reversible after cessation
of medication 52-58,65 .
Increased iris pigmentation, especially seen in patients with green-brown, blue/gray-brown or yellowbrown
irides. The long-term effects on the iris or other parts of the eye are currently unknown. This
effect is to be considered permanent 62-64 . Unoprostone is less likely to change iris color.
Cystoid macular edema in aphakes/pseudophakes has been reported in few cases, most occurring in
aphakic patients, in pseudophakic patients with a posterior lens capsule rupture, or in patients with
known risk factors for macular edema 69,70 .
Reactivation of herpes keratitis 66,67 .
Anterior uveitis 68 .
Systemic: The following events have been identified during postmarketing use of prostaglandin analogues in clinical
practice. Because they are reported voluntarily from a population of unknown size, estimates of
frequency cannot be made.The events include: dyspnea, asthma and exacerbation of asthma.
Prostaglandin derivatives and prostamides appears to have very few systemic side effects in comparison
with β blockers and selective α2 agonists 71-73 .
Pregnancy and nursing mothers
There are no adequate and well controlled studies in pregnant women. Only to be used during pregnancy if potential
benefit justifies the potential risk to the fetus.
It is not known whether the drugs or their metabolites are excreted in human milk.
Ch. 3 - 19 EGS