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Bimatoprost

Generic name: bimatoprost ophthalmic

Brand names: Lumigan, Durysta

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, External:

Latisse: 0.03% (3 mL, 5 mL) [contains benzalkonium chloride]

Generic: 0.03% (3 mL, 5 mL)

Solution, Ophthalmic:

Lumigan: 0.01% (2.5 mL, 5 mL, 7.5 mL) [contains benzalkonium chloride]

Generic: 0.03% (2.5 mL, 5 mL, 7.5 mL)

Pharmacology

Mechanism of Action

As a synthetic analog of prostaglandin with ocular hypotensive activity, bimatoprost decreases intraocular pressure by increasing the outflow of aqueous humor. Bimatoprost may increase the percent and duration of hairs in the growth phase, resulting in eyelash growth.

Pharmacokinetics/Pharmacodynamics

Distribution

Vd: 0.67 L/kg

Metabolism

Undergoes oxidation, N-deethylation, and glucuronidation after reaching systemic circulation; forms metabolites

Excretion

Urine (67%); feces (25%)

Onset of Action

Reduction of IOP: ~4 hours; Peak effect: Maximum reduction of IOP: ~8 to 12 hours

Time to Peak

≤10 minutes

Half-Life Elimination

IV: ≤45 minutes

Protein Binding

~88%

Use: Labeled Indications

Elevated intraocular pressure (Lumigan; Vistitan [Canadian product]): Reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension

Hypotrichosis of the eyelashes (Latisse): Treatment of hypotrichosis of the eyelashes

Contraindications

Hypersensitivity to bimatoprost or any component of the formulation.

Dosage and Administration

Dosing: Adult

Elevated intraocular pressure (Lumigan; Vistitan [Canadian product]): Ophthalmic: Instill 1 drop into affected eye(s) once daily in the evening; do not exceed once-daily dosing (may decrease IOP-lowering effect). If used with other topical ophthalmic agents, separate administration by at least 5 minutes.

Hypotrichosis of the eyelashes (Latisse): Ophthalmic, topical: Place one drop on applicator and apply evenly along the skin of the upper eyelid at base of eyelashes once daily at bedtime; repeat procedure for second eye (use a clean applicator).

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Elevated intraocular pressure (Lumigan): Adolescents ≥16 years: Refer to adult dosing.

Hypotrichosis of the eyelashes (Latisse): Children ≥5 years and Adolescents: Refer to adult dosing.

Administration

Latisse: Remove make-up and contact lenses prior to application; ensure face is clean. Apply with the sterile applicator provided only; do not use other brushes or applicators. Use a tissue or cloth to blot any excess solution on the outside of the upper eyelid margin; do not apply to lower eyelash line. Do not reuse applicators; use new applicator for second eye. Applying more than once nightly will not increase eyelash growth; eyelash growth is expected to return to baseline when therapy is discontinued. May reinsert contacts 15 minutes after application.

Lumigan; Vistitan [Canadian product]: May be used with other eye drops to lower intraocular pressure. If using more than one ophthalmic product, wait at least 5 minutes in between application of each medication. Remove contact lenses prior to administration and wait 15 minutes before reinserting.

Storage

Store between 2°C to 25°C (36°F to 77°F).

Drug Interactions

Latanoprost: The concomitant use of Latanoprost and Bimatoprost may result in increased intraocular pressure. Monitor therapy

Latanoprostene Bunod: The concomitant use of Bimatoprost and Latanoprostene Bunod may result in increased intraocular pressure. Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: May diminish the therapeutic effect of Prostaglandins (Ophthalmic). Nonsteroidal Anti-Inflammatory Agents may also enhance the therapeutic effects of Prostaglandins (Ophthalmic). Monitor therapy

Nonsteroidal Anti-Inflammatory Agents (Ophthalmic): May diminish the therapeutic effect of Prostaglandins (Ophthalmic). Nonsteroidal Anti-Inflammatory Agents (Ophthalmic) may enhance the therapeutic effect of Prostaglandins (Ophthalmic). Monitor therapy

Adverse Reactions

Adverse reactions and percentages are for Lumigan unless noted:

>10%:

Dermatologic: Increased growth in number of eyelashes

Ophthalmic: Conjunctival hyperemia (25% to 45%; Latisse: <4%), eye pruritus (>10%; Latisse: <4%)

1% to 10%:

Central nervous system: Headache (1% to 5%), foreign body sensation of eye

Dermatologic: Erythema of eyelid (1% to 10%; Latisse: <4%), hyperpigmentation of eyelashes, local skin hyperpigmentation (Lumigan and Latisse)

Endocrine & metabolic: Hirsutism

Hepatic: Abnormal hepatic function tests (1% to 5%)

Infection: Infection (10% [primarily colds and upper respiratory tract infections])

Neuromuscular & skeletal: Asthenia (1% to 5%)

Ophthalmic: Dry eye syndrome (1% to 10%; Latisse: <4%), eye irritation (1% to 10%; Latisse: <4%), allergic conjunctivitis, asthenopia, blepharitis, burning sensation of eyes, cataract, conjunctival edema, conjunctival hemorrhage, eye discharge, eye pain, iris hyperpigmentation (may be delayed), lacrimation, photophobia, superficial punctate keratitis, visual disturbance

<1%, postmarketing, and/or case reports: Acute bronchospastic disease, bacterial keratitis (caused by inadvertent contamination of multiple-dose ophthalmic solutions), blurred vision, cystoid macular edema, deepening of the eyelid sulcus, dizziness, dyspnea, eyelid edema, hypertension, iritis, local dryness, local hypersensitivity reaction, macular edema, madarosis of eyebrow, nausea, skin rash (including macular and erythematous), trichorrhexis, uveitis

Warnings/Precautions

Concerns related to adverse effects:

  • Bacterial keratitis: Inadvertent contamination of multiple-dose ophthalmic solutions, has caused bacterial keratitis.
  • Ocular effects: May permanently change/increase brown pigmentation of the iris, the eyelid skin, periorbital tissue, and eyelashes. In addition, may increase the length, thickness, and/or number of eyelashes (may vary between eyes); changes occur slowly and may not be noticeable for months or years. Pigmentation of the iris is likely to be permanent, while pigmentation of the periorbital tissue and eyelash changes may be reversible following discontinuation of therapy. Long-term consequences of increased pigmentation are not known.
  • Ocular inflammation: Intraocular inflammation and exacerbation of inflammation may occur; use with caution in patients with active intraocular inflammation (eg, uveitis).

Disease-related concerns:

  • Ocular disease: Use with caution in aphakic patients, pseudophakic patients with a torn posterior lens capsule, or patients with risk factors for macular edema. Safety and efficacy of Lumigan have not been determined for use in patients with angle-closure-, inflammatory-, or neovascular glaucoma.

Special populations:

  • Contact lens wearers: Contains benzalkonium chloride which may be adsorbed and cause discoloration of soft contact lenses; remove contacts prior to administration and wait 15 minutes before reinserting.

Dosage form specific issues:

  • Latisse: Patients receiving medications to reduce intraocular pressure should consult their healthcare provider prior to using; may interfere with desired reduction of intraocular pressure. Unintentional hair growth may occur on skin that has repeated contact with solution; apply to upper eyelid only, blot away excess.

Monitoring Parameters

Monitor IOP

Pregnancy

Pregnancy Considerations

According to the manufacturer, an increased risk of major birth defects or miscarriages has not been observed following use of bimatoprost in pregnant women. If ophthalmic agents are needed during pregnancy, the minimum effective dose should be used in combination with punctal occlusion to decrease potential exposure to the fetus (Samples 1988).

Patient Education

What is this drug used for?

  • It is used to treat glaucoma.
  • It is used to lower high eye pressure.
  • It is used to help eyelashes grow. It may take 2 months to see the full effect.

Frequently reported side effects of this drug

  • Eyelid changes or eyelash changes

Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:

  • Vision changes
  • Eye pain
  • Severe eye irritation
  • Sensitivity to light
  • Eye discharge
  • Eye discoloration
  • Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Source: Wolters Kluwer Health. Last updated December 21, 2019.