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Travoprost

Generic name: travoprost ophthalmic

Brand names: Travatan, Travatan Z, Izba

Dosage Forms

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

Solution, Ophthalmic:

Travatan Z: 0.004% (2.5 mL, 5 mL) [benzalkonium free; contains cremophor el, propylene glycol]

Generic: 0.004% (2.5 mL, 5 mL)

Pharmacology

Mechanism of Action

A selective FP prostanoid receptor agonist which lowers intraocular pressure by increasing trabecular meshwork and outflow

Pharmacokinetics/Pharmacodynamics

Absorption

Absorbed via cornea; plasma levels <10 pg/mL within 1 hour

Metabolism

Hydrolyzed by esterases in the cornea to active free acid; systemically; the free acid is metabolized to inactive metabolites

Onset of Action

~2 hours; Peak effect: 12 hours

Half-Life Elimination

45 minutes (range:17 to 86 minutes)

Use in Specific Populations

Special Populations: Race

The IOP-lowering effect was shown to be 7 to 8 mm Hg in clinical studies. The mean IOP reduction in African-American patients was up to 1.8 mm Hg greater than in non-African-American patients. The reason for this effect is unknown.

Use: Labeled Indications

Elevated intraocular pressure: Reduction of elevated intraocular pressure in patients ≥16 years with open-angle glaucoma or ocular hypertension

Contraindications

There are no contraindications listed in the manufacturer’s labeling.

Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to travoprost or any component of the formulation; pregnancy or women attempting to become pregnant

Dosage and Administration

Dosing: Adult

Elevated intraocular pressure: Ophthalmic: Instill 1 drop into affected eye(s) once daily in the evening; do not exceed once-daily dosing (may decrease IOP-lowering effect).

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Elevated intraocular pressure: Ophthalmic: Children and Adolescents: Limited data available: 1 drop into affected eye(s) once daily in the evening (Yanovich, 2008). Note: Do not exceed once-daily dosing (may decrease IOP-lowering effect).

Administration

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 (after administration) before reinserting. Minimize contamination by not touching the eyelids or surrounding areas with the dropper tip; keep bottle tightly closed when not in use.

Storage

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

Drug Interactions

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

>10%: Ophthalmic: Ocular hyperemia (30% to 50%)

1% to 10%:

Cardiovascular: Angina pectoris (1% to 5%), bradycardia (1% to 5%), chest pain (1% to 5%), hypertension (1% to 5%), hypotension (1% to 5%)

Central nervous system: Foreign body sensation of eye (5% to 10%), anxiety (1% to 5%), depression (1% to 5%), headache (1% to 5%), pain (1% to 5%)

Dermatologic: Hyperpigmentation of eyelashes, increased growth in number of eyelashes

Endocrine & metabolic: Hypercholesterolemia (1% to 5%)

Gastrointestinal: Dyspepsia (1% to 5%), gastrointestinal distress (1% to 5%)

Genitourinary: Prostatic disease (1% to 5%), urinary incontinence (1% to 5%), urinary tract infection (1% to 5%)

Hypersensitivity: Hypersensitivity reaction (1% to 5%)

Infection: Infection (1% to 5%)

Neuromuscular & skeletal: Arthritis (1% to 5%), back pain (1% to 5%)

Ophthalmic: Decreased visual acuity (5% to 10%), eye discomfort (5% to 10%), eye pain (5% to 10%), eye pruritus (5% to 10%), blepharitis (1% to 4%), blurred vision (1% to 4%), cataract (1% to 4%), conjunctivitis (1% to 4%), corneal staining (1% to 4%), crusting of eyelid (1% to 4%), dry eye syndrome (1% to 4%), hyperpigmentation of eyelids (periorbital; 1% to 4%), iris discoloration (1% to 4%), keratitis (1% to 4%), lacrimation (1% to 4%), ophthalmic inflammation (1% to 4%), photophobia (1% to 4%), subconjunctival hemorrhage (1% to 4%), visual disturbance (1% to 4%), increased eyelash length, increased eyelash thickness

Respiratory: Bronchitis (1% to 5%), flu-like symptoms (1% to 5%), sinusitis (1% to 5%)

<1%, postmarketing, and/or case reports: Abdominal pain, arthralgia, asthma, bacterial keratitis (due to solution contamination), cardiac arrhythmia, chest discomfort, corneal edema, cystoid macular edema, diarrhea, dyspnea, dysuria, enophthalmos, epistaxis, erythema of skin, insomnia, iritis, macular edema, musculoskeletal pain, nausea, prostate specific antigen increase, pruritus, tachycardia, tinnitus, uveitis, vomiting

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, 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. Long-term consequences and potential injury to eye are not known.

Disease-related concerns:

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

Special populations:

  • Contact lens wearers: Remove contact lens prior to instillation; may reinsert 15 minutes following administration.
  • Pediatric: Use in pediatric patients (<16 years of age) is not recommended due to possible safety issues of increased pigmentation following long-term chronic use.

Pregnancy

Pregnancy Risk Factor

C

Pregnancy Considerations

Adverse events have been observed in animal reproduction studies following systemic administration. 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.

Frequently reported side effects of this drug

  • Itching
  • Foreign body sensation of eye
  • 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
  • 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 January 24, 2020.