Rhopressa (netarsudil ophthalmic) dosing, indications, interactions, adverse effects, and more

Sections

Sections netarsudil ophthalmic
Dosing & Uses
Adverse Effects
Warnings
Pregnancy
Pharmacology
Administration
Images
Patient Handout
Formulary

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

ophthalmic solution

0.02% (0.2mg/mL)

Elevated Intraocular Pressure

Indicated for the reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension

Instill 1 drop in the affected eye(s) qDay in the evening

Also see Administration

Dosing Considerations

Contains benzalkonium chloride, which may be absorbed by soft contact lenses; remove contact lenses prior to instilling ophthalmic solution into eye(s); may reinsert contact lenses 15 minutes following its administration (see Warnings)

<18 years: Safety and efficacy not established

>10%

Hyperemia (53%)

~20%

Corneal verticillata
Instillation site pain
Conjunctival hemorrhage

1-10%

5-10%

Instillation site erythema
Corneal staining
Blurred vision
Increased lacrimation
Erythema of eyelid
Reduced visual acuity

Contraindications

None

Cautions

Bacterial keratitis associated with use of multiple-dose containers of topical ophthalmic products; containers had been inadvertently contaminated by patients who had a concurrent corneal disease or a disruption of the ocular epithelial surface

Remove contact lenses prior to instilling ophthalmic solution; may reinsert lenses 15 minutes following administration

Instruct patients to avoid allowing tip of dispensing container to contact the eye, surrounding structures, fingers, or any other surface in order to minimize contamination of the solution; serious damage to the eye and subsequent loss of vision may result from using contaminated solutions

Advise patients that if they develop an intercurrent ocular condition (eg, trauma or infection), have ocular surgery, or develop any ocular reactions, particularly conjunctivitis and eyelid reactions, they should immediately seek their physician’s advice concerning continued use of this drug

Pregnancy

Data are not available on use in pregnant women to inform of any drug associated risk; however, systemic exposure to netarsudil from ocular administration is low

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 on the presence 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 unknown whether measurable levels of netarsudil would be present in maternal milk following topical ocular administration

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

Mechanism of Action

Dual inhibitor of Rho kinase and the norepinephrine plasma membrane transport protein

Increases trabecular outflow

Absorption

Plasma concentration, after 8 days: 0.11 ng/mL (active metabolite)

Metabolism

Metabolized by esterases in the eye

Ocular Administration

Instill 1 drop in the affected eye(s) qDay in the evening

Missed dose

One missed dose: Continue with the next dose in the evening; twice a day dosing is not well tolerated and is not recommended
Concomitant use with other topical ophthalmic drug products to lower IOP: Administer each drug product >5 minutes apart

Storage

Unopened bottle: Store at 2-8°C (36-46°F) until opened

Open bottle: Store at 2-25°C (36-77°F) for up to 6 weeks

During shipment, bottle may be maintained at temperatures up to 40°C (104°F) for a period not exceeding 14 days

BRAND	FORM.	UNIT PRICE	PILL IMAGE
Rhopressa ophthalmic (eye) -	0.02 % drops

Patient Handout

A Patient Handout is not currently available for this monograph.

Formulary

FormularyPatient Discounts

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The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

View explanations for tiers and restrictions

Tier	Description
1	This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2	This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC	NOT COVERED – Drugs that are not covered by the plan.

Code	Definition
PA	Prior Authorization Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL	Quantity Limits Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST	Step Therapy Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR	Other Restrictions Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.

Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.

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