latanoprost/netarsudil ophthalmic (Rx)

Brand and Other Names:Rocklatan
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Dosing & Uses

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Dosage Forms & Strengths

netarsudil/latanoprost

ophthalmic solution

  • 0.02%/0.005% (0.2mg/mL and 0.05mg/mL)
  • Bottle: 2.5-mL fill in 4-mL container

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

Dosing Considerations

May be used concomitantly with other topical ophthalmic drug products to lower IOP

If other topical ophthalmics are used, administer drops at least 5 minutes apart

Safety and efficacy not established

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Interactions

Interaction Checker

and latanoprost/netarsudil ophthalmic

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     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (0)

              Serious - Use Alternative (4)

              • bimatoprost

                latanoprost, bimatoprost. unspecified interaction mechanism. Avoid or Use Alternate Drug. Combined use of 2 or more ophthalmic prostaglandins may decrease the IOP lowering effect or cause paradoxical elevations in IOP.

              • latanoprostene bunod ophthalmic

                latanoprost, latanoprostene bunod ophthalmic. unspecified interaction mechanism. Avoid or Use Alternate Drug. Combined use of 2 or more ophthalmic prostaglandins may decrease the IOP lowering effect or cause paradoxical elevations in IOP.

              • tafluprost

                latanoprost, tafluprost. unspecified interaction mechanism. Avoid or Use Alternate Drug. Combined use of 2 or more ophthalmic prostaglandins may decrease the IOP lowering effect or cause paradoxical elevations in IOP.

              • travoprost ophthalmic

                latanoprost, travoprost ophthalmic. unspecified interaction mechanism. Avoid or Use Alternate Drug. Combined use of 2 or more ophthalmic prostaglandins may decrease the IOP lowering effect or cause paradoxical elevations in IOP.

              Monitor Closely (31)

              • aspirin

                latanoprost, aspirin. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • aspirin rectal

                latanoprost, aspirin rectal. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • bromfenac ophthalmic

                latanoprost, bromfenac ophthalmic. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • celecoxib

                latanoprost, celecoxib. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • choline magnesium trisalicylate

                latanoprost, choline magnesium trisalicylate. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • diclofenac

                latanoprost, diclofenac. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • diclofenac ophthalmic

                latanoprost, diclofenac ophthalmic. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • diflunisal

                latanoprost, diflunisal. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • etodolac

                latanoprost, etodolac. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • fenoprofen

                latanoprost, fenoprofen. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • flurbiprofen

                latanoprost, flurbiprofen. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • flurbiprofen ophthalmic

                latanoprost, flurbiprofen ophthalmic. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • ibuprofen

                latanoprost, ibuprofen. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • ibuprofen IV

                latanoprost, ibuprofen IV. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • ibuprofen/famotidine

                latanoprost, ibuprofen/famotidine. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • indomethacin

                latanoprost, indomethacin. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • ketoprofen

                latanoprost, ketoprofen. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • ketorolac

                latanoprost, ketorolac. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • ketorolac intranasal

                latanoprost, ketorolac intranasal. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • ketorolac ophthalmic

                latanoprost, ketorolac ophthalmic. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • meclofenamate

                latanoprost, meclofenamate. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • mefenamic acid

                latanoprost, mefenamic acid. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • meloxicam

                latanoprost, meloxicam. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • nabumetone

                latanoprost, nabumetone. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • naproxen

                latanoprost, naproxen. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • nepafenac ophthalmic

                latanoprost, nepafenac ophthalmic. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • oxaprozin

                latanoprost, oxaprozin. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • piroxicam

                latanoprost, piroxicam. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • salsalate

                latanoprost, salsalate. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • sulindac

                latanoprost, sulindac. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              • tolmetin

                latanoprost, tolmetin. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).

              Minor (0)

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                Adverse Effects

                >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%)

                Frequency Not Defined (Netarsudil)

                Instillation site erythema

                Corneal staining

                Increased lacrimation

                Eyelid erythema

                Frequency Not Defined (Latanoprost)

                Foreign body sensation

                Punctate keratitis

                Burning and stinging

                Itching

                Increased iris pigmentation

                Excessive tearing

                Eyelid discomfort

                Dry eye

                Eye pain

                Eyelid margin crusting

                Eyelid erythema/edema

                Upper respiratory tract infection/nasopharyngitis/influenza

                Photophobia

                Myalgia/arthralgia/back pain

                Rash/allergic reactions

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                Warnings

                Contraindications

                None

                Cautions

                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

                Remove contact lenses before administration

                Drug interaction overview

                • 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
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                Pregnancy

                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

                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.

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                Pharmacology

                Mechanism 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

                Absorption

                Netarsudil and active metabolite: Little to no quantifiable plasma concentrations measured during 8 days of daily use

                Distribution

                Latanoprost: 0.16 L/kg

                Metabolism

                Netarsudil: Metabolized by esterases in the eye to an active metabolite, AR-13503

                Latanoprost: Hydrolyzed by esterases in the cornea to the biologically active acid; active acid that reaches systemic circulation is primarily metabolized by the liver to the 1,2-dinor and 1,2,3,4-tetranor metabolites via fatty acid beta-oxidation

                Elimination

                Latanoprost

                • Half-life: 17 minutes
                • Clearance: 7 mL/min/kg
                • Excretion: Urine 88%
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                Administration

                Ophthalmic 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

                Missed dose: If dose is missed, continue treatment with the next dose in the evening; do not exceed 1 dose/day

                Storage

                Protect from light

                Store at 2-8°C (36-46°F)

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

                After opening, bottle can be used until expiration date

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                Images

                No images available for this drug.
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                Patient Handout

                A Patient Handout is not currently available for this monograph.
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                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.

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