Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
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)
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
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
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.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%
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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Formulary
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