Latanoprost

Registered South African indications:

• Reduction of elevated intraocular pressure
  - In patients with open angle glaucoma, chronic angle closure glaucoma and ocular hypertension

Registered South African contraindications

• Hypersensitivity to latanoprost, benzalkonium chloride or to any of the excipients 
• Pregnancy
• Lactation

Contraindications registered in other jurisdictions

• Hypersensitivity to the active ingredients or any of its excipients

• Pregnancy (Recommendations in other jurisdictions)
• Breastfeeding (Recommendations in other jurisdictions)
• Chronic closed angle glaucoma
• Open angle glaucoma in pseudophakic patients
• Pigmentary glaucoma
• Inflammatory glaucoma
• Neovascular glaucoma
• Inflammatory ocular conditions
• Risk factors for iritis/uveitis
• Peri-operative period of cataract surgery
• History of, or active herpes simplex keratitis
• Aphakic patients
• Pseudophakic patients with torn posterior lens capsule or anterior chamber lenses 
• Risk factors for cystoid macular oedema
• Asthma
• Dry eye conditions
• Compromised cornea
• Children
• Concomitant use of contact lenses

Forms avail. in SA and covered in this monograph: opd

South African registered indications and dosages

Reduction of elevated intraocular pressure
- In patients with open angle glaucoma, chronic angle closure glaucoma and ocular hypertension

• Ophthalmic (opd): 1 drop into affected eye(s), once daily; Max: 1 drop/eye/24hrs

Optimal effect obtained if administered in the evening

The dosage of latanoprost should not exceed once daily since it has been shown that more frequent administration decreases the intra-ocular pressure lowering effect. If one dose is missed, treatment should continue with the next dose as normal

Reduction of the intraocular pressure starts about 3-4 hours after administration and maximum effect is reached after 8-12 hours. Pressure reduction is maintained for at least 24 hours

Can be used concomitantly with other classes of topical ophthalmic medicines to lower intraocular pressure. If more than one topical ophthalmic medicine is being used, the medicines should be used at least 5 minutes apart. Remove contact lenses before instillation and reinsert after 15 minutes

Paed. forms avail. in SA and covered in this monograph: opd

South African registered indications and dosages

Reduction of elevated intraocular pressure
- In patients with open angle glaucoma, chronic angle closure glaucoma and ocular hypertension
(In children less than 3 years of age, latanoprost can be initiated prior to other corrective procedures and may be continued if therapeutic response is adequate)

Preterm infants and younger than 1 year

• Not established for use

Older than 1 year

• See adult dosage

Latanoprost may be used in paediatric patients at the same posology as in adults

No data are available for preterm infants (less than 36 weeks gestational age). Data in the age group < 1 year (4 patients) are limited

Pregnancy

South African recommendations

• Contraindicated
• The use of latanoprost in pregnancy is contraindicated. Latanoprost has potential hazardous pharmacological effects with respect to the course of pregnancy, to the unborn or the neonate, and should therefore not be used in pregnancy

Recommendations in other jurisdictions

• Caution; not recommended 
• The safety of latanoprost for use in human pregnancy has not been established. It has potential hazardous pharmacological effects with respect to the course of pregnancy, to the unborn or the neonate. Therefore, latanoprost should not be used during pregnancy 

Breastfeeding

South African recommendations

• Contraindicated
• The safety in lactation has not been established. Mothers treated with latanoprost should not breastfeed their infants

Recommendations in other jurisdictions

• Caution; not recommended
• Latanoprost and its metabolites may pass into breast milk and latanoprost should therefore not be used in breastfeeding women or breastfeeding should be stopped

Fertility

South African recommendations

• No information available

Recommendations in other jurisdictions

• Latanoprost has not been found to have any effect on male or female fertility in animal studies

• No dose adjustment recommended

• No dose adjustment recommended

• No dose adjustment recommended

Central Nervous System Disorders

• Headache
• Dizziness

Cardiovascular Disorders

• Chest pain
• Palpitations
• Unstable angina

Respiratory Disorders

• Asthma
• Dyspnoea
• Asthma exacerbation

Musculoskeletal Disorders

• Myalgia
• Arthralgia

Skin and Subcutaneous Tissue Disorders

• Rash
• Pruritus
• Localised skin reaction on the eyelids
• Darkening of the palpebral skin of the eyelids

Sensory Disorders

• Herpetic keratitis
• Iris hyperpigmentation
• Mild to moderate conjunctival hyperaemia
• Eye irritation
• Eyelash and vellus hair changes of the eyelid
• Punctate keratitis
• Blepharitis
• Eye pain
• Photophobia
• Conjunctivitis
• Dry eye
• Blurred vision
• Macular oedema
• Uveitis
• Iritis
• Corneal oedema
• Corneal erosion
• Periorbital oedema
• Trichiasis
• Distichiasis
• Iris cyst
• Pseudopemphigoid of ocular conjunctiva
• Periorbital and lid changes resulting in deepening of the eyelid sulcus

• Other ocular prostaglandins

None routine

Latanoprost is a prostaglandin F2-alpha analogue. It reduces intraocular pressure by increasing aqueous humour outflow through the trabecular meshwork and uveoscleral pathways.

Eye drops (per ml) 50μg

• Atana (Actor)
• Ocuprost (Arrow)
• Spersatan (Adcock)
• Xalatan (UpJohn) originator

COMBINATION PREPARATIONS

Timolol/ Latanoprost

Eye drops (per ml) 5mg/50μg

• Co-Atana (Actor)
• Xalacom (Pfizer) originator