Note: Multiple dosage forms exist (ie, topical solution, ophthalmic solution, and ophthalmic insert [adult use only]) which are not interchangeable; use extra caution when prescribing and administering.
Elevated intraocular pressure: Ophthalmic solution 0.01% (eg, Lumigan): Adolescents ≥16 years: Ophthalmic: Instill 1 drop into the affected eye(s) once daily in the evening. Note: Do not exceed once-daily dosing; may reduce efficacy.
Hypotrichosis of the eyelashes: Topical solution 0.03% (eg, Latisse): Children ≥5 years and Adolescents: Topical: 1 drop applied evenly on the skin of the upper eyelid at base of eyelashes once daily at bedtime; repeat procedure for second eye (see "Administration: Pediatric"); pediatric patient experience is primarily in patients who are post-chemotherapy and those diagnosed with alopecia areata (Ref). Note: More frequent dosing has not been shown to increase eyelash growth. Upon discontinuation, eyelash growth rate is expected to return to baseline.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
(For additional information see "Bimatoprost: Drug information")
Elevated intraocular pressure:
Implant (Durysta): Intracameral: Insert 1 implant (10 mcg) in anterior chamber of affected eye. Limit to a single implant per eye; do not readminister to an eye that has received a prior implant.
Solution (Lumigan; Vistitan [Canadian product], Zimed PF [Canadian product]): Ophthalmic, topical: Instill 1 drop into affected eye(s) once daily in the evening; do not exceed once-daily dosing (may decrease IOP-lowering effect). If used with other topical ophthalmic agents, separate administration by at least 5 minutes.
Hypotrichosis of the eyelashes (Latisse): Ophthalmic, topical: Place one drop on applicator and apply evenly along the skin of the upper eyelid at base of eyelashes once daily at bedtime; repeat procedure for second eye (use a clean applicator). Note: Onset of effect is gradual but is not significant in the majority of patients until 2 months.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Reported adverse reactions are for adults.
Ophthalmic implant (Durysta):
>10%: Ophthalmic: Conjunctival hyperemia (27%)
1% to 10%:
Nervous system: Headache (5%)
Ophthalmic: Anterior chamber inflammation (including anterior chamber flare: 1% to 5%), blurred vision (5% to 10%), conjunctival hemorrhage (5% to 10%), corneal edema (1% to 5%), corneal erosion (endothelial cell loss: 5% to 10%), corneal sensitivity (1% to 5%), dry eye syndrome (5% to 10%), eye discharge (aqueous humor leakage: 1% to 5%), eye discomfort (1% to 5%), eye irritation (5% to 10%), eye pain (5% to 10%), foreign body sensation of eye (5% to 10%), increased intraocular pressure (5% to 10%), increased lacrimation (1% to 5%), iris hyperpigmentation (1% to 5%), iritis (5% to 10%), macular edema (1% to 5%), photophobia (5% to 10%), synechiae of iris (1% to 5%)
<1%:
Local: Local hypersensitivity reaction
Ophthalmic: Anterior chamber eye hemorrhage (hyphema), corneal decompensation, corneal opacity, cystoid macular edema, iridocyclitis, uveitis
Ophthalmic solution (Latisse, Lumigan 0.01%, Lumigan 0.03%): The following adverse drug reactions are reported for Lumigan ophthalmic solutions, unless otherwise indicated.
>10%: Ophthalmic: Conjunctival hyperemia (Latisse: <4%; Lumigan: ≤45%), eye pruritus (Latisse, Lumigan 0.01%: ≤4%; Lumigan 0.03%: 15% to 45%), hypertrichosis of eyelid (Lumigan 0.01%: 1% to 4%; Lumigan 0.03%: 15% to 45%)
1% to 10%:
Dermatologic: Erythema of eyelid (1% to 4%), erythema of skin (Latisse, Lumigan [including periorbital]), hypertrichosis (1% to 4%)
Endocrine & metabolic: Hirsutism (Latisse; Lumigan: 1% to 5%)
Hepatic: Abnormal hepatic function tests (1% to 5%)
Local: Local skin hyperpigmentation (Latisse, Lumigan [including periocular])
Nervous system: Asthenia (1% to 5%), headache (1% to 5%)
Ophthalmic: Allergic conjunctivitis (1% to 3%), asthenopia (1% to 3%), blepharitis (3% to 10%), blurred vision (1% to 4%), burning sensation of eyes (3% to 10%), cataract (3% to 10%), conjunctival edema (1% to 4%), conjunctival hemorrhage (1% to 4%), decreased visual acuity (1% to 4%), dry eye syndrome (Latisse, Lumigan), eye discharge (1% to 3%), eye irritation (Latisse, Lumigan), eye pain, eyelid pruritus (1% to 4%), foreign body sensation of eye (Latisse; Lumigan: 3% to 10%), hyperpigmentation of eyelashes (3% to 10%), iris hyperpigmentation (Latisse; Lumigan: 1% to 3%), lacrimation (1% to 3%), photophobia (1% to 3%), punctate keratitis (1% to 4%), superficial punctate keratitis (3% to 10%), visual disturbance (3% to 10%)
<1%: Ophthalmic: Iritis
Frequency not defined (any formulation): Ophthalmic: Hypotony of eye
Postmarketing (any formulation):
Cardiovascular: Hypertension
Dermatologic: Allergic dermatitis, erythematous rash, macular eruption, skin discoloration (including periorbital and non-periorbital), skin tightness (periorbital), trichorrhexis, xeroderma (eyelid)
Gastrointestinal: Nausea
Hypersensitivity: Hypersensitivity reaction
Local: Local dryness of skin (periocular), local hypersensitivity reaction, local skin exfoliation (periorbital)
Nervous system: Dizziness
Ophthalmic: Abnormal eyelash growth (madarosis), blepharoptosis, deepening of the eyelid sulcus, enophthalmos, eyelid edema, eyelid entropion, eyelid retraction, hordeolum, hyperpigmentation of eyelid, increased lacrimation, intraocular inflammation, macular edema (including cystoid macular edema), misdirected growth of eyelashes, ocular allergy, ocular edema, periorbital swelling, scaling of eyelid
Respiratory: Dyspnea, pulmonary signs and symptoms (asthma-like)
Hypersensitivity to bimatoprost or any component of the formulation.
Additional product-specific contraindications: Implant (Durysta): Active or suspected ocular or periocular infection; corneal endothelial cell dystrophy (eg, Fuchs dystrophy); prior corneal transplantation or endothelial cell transplant (eg, Descemet stripping automated endothelial keratoplasty); absent or ruptured posterior lens capsule (Note: Laser posterior capsulotomy in pseudophakic patients is not a contraindication if the intraocular lens fully covers the opening in the posterior capsule).
Concerns related to adverse effects:
• Bacterial keratitis: Inadvertent contamination of multiple-dose ophthalmic solutions has caused bacterial keratitis.
• Corneal effects: Intracameral implant may cause corneal adverse effects and increased risk of corneal endothelial cell loss; use with caution in patients with limited corneal endothelial cell reserve. Limit administration to a single implant per eye without retreatment.
• Endophthalmitis: Intraocular surgical procedures and injections are associated with endophthalmitis. Use proper aseptic injection technique and monitor patients appropriately.
• Macular edema: Macular edema, including cystoid macular edema, has been reported; use with caution in aphakic patients, pseudophakic patients with a torn posterior lens capsule, or patients with risk factors for macular edema.
• Ocular effects: May permanently change/increase brown pigmentation of the iris, the eyelid skin, periorbital tissue, and eyelashes; area(s) affected may vary based on bimatoprost formulation used. 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. Pigmentation of the iris is likely to be permanent, while pigmentation of the periorbital tissue and eyelash changes may be reversible following discontinuation of therapy. Long-term consequences of increased pigmentation are not known; some products not recommended in pediatric patients; refer to product-specific labeling.
• Ocular inflammation: Intraocular inflammation and exacerbation of inflammation may occur; use with caution in patients with active intraocular inflammation (eg, uveitis).
Disease-related concerns:
• Iridocorneal angle: Use intracameral implant with caution in patients with narrow iridocorneal angles (Shaffer grade <3) or anatomical obstruction (eg, scarring) that may prohibit the implant from settling in the inferior angle.
Special populations:
• Contact lens wearers: Topical solution formulations contain benzalkonium chloride which may be adsorbed and cause discoloration of soft contact lenses; remove contacts prior to administration and wait 15 minutes before reinserting.
Dosage form specific issues:
• Latisse: Patients receiving medications to reduce intraocular pressure should consult their healthcare provider prior to using; may interfere with desired reduction of intraocular pressure. Unintentional hair growth may occur on skin that has repeated contact with solution; apply to upper eyelid only, blot away excess.
• Lumigan: Safety and efficacy have not been determined for use in patients with angle-closure, inflammatory, or neovascular glaucoma.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Implant, Intraocular:
Durysta: 10 mcg (1 ea) [contains polyethylene glycol (macrogol)]
Solution, External:
Latisse: 0.03% (3 mL, 5 mL) [contains benzalkonium chloride]
Generic: 0.03% (3 mL, 5 mL)
Solution, Ophthalmic:
Lumigan: 0.01% (2.5 mL, 5 mL, 7.5 mL) [contains benzalkonium chloride]
Generic: 0.03% (2.5 mL, 5 mL, 7.5 mL)
May be product dependent
Implant (Durysta Intraocular)
10 mcg (per each): $2,384.40
Solution (Bimatoprost External)
0.03% (per mL): $48.21 - $48.22
Solution (Bimatoprost Ophthalmic)
0.03% (per mL): $26.40 - $53.85
Solution (Latisse External)
0.03% (per mL): $51.43
Solution (Lumigan Ophthalmic)
0.01% (per mL): $120.62
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, External:
Latisse: 0.03% (1.5 mL, 3 mL, 5 mL) [contains benzalkonium chloride]
Solution, Ophthalmic:
Lumigan RC: 0.01% (3 mL, 5 mL, 7.5 mL) [contains benzalkonium chloride]
Vistitan: 0.03% (3 mL, 5 mL) [contains benzalkonium chloride]
Zimed PF: 0.03% (3 mL)
Ophthalmic: Solution: 0.01% (eg, Lumigan): Adolescents ≥16 years: May be used with other eye drops to lower intraocular pressure. If using more than one ophthalmic product, wait at least 5 minutes between application of each medication. Remove contact lenses prior to administration and wait 15 minutes before reinserting.
Topical: Solution: 0.03% (eg, Latisse): Children ≥5 years and Adolescents: Remove makeup and contact lenses prior to application; ensure face is clean. Place one drop on supplied sterile applicator and apply along the skin of the upper eyelid margin at the base of the eyelashes; do not use other brushes or applicators. Repeat process for second eye. Use a tissue or cloth to blot any excess solution on the outside of the upper eyelid margin; do not apply to lower eyelash line. Do not reuse applicators; use new applicator for second eye. May reinsert contacts 15 minutes after application.
Intracameral (Durysta): Insert implant under aseptic conditions. Use immediately after foil pouch is opened. Affected eye should not be dilated prior to procedure. Patient should remain upright for ≥1 hour after procedure. Refer to manufacturer's labeling for detailed administration instructions.
Ophthalmic, topical:
Latisse: Remove make-up and contact lenses prior to application; ensure face is clean. Apply with the sterile applicator provided only; do not use other brushes or applicators. Use a tissue or cloth to blot any excess solution on the outside of the upper eyelid margin; do not apply to lower eyelash line. Do not reuse applicators; use new applicator for second eye. Applying more than once nightly will not increase eyelash growth; eyelash growth is expected to return to baseline when therapy is discontinued. May reinsert contacts 15 minutes after application.
Lumigan; Vistitan [Canadian product], Zimed PF [Canadian product]: 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 before reinserting.
Implant: Store at 2°C to 8°C (36°F to 46°F).
Solution:
Lumigan; Vistitan [Canadian product]: Store at 2°C to 25°C (36°F to 77°F).
Zimed PF [Canadian product]: Store in original container at 15°C to 25°C (59°F to 77°F); do not freeze. Discard any amount not used within 28 days of opening.
Ophthalmic: Reduction of intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension (Solution: Lumigan: FDA approved in ages ≥16 years and adults; implant: Durysta: FDA approved in adults).
Topical: Treatment of hypotrichosis of the eyelashes (Latisse: FDA approved in pediatric patients [age not specified] and adults).
Lumigan may be confused with lumasiran.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Latanoprost: The concomitant use of Prostaglandins (Ophthalmic) and Latanoprost may result in increased intraocular pressure. Risk X: Avoid combination
Latanoprostene Bunod: The concomitant use of Bimatoprost and Latanoprostene Bunod may result in increased intraocular pressure. Risk C: Monitor therapy
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). Risk C: 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). Risk C: Monitor therapy
Ophthalmic prostaglandins, such as bimatoprost, have a theoretical risk of miscarriage. To decrease this risk, agents other than bimatoprost may be preferred for the treatment of glaucoma in patients planning to become pregnant (Strelow 2020).
According to the manufacturer, an increased risk of major birth defects or miscarriages has not been observed following use of bimatoprost ophthalmic drops in pregnant patients. However, ophthalmic prostaglandins, such as bimatoprost, are generally avoided during pregnancy due to a theoretical risk of miscarriage and premature labor. Agents other than bimatoprost may be preferred for the treatment of glaucoma during pregnancy, especially during the first trimester. In general, if ophthalmic agents are needed in pregnancy, the minimum effective dose should be used in combination with punctal occlusion to decrease exposure to the fetus (Belkin 2020; Prum 2016; Strelow 2020).
Intraocular pressure, ocular pigmentation changes.
As a synthetic analog of prostaglandin with ocular hypotensive activity, bimatoprost decreases intraocular pressure by increasing the outflow of aqueous humor. Bimatoprost may increase the percent and duration of hairs in the growth phase, resulting in eyelash growth.
Ophthalmic solution:
Note: Pharmacokinetic data based on topical solution formulation (unless otherwise noted).
Onset of action: Reduction of IOP: ~4 hours.
Peak effect: Maximum reduction of IOP: ~8 to 12 hours.
Distribution: Vd: 0.67 L/kg.
Protein binding: ~88%.
Metabolism: Undergoes oxidation, N-deethylation, and glucuronidation after reaching systemic circulation; forms metabolites.
Half-life elimination: IV: ~45 minutes.
Time to peak: ≤10 minutes.
Excretion: Urine (≤67%); feces (25%).
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