Drug Guide
Latanoprost; Netarsudil Dimesylate
Classification
Therapeutic: Glaucoma and Ocular Hypertension Agent
Pharmacological: Prostaglandin Analogue and Rho Kinase Inhibitor combination
FDA Approved Indications
- Reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension
Mechanism of Action
Latanoprost is a prostaglandin F2α analogue that increases uveoscleral outflow of aqueous humor. Netarsudil inhibits Rho kinase, leading to increased outflow through the trabecular meshwork and decreased aqueous humor production, contributing to lowered intraocular pressure.
Dosage and Administration
Adult: One drop in the affected eye(s) once daily in the evening.
Pediatric: Safety and effectiveness in pediatric patients have not been established.
Geriatric: Use with caution due to possible increased susceptibility to side effects.
Renal Impairment: No specific adjustments required.
Hepatic Impairment: No specific adjustments required.
Pharmacokinetics
Absorption: Bioavailability of topical ocular medications is variable but generally limited to ocular tissue.
Distribution: Distributed primarily within ocular tissues.
Metabolism: Latanoprost is hydrolyzed by esterases; netarsudil is metabolized via hepatic pathways.
Excretion: Metabolites are eliminated primarily through the hepatobiliary route.
Half Life: Latanoprost: approximately 17 minutes in plasma; Netarsudil: approximately 16 hours.
Contraindications
- Hypersensitivity to any component of the formulation.
Precautions
- Use with caution in patients with active inflammation of the eye, history of herpes keratitis, or certain retinal conditions.
Adverse Reactions - Common
- Eye redness (Common)
- Eye discomfort or irritation (Common)
- Eyelash growth (Common)
Adverse Reactions - Serious
- Uveitis or intraocular inflammation (Rare)
- Corneal edema (Rare)
- Pigmentation changes of the iris or eyelid (Less common)
Drug-Drug Interactions
- Other ocular medications that may increase intraocular pressure or cause ocular irritation.
Drug-Food Interactions
- No significant interactions reported.
Drug-Herb Interactions
- No well-documented interactions.
Nursing Implications
Assessment: Monitor intraocular pressure (IOP) periodically. Assess for ocular inflammation or irritation.
Diagnoses:
- Risk for ocular irritation or injury.
- Risk for increased IOP if medication discontinued or improperly used.
Implementation: Instruct patient on proper administration technique. Adhere to dosing schedule. Assess for side effects.
Evaluation: Evaluate reduction in IOP and monitor for adverse reactions.
Patient/Family Teaching
- Use drops exactly as prescribed. Do not touch the dropper tip to the eye.
- Wash hands before and after application.
- Report any eye pain, redness, or vision changes.
- Use regularly to maintain IOP control.
- Inform that some eye discoloration may occur temporarily.
Special Considerations
Black Box Warnings:
- None
Genetic Factors: None identified.
Lab Test Interference: No significant effect on laboratory tests.
Overdose Management
Signs/Symptoms: Excessive ocular exposure may cause ocular irritation, redness, or systemic effects if small amounts are ingested or contacted.
Treatment: Remove excess medication from the eye with clean water. Seek medical attention for severe reactions or ingestion.
Storage and Handling
Storage: Store at room temperature, 15-25°C (59-77°F). Keep container tightly closed.
Stability: Stable under normal conditions for the duration of the labeled shelf life.