Rocklatan (netarsudil mesylate/latanoprost)

For the treatment of open-angle glaucoma or ocular hypertension, the usual adult dosage of latanoprost is 1 drop of a 0.005% ophthalmic solution or emulsion (1.5 mcg) in the affected eye(s) once daily in the evening.

If the target intraocular pressure (IOP) is not achieved, alternative or additional ocular hypotensive agents may be required. (See Uses: Ocular Hypertension and Glaucoma.) However, concomitant use of 2 or more prostaglandin analogs is not recommended. When latanoprost is used in fixed combination with netarsudil, the usual adult dosage is 1 drop of an ophthalmic solution containing netarsudil 0.02% and latanoprost 0.005% in the affected eye(s) once daily in the evening.

Patients should be instructed that topical ophthalmic preparations containing latanoprost should be applied no more frequently than once daily since more frequent dosing may reduce the IOP-lowering effect of the drug or cause paradoxical elevation of IOP. If the patient misses a dose, the usual schedule should be continued with the next dose applied the following evening.

Latanoprost is applied topically to the eye as an ophthalmic solution or emulsion. Latanoprost also is commercially available in fixed combination with netarsudil for topical application to the eye as an ophthalmic solution. Care should be taken to avoid contamination of the dispensing container. (See Cautions: Precautions and Contraindications.)

Latanoprost ophthalmic solution and netarsudil and latanoprost fixed-combination ophthalmic solution contain benzalkonium chloride, which may be absorbed by some contact lenses. The manufacturers of latanoprost ophthalmic solution or emulsion and netarsudil and latanoprost fixed-combination ophthalmic solution state that contact lenses should be removed prior to administration of each dose of these preparations but may be reinserted 15 minutes after the dose.

If the patient is receiving more than one topical ophthalmic preparation, the preparations should be administered at least 5 minutes apart.

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There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

Moderate Interaction: Assess the risk to the patient and take action as needed.

Iop-Lowering Prostaglandin Analogs/Bimatoprost Topical

SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.

MECHANISM OF ACTION: When used ophthalmically to lower intraocular pressure, prostaglandin analogs may be at the top of the dose-response curve. Use of an additional prostaglandin may result in decreased effectiveness.(1)

CLINICAL EFFECTS: Concurrent use of topical bimatoprost may result in decreased effectiveness of ophthalmic prostaglandin analogs and an increase in intraocular pressure.(1)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Patients using ophthalmic prostaglandin analogs to lower intraocular pressure should be monitored for changes in their intraocular pressure.(1) Use of topical bimatoprost may need to be discontinued in patients who stop responding to their ophthalmic prostaglandin analogue.

DISCUSSION: Studies have shown that the ophthalmic administration of bimatoprost twice daily is less effective at lowering intraocular pressure than ophthalmic bimatoprost administered once daily. Concurrent use of topical bimatoprost may decrease the effectiveness of ophthalmic prostaglandin analogs.(1)

Latanoprost/Thimerosal

SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.

MECHANISM OF ACTION: Latanoprost is physically incompatible with thimerosal.

CLINICAL EFFECTS: The simultaneous application of these products may result in a precipitate forming in the eye.(1)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Patients should be instructed to separate the administration of latanoprost eye drops and other eye drops that contain thimerosal by at least 5 minutes.(1)

DISCUSSION: In vitro studies have shown that precipitation occurs when eye drops containing thimerosal are mixed with latanoprost eye drops.(1)

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There are no contraindication contraindications for this drug.

• Herpes simplex keratitis
• Iritis
• Maculopathy
• Ocular inflammation
• Uveitis

• Aphakia
• Conjunctivitis
• Corneal edema
• Cystoid macular edema
• Macular retinal edema
• Pseudophakia
• Surgical procedure on eye proper

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More Frequent

• Macular retinal edema
• Punctate epithelial keratopathy

Less Frequent

• Angina
• Chest pain
• Corneal edema

Rare or Very Rare

• Asthma
• Asthma exacerbation
• Bacterial keratitis
• Calcification of cornea
• Corneal erosion
• Cystoid macular edema
• Dyspnea
• Endophthalmitis
• Herpes simplex keratitis
• Influenza
• Retinal detachment
• Retinal thrombosis
• Toxic epidermal necrolysis

More Frequent

• Blurred vision
• Conjunctival hemorrhage
• Conjunctival hyperemia
• Conjunctival hyperemia
• Corneal verticillata
• Eye tearing
• Foreign body sensation of eye
• Iris hyperpigmentation
• Ocular irritation
• Ocular itching
• Ocular pain
• Ocular redness
• Upper respiratory infection

Less Frequent

• Arthralgia
• Back pain
• Blurred vision
• Corneal staining
• Deepening of upper eyelid sulcus
• Dry eye
• Eye tearing
• Eyelid crusting
• Eyelid edema
• Eyelid erythema
• Flu-like symptoms
• Myalgia
• Ocular pain
• Photophobia
• Reduced visual acuity
• Skin pigmentation enhancement
• Skin rash

Rare or Very Rare

• Conjunctivitis
• Diplopia
• Dizziness
• Headache disorder
• Hypertrichosis of eyelid eyelashes
• Keratoconjunctivitis
• Nausea
• Ocular discharge
• Palpitations
• Periorbital edema
• Pharyngitis
• Pruritus of skin
• Vomiting

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Latanoprost has been embryocidal in rabbits when given in dosages greater than 15 times the maximum human dose. In rabbits given latanoprost dosages 80 times the maximum human dose, approximately 25% of dams had no viable fetuses.

There are no adequate and well-controlled studies to date evaluating latanoprost in pregnant women, and the drug should be used during pregnancy only when the potential benefits justify the possible risks to the fetus.

It is not known whether latanoprost or its metabolites are distributed into milk following topical application to the eye or whether the drug has any effects on the breast-fed infant or on milk production.

Latanoprost ophthalmic solution or emulsion should be used with caution in nursing women.

The manufacturer of netarsudil and latanoprost fixed-combination ophthalmic solution states that the developmental and health benefits of breast-feeding should be considered along with the mother's clinical need for the drugs and any potential adverse effects of the drugs on the breast-fed infant.

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