bimatoprost
Lumigan

Available forms
Available by prescription only
Ophthalmic solution: 0.03%

Indications and dosages
 Reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension who are intolerant of or unresponsive to other IOP-lowering drugs. Adults: Instill 1 drop in the conjunctival sac of the affected eye or eyes once daily in the evening.

Pharmacodynamics
Ocular hypotensive activity: Bimatoprost is a prostamide, which is a synthetic analog of prostaglandin. It selectively mimics the effects of naturally occurring prostaglandins. Bimatoprost is believed to lower IOP by increasing the outflow of aqueous humor through the trabecular meshwork and uveoscleral routes.

Pharmacokinetics
Absorption: Absorbed through the cornea.
Distribution: Moderately distributed into tissues. Bimatoprost resides mainly in plasma, and about 12% remains unbound in plasma.
Metabolism: Bimatoprost is mainly metabolized by oxidation.
Excretion: Metabolites are 67% eliminated in urine; 25% are eliminated in feces.

Contraindications and precautions
Contraindicated in patients hypersensitive to bimatoprost, benzalkonium chloride, or other ingredients of this product. Use cautiously in patients with renal or hepatic impairment. Use cautiously in patients with active intraocular inflammation (iritis or uveitis), aphakic patients, pseudophakic patients with a torn posterior lens capsule, or patients at risk for macular edema.

Interactions
None significant.

Adverse reactions
CNS: headache, asthenia.
EENT: conjunctival hyperemia, growth of eyelashes, ocular pruritus, ocular dryness, visual disturbance, ocular burning, foreign body sensation, eye pain, pigmentation of the periocular skin, blepharitis, cataract, superficial punctate keratitis, eyelid erythema, ocular irritation, eyelash darkening, eye discharge, tearing, photophobia, allergic conjunctivitis, asthenopia, increased iris pigmentation, conjunctival edema.
Hepatic: liver impairment.
Respiratory: upper respiratory tract infection.
Skin: hirsutism.
Other: infection.

Effects on lab test results
• May cause abnormal liver function test values.

Overdose and treatment
No information available. Treatment should be symptomatic if overdose occurs.

Special considerations
• Don’t use drug in patients with angle-closure glaucoma, inflammatory glaucoma, or neovascular glaucoma.
• Temporary or permanent increase in pigmentation of the iris, eyelid, and eyelashes may occur, as well as growth of the eyelashes.
• Contact lenses should be removed before instilling drug and may be reinserted 15 minutes afterward.
• If more than one ophthalmic drug is being used, they should be given at least 5 minutes apart.
• Monitor patient for excessive ocular irritation, and evaluate the success of treatment.
• Store drug in original container between 59° and 77° F (15° to 25° C).
Breast-feeding patients
• It isn’t known if drug appears in breast milk. Use cautiously when administering drug to breast-feeding women.
Pediatric patients
• Safety and efficacy in children haven’t been established.
Geriatric patients
• No overall differences in safety or effectiveness have been observed between elderly and other adult patients.

Patient education
• Tell the patient receiving treatment in only one eye about the risk for increased brown pigmentation of the iris, darkening of the eyelid skin, and increased length, thickness, pigmentation, and number of lashes in the treated eye.
• Tell patient to remove contact lenses before instilling drops. Explain that they can be reinserted 15 minutes after administration.
• Teach patient to instill drops. Tell him to wash his hands before and after doing so. Warn him not to touch the dropper tip to eye or surrounding tissue.
• Advise patient to apply light pressure on lacrimal sac for 1 minute after instillation to minimize systemic absorption of the drug.
• Advise patient that if more than one ophthalmic drug is being used, they should be administered at least 5 minutes apart.
• Urge patient to immediately report conjunctivitis or lid reactions.
• Tell patient that if eye trauma or infection occurs or if eye surgery is needed, he should seek medical advice before continuing to use the multi-dose container.
• Stress the importance of compliance with the recommended therapy.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use