LUMIGAN 0.01%

Indications

• Open-angle glaucoma
• Ocular hypertension

Dosage

Children: Refer to the BNF for Children for appropriate dosing information.

Adults: Apply one drop to the affected eye(s) once daily, preferably in the evening.

Mechanism of action

Bimatoprost mimics the actions of prostamides, specifically prostaglandin F2α, by enhancing the outflow of aqueous humor through the trabecular meshwork and uveoscleral pathways. It decreases tonographic resistance to aqueous humor outflow without affecting its production, resulting in lowered intraocular pressure.

Pharmacodynamics

High intraocular pressure is a significant risk factor for glaucoma-related visual field loss, with a direct relationship between pressure levels and optic nerve damage risk. Bimatoprost effectively decreases intraocular pressure, mitigating the risk of visual impairment associated with ocular hypertension and glaucoma. Additionally, it can lead to notable changes in eyelid, iris, and eyelash pigmentation, especially if used unilaterally.

Pharmacokinetics

Bimatoprost is administered as eye drops and is rapidly absorbed into the ocular tissues. Following instillation, it exhibits a half-life that allows for once-daily dosing. Its metabolism occurs primarily in the liver, with subsequent excretion through urine. The drug's systemic absorption is minimal, which limits the potential for widespread adverse effects.

Contra-indications

• Angle-closure glaucoma
• Aphakia
• Asthma
• Chronic obstructive pulmonary disease

Adverse effects

• Increased pigmentation of the iris
• Increased eyelash growth
• Changes in eyelid pigmentation
• Ocular hyperemia
• Eye irritation
• Dry eyes
• Headache

Interactions

• Beta-blockers
• Non-selective beta-blockers

Precautions

• Use with caution in patients with moderate to severe hepatic impairment
• Use with caution in renal impairment
• Inform patients of potential changes in eye color and eyelash growth

Pregnancy

Manufacturer advises use only if potential benefit outweighs risk.

Breast-feeding

Manufacturer advises avoiding use as it is present in milk in animal studies.

Storage

Store at room temperature. Protect from light. Do not freeze.

Formulations

• Bimatoprost 100 micrograms/ml eye drops | 3 ml
• Bimatoprost 300 micrograms/ml eye drops | 0.4 ml unit dose preservative free
• Bimatoprost 300 micrograms/ml eye drops | 3 ml

Mechanism of action

Bimatoprost imitates the effects of prostamides, specifically prostaglandin F2α. Bimatoprost mildly stimulates aqueous humor outflow, relieving elevated intraocular pressure and decreasing the risk of optic nerve damage. It is thought that bimatoprost reduces intraocular pressure (IOP) in humans by causing an increase in outflow of the aqueous humor via the trabecular meshwork and uveoscleral pathways. It achieves the above effects by decreasing tonographic resistance to aqueous humor outflow. Bimatoprost does not affect aqueous humor production.

Pharmacodynamics

High intraocular pressure is a major risk factor for glaucoma-related visual field loss. A linear relationship exists between intraocular pressure and the risk of damaging the optic nerve, which can lead to considerable visual impairment. Therefore, conditions such as ocular hypertension and glaucoma can cause dangerous elevations of intraocular pressure. Bimatoprost rapidly decreases intraocular pressure and reduces the risk for visual field loss from ocular hypertension due to various causes. Other effects of this drug may include gradual changes in eyelid pigmentation, changes in iris pigmentation, changes in eyelash pigmentation, growth and thickness. Patients should be informed of these possible effects, especially if this drug is only administered to one eye, which may noticeably change in appearance with bimatoprost treatment.