Bimat is a prescription ophthalmic solution indicated for the reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. As a synthetic prostamide analog, it functions by increasing the outflow of aqueous humor through both the trabecular meshwork and uveoscleral pathways, effectively lowering IOP to mitigate the risk of optic nerve damage and preserve visual field integrity. Its formulation is designed for optimal ocular surface tolerance and consistent 24-hour IOP control, making it a cornerstone in the long-term management of these chronic conditions.

Features

• Active pharmaceutical ingredient: Bimatoprost 0.01% or 0.03% (w/v)
• Pharmacological class: Synthetic prostamide analog
• Mechanism of action: Dual mechanism (trabecular and uveoscleral outflow enhancement)
• Presentation: Sterile, isotonic, buffered, preserved ophthalmic solution
• Primary container: 2.5 mL or 5 mL low-density polyethylene (LDPE) dispenser bottle with a controlled dropper tip
• pH: Approximately 7.2; osmolarity: Approximately 290 mOsm/kg
• Preservative: Benzalkonium chloride 0.05 mg/mL
• Excipients: Sodium chloride, sodium phosphate dibasic, citric acid monohydrate, purified water

Benefits

• Provides significant and sustained reduction of intraocular pressure, a primary modifiable risk factor in glaucoma progression.
• Offers a convenient once-daily dosing regimen, enhancing patient adherence to long-term therapy.
• Demonstrates a dual mechanism of action, increasing aqueous outflow through both pressure-sensitive and pressure-insensitive pathways for comprehensive IOP control.
• Proven efficacy in monotherapy and as an adjunctive agent when combined with other intraocular pressure-lowering medications.
• Formulated for high ocular surface biocompatibility, minimizing discomfort upon instillation for many patients.
• Helps to preserve visual field and protect the optic nerve head from further damage, thereby maintaining functional vision.

Common use

Bimat is primarily prescribed for the chronic management of elevated intraocular pressure associated with open-angle glaucoma and ocular hypertension. Open-angle glaucoma is a progressive optic neuropathy characterized by a specific pattern of optic disc cupping and visual field loss, often concomitant with elevated IOP. Ocular hypertension refers to a condition where intraocular pressure is consistently elevated above statistically normal levels (typically >21 mmHg) in the absence of detectable glaucomatous damage. Lowering IOP with medications like Bimat is the only evidence-based strategy to slow or halt disease progression in these patients. It may be used as a first-line monotherapy or as an adjunctive therapy when a single agent does not achieve the target IOP reduction.

Dosage and direction

The recommended dosage is one drop in the affected eye(s) once daily, administered in the evening. The dosage should not exceed once daily, as more frequent administration may diminish the IOP-lowering effect. To ensure proper administration and minimize systemic absorption, patients should be instructed to follow these steps:

1. Wash hands thoroughly with soap and water.
2. Tilt the head backwards and look up.
3. Gently pull down the lower eyelid to form a pouch.
4. Without touching the dropper tip to the eye, eyelid, fingers, or any other surface, instill one drop into the conjunctival sac of the affected eye(s).
5. Close the eye gently and apply light pressure to the nasolacrimal duct (the inner corner of the eye, next to the nose) for 1 to 2 minutes. This helps reduce systemic drainage and absorption, potentially minimizing systemic side effects.
6. If more than one topical ophthalmic medication is being used, they should be administered at least 5 minutes apart.
7. Replace the cap on the bottle securely after each use.

Precautions

• Patients must be informed that Bimat may gradually increase the pigmentation of the iris (colored part of the eye), the eyelid skin, and the eyelashes. The iris color change is likely to be permanent, while changes to the periocular skin and eyelashes may be reversible upon discontinuation of the drug.
• The medication can gradually increase the length, thickness, and darkness of eyelashes; these changes are usually reversible upon discontinuation.
• Bimat may cause macular edema, including cystoid macular edema, particularly in aphakic patients, pseudophakic patients with a torn posterior lens capsule, or in patients with known risk factors for macular edema. Use with caution in these populations.
• There is a potential for bacterial keratitis associated with the use of multiple-dose containers of topical ophthalmic products, which can be contaminated by patients who inadvertently contaminate the dropper tip.
• Contact lenses should be removed prior to instillation and may be reinserted 15 minutes after administration, as the preservative (benzalkonium chloride) can be absorbed by soft contact lenses.
• Patients should be advised that if they develop an intercurrent ocular condition (e.g., trauma, infection) or undergo ocular surgery, they should immediately seek their physician’s advice concerning the continued use of the multi-dose container.

Contraindications

Bimat is contraindicated in patients with known hypersensitivity to bimatoprost, benzalkonium chloride, or any other component of the formulation. Hypersensitivity reactions may manifest as severe ocular itching, conjunctival redness, eyelid swelling, or dermatitis.

Possible side effect

The most common ocular side effects, reported in 5-15% of patients, are conjunctival hyperemia (eye redness), growth of eyelashes, and ocular pruritus (itching). Other commonly reported side effects (1-4% of patients) include:

• Ocular dryness
• Visual disturbance
• Foreign body sensation
• Eye pain
• Pigmentation of the periocular skin
• Blepharitis (inflammation of the eyelids)
• Cataract
• Superficial punctate keratitis
• Eyelid erythema (redness)
• Ocular irritation
• Photophobia (light sensitivity) Less common but more serious side effects include:
• Iris pigmentation changes (permanent)
• Macular edema, including cystoid macular edema
• Anterior uveitis (inflammation inside the eye)
• Periorbital and eyelid skin darkening
• Systemic effects such as headaches, asthenia (weakness), and hirsutism (in rare instances)

Drug interaction

While formal systemic drug interaction studies have not been conducted with topical bimatoprost, interactions are considered unlikely due to low systemic plasma concentrations following ocular instillation. However, the potential for additive effects exists when Bimat is used concomitantly with other IOP-lowering agents (e.g., prostaglandin analogs, beta-blockers, carbonic anhydrase inhibitors, alpha-agonists), which is often the intended therapeutic goal. Patients using eye drops containing thimerosal should administer them at least 5 minutes before instilling Bimat, as thimerosal may precipitate when mixed with benzalkonium chloride.

Missed dose

If a dose is missed, the patient should instill the drop as soon as they remember. However, if it is nearly time for the next scheduled dose, the missed dose should be skipped, and the regular dosing schedule should be resumed. The patient should not instill a double dose to make up for the missed one.

Overdose

Topical overdose of Bimat is unlikely to produce life-threatening systemic effects due to the small volume contained in a single drop. Accidental oral ingestion of the contents of a bottle is also not expected to produce serious systemic effects in adults, though gastrointestinal upset may occur. In case of accidental ingestion, symptomatic treatment is recommended. Ocular overdose may be flushed from the eye(s) with warm tap water.

Storage

Store the unopened bottle in a refrigerator (2°C to 8°C / 36°F to 46°F). Once the bottle is opened for use, it may be stored at room temperature (up to 25°C / 77°F) for 6 weeks. Protect from light. Do not freeze. Keep the bottle tightly closed when not in use. Keep out of the reach and sight of children.

Disclaimer

This information is for educational and informational purposes only and does not constitute medical advice. The content provided is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read here. The manufacturer and publisher are not responsible for any errors or omissions or for any consequences from application of the information in this document.

Reviews

“After being diagnosed with ocular hypertension, my ophthalmologist started me on Bimat. My pressures have been consistently in the low teens since beginning treatment, which is exactly where my doctor wants them. The once-a-day dosing is simple to remember. I did experience some initial redness and a slight stinging sensation, but both subsided after the first few weeks. The noticeable darkening and lengthening of my eyelashes was an unexpected but welcome cosmetic benefit.” – M.K., 58

“As a glaucoma specialist, I find Bimat to be a highly effective first-line agent for a significant portion of my patients. Its potent IOP-lowering efficacy and 24-hour duration of action make it a reliable choice. I always counsel patients on the potential for permanent iris color change and eyelash growth during the informed consent process. Patient adherence is generally excellent due to the simple dosing schedule. It remains a fundamental tool in our arsenal against glaucomatous optic neuropathy.” – Dr. A. Sharma, MD

“I’ve been using Bimat for over three years to manage my open-angle glaucoma. It has successfully controlled my eye pressure and stabilized my visual field tests. The only side effect I’ve noticed is that my blue eyes have developed a slightly darker, hazel-brown ring around the pupil. I was made aware this could happen, and for me, the benefit of preserving my vision far outweighs this cosmetic change. The bottle is easy to use, and I’ve had no issues with irritation.” – R.B., 67