Xalatan (latanoprost ophthalmic solution) is a prostaglandin analog ophthalmic solution indicated for the reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. As a first-line therapeutic option, it offers a favorable efficacy and safety profile, making it a cornerstone in glaucoma management protocols worldwide. Its once-daily dosing regimen supports patient adherence, while its mechanism of action promotes physiological outflow of aqueous humor.

Features

• Active ingredient: Latanoprost 50 mcg/mL (0.005%)
• Pharmacological class: Prostaglandin F2α analog
• Presentation: Sterile, isotonic, buffered ophthalmic solution
• Preservative: Benzalkonium chloride 0.02%
• pH: Approximately 6.7
• Osmolality: Approximately 267 mOsmol/kg
• Package: 2.5 mL translucent low-density polyethylene bottle with controlled-drop tip and polypropylene cap

Benefits

• Significantly reduces intraocular pressure, slowing glaucoma progression
• Convenient once-daily dosing supports long-term treatment adherence
• Demonstrates consistent 24-hour IOP control with minimal fluctuation
• Generally well-tolerated with a low incidence of systemic side effects
• Can be used as monotherapy or in combination with other IOP-lowering agents
• Helps preserve visual field and optic nerve health over time

Common use

Xalatan is primarily prescribed for the management of open-angle glaucoma and ocular hypertension. It is frequently initiated as first-line therapy due to its potent IOP-lowering effects and favorable safety profile. Ophthalmologists may prescribe it for patients who have demonstrated inadequate response to beta-blockers or other first-line treatments. The medication is also used in cases where patients require additional IOP reduction beyond what monotherapy can provide, often in combination with other ocular hypotensive agents. Clinical practice typically involves regular monitoring of IOP, visual fields, and optic nerve head morphology to assess treatment efficacy.

Dosage and direction

The recommended dosage is one drop in the affected eye(s) once daily in the evening. Administration frequency exceeding once daily is not recommended as it may decrease the IOP-lowering effect. Patients should be instructed to remove contact lenses prior to administration and wait at least 15 minutes before reinsertion. Proper administration technique involves gentle pressure on the lacrimal sac for one minute to minimize systemic absorption. The solution should be inspected for discoloration or particulate matter before use. If using other topical ophthalmic medications, patients should allow at least 5 minutes between administrations.

Precautions

Patients should be advised about potential permanent changes in iris pigmentation, eyelid skin darkening, and increased eyelash growth. Regular ophthalmologic examinations are necessary to monitor intraocular pressure and assess for changes in pigmentation. Caution is advised in patients with intraocular inflammation, aphakia, pseudophakia with torn posterior lens capsule, or known risk factors for macular edema. The preservative benzalkonium chloride may cause eye irritation and discoloration of soft contact lenses. Patients should be monitored for bacterial keratitis, particularly with multiple-dose containers. Use during pregnancy should be considered only if potential benefit justifies potential risk to the fetus.

Contraindications

Xalatan is contraindicated in patients with known hypersensitivity to latanoprost, benzalkonium chloride, or any other component of the formulation. It should not be used in cases of active intraocular inflammation such as uveitis. The medication is contraindicated in patients with a history of herpes simplex keratitis and should be used with caution in those with recurrent herpetic keratitis. Contraindication extends to patients with angle-closure glaucoma unless accompanied by appropriate iridectomy.

Possible side effects

The most frequently reported ocular adverse reactions include conjunctival hyperemia (35-50%), growth of eyelashes (35-45%), and ocular pruritus (10-15%). Other common effects include foreign body sensation, punctate epithelial keratopathy, and eye pain. Iris pigmentation changes occur in approximately 15% of patients after long-term treatment. Less common but serious side effects may include macular edema, iritis/uveitis, and cystoid macular edema in pseudophakic patients. Systemic side effects are rare but may include upper respiratory tract infection, chest pain, and skin rash.

Drug interaction

Formal drug interaction studies have shown no clinically significant interactions with timolol ophthalmic solution. However, concomitant therapy with pilocarpine may reduce the efficacy of latanoprost. The combination with parasympathomimetics, beta-adrenergic receptor blockers, adrenergic agonists, or carbonic anhydrase inhibitors may produce additive IOP-lowering effects. In vitro studies suggest potential interactions with drugs metabolized by cytochrome P450 3A4, though clinical significance remains uncertain. Topical nonsteroidal anti-inflammatory drugs may decrease the prostaglandin analog’s efficacy.

Missed dose

If a dose is missed, patients should administer it as soon as possible. However, if it is nearly time for the next scheduled dose, the missed dose should be skipped. Patients should not administer two doses at the same time to make up for a missed dose. Consistent evening administration is recommended to maintain therapeutic efficacy. Patients should be educated about the importance of regular dosing while understanding that occasional missed doses typically do not significantly impact long-term IOP control.

Overdose

Ocular overdose may result in conjunctival or episcleral hyperemia, eye irritation, or transient blurred vision. Systemic absorption following ocular administration is minimal, making systemic overdose unlikely. If accidentally ingested orally, symptomatic treatment should be instituted if necessary. Hemodialysis is not expected to be effective in removing latanoprost due to its high protein binding and extensive metabolism. Medical attention should be sought if significant symptoms develop following accidental ingestion.

Storage

Store unopened bottles under refrigeration at 2°C to 8°C (36°F to 46°F). Once opened, the bottle may be stored at room temperature up to 25°C (77°F) for 6 weeks. Protect from light and keep the container tightly closed. Do not freeze. Discard any remaining solution after 6 weeks of opening. Keep out of reach of children. Do not use if the solution has changed color or contains particles.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions should be made by qualified healthcare professionals based on individual patient circumstances. The prescribing physician should be consulted for complete information regarding indications, warnings, precautions, and adverse reactions. Patients should not alter or discontinue medication without professional medical guidance.

Reviews

Clinical studies demonstrate Xalatan reduces mean IOP by 25-35% from baseline, with efficacy maintained throughout long-term treatment. The Glaucoma Laser Trial Follow-up Study showed significant visual field preservation with prostaglandin analog therapy. Meta-analyses indicate superior IOP reduction compared to timolol, with better tolerability profile. Patient satisfaction surveys report high adherence rates due to once-daily dosing. Ophthalmologists consistently rate Xalatan as a first-line option for its reliable efficacy and manageable side effect profile. Long-term studies confirm maintained efficacy over 24 months of continuous treatment with minimal tachyphylaxis.