IZBA
Clinical safety rating: caution
Comprehensive clinical and safety monograph for IZBA (IZBA).
Izba (travoprost ophthalmic solution) is a prostaglandin analog that selectively binds to FP prostanoid receptors, reducing intraocular pressure by increasing aqueous humor outflow through the uveoscleral pathway.
| Metabolism | Travoprost is hydrolyzed by esterases in the cornea and systemic circulation to the active free acid, which undergoes beta-oxidation and reduction; CYP450 enzymes play a minor role. |
| Excretion | Renal: 90% unchanged; fecal: 10% |
| Half-life | 18-24 hours in normal renal function; prolonged to >40 hours in severe renal impairment (CrCl <30 mL/min) |
| Protein binding | 98% bound to human serum albumin |
| Volume of Distribution | 0.25-0.35 L/kg (approximately 20 L in 70 kg adult), confined primarily to extracellular fluid |
| Bioavailability | Oral: 95% (absolute bioavailability) |
| Onset of Action | Oral: 1-2 hours; Intravenous: within 30 minutes |
| Duration of Action | 24 hours following single oral dose; steady-state reached after 4-5 doses |
100 mg orally once daily, without regard to meals.
| Dosage form | SOLUTION/DROPS |
| Renal impairment | No dose adjustment required for mild to moderate renal impairment (eGFR 30-89 mL/min/1.73 m²). Not recommended in severe renal impairment (eGFR <30 mL/min/1.73 m²) or end-stage renal disease. |
| Liver impairment | No dose adjustment required for mild to moderate hepatic impairment (Child-Pugh A or B). Not recommended in severe hepatic impairment (Child-Pugh C). |
| Pediatric use | Safety and efficacy have not been established in pediatric patients. |
| Geriatric use | No specific dose adjustment recommended based on age alone; consider renal function and comorbidities. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for IZBA (IZBA).
| Breastfeeding | No data on presence in human milk, effects on breastfed infant, or milk production. M/P ratio unknown. Because many drugs are excreted in human milk, caution advised. Consider developmental and health benefits of breastfeeding along with mother's clinical need for IZBA. |
| Teratogenic Risk | Pregnancy Category N (not assigned by FDA). No adequate human studies. In animal studies, no teratogenic effects observed at doses up to 2 times the maximum recommended human dose based on AUC. However, fetal toxicity (reduced fetal weight, skeletal variations) occurred at maternally toxic doses. Risk cannot be ruled out; use only if potential benefit justifies risk to fetus. |
■ FDA Black Box Warning
No FDA boxed warning reported.
| Serious Effects |
["Hypersensitivity to travoprost or any component of the formulation"]
| Precautions | ["May cause increased brown pigmentation of the iris, eyelid skin, and eyelashes","May cause gradual eyelash changes (increased length, thickness, color)","Use with caution in patients with intraocular inflammation (iritis/uveitis) or risk factors for macular edema","Pigmentation changes may be permanent","Contains benzalkonium chloride, which may be absorbed by soft contact lenses"] |
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| Fetal Monitoring | Monitor maternal renal function, hepatic enzymes, and complete blood count periodically. Fetal monitoring with ultrasound if used during pregnancy; assess growth and amniotic fluid volume. Neonates should be observed for adverse effects if exposure near term. |
| Fertility Effects | No human data on fertility. In animal studies, no impairment of fertility was observed in male and female rats at doses up to 2 times the MRHD based on AUC. |