TRAVATAN
Clinical safety rating: caution
Comprehensive clinical and safety monograph for TRAVATAN (TRAVATAN).
Selective FP prostanoid receptor agonist; increases uveoscleral outflow of aqueous humor by relaxing the ciliary muscle and remodeling the extracellular matrix in the ciliary body.
| Metabolism | Hydrolyzed by esterases in the cornea and plasma to the active free acid, which is further metabolized via beta-oxidation and phase II conjugation. |
| Excretion | Renal (primarily as metabolites): ~70%; Fecal: ~25%; Unchanged drug in urine: <1% |
| Half-life | Terminal elimination half-life is approximately 45 minutes for travoprost acid (active metabolite). Clinical context: due to rapid systemic clearance, ocular hypotensive effect persists for 24 hours from corneal tissue binding. |
| Protein binding | 99.8% bound to plasma proteins (primarily albumin) |
| Volume of Distribution | 0.17 L/kg (active metabolite); small Vd consistent with extensive protein binding and limited tissue distribution |
| Bioavailability | Ocular topical: minimal systemic absorption (plasma concentrations below 10 pg/mL after therapeutic dose); systemic bioavailability not assessed due to low systemic exposure |
| Onset of Action | Ocular topical: 2 hours (maximal intraocular pressure reduction seen at 12 hours) |
| Duration of Action | 24 hours with once-daily dosing; sustained IOP reduction for up to 35 hours post single dose |
| Molecular Weight | 500.56 Da (travoprost free acid) |
One drop of 0.004% ophthalmic solution in the affected eye(s) once daily in the evening.
| Dosage form | SOLUTION/DROPS |
| Renal impairment | No dosage adjustment required. Use with caution in severe renal impairment (CrCl < 15 mL/min). |
| Liver impairment | No dosage adjustment recommended for mild to moderate hepatic impairment. Not studied in severe hepatic impairment. |
| Pediatric use | Safety and efficacy not established. Not recommended for use in pediatric patients. |
| Geriatric use | No specific dose adjustment required. Elderly patients may have increased risk of ocular adverse events; monitor closely. |
| 1st trimester | Avoid unless clearly needed; may cause fetal harm based on animal studies. No adequate human studies. |
| 2nd trimester | Avoid unless clearly needed; potential for increased uterine tone and decreased uterine blood flow. |
| 3rd trimester | Avoid unless clearly needed; may induce premature labor due to prostaglandin analogue activity. |
Clinical note
Comprehensive clinical and safety monograph for TRAVATAN (TRAVATAN).
| Placental transfer | Likely crosses placenta due to low molecular weight; no human data. |
| Breastfeeding | Excreted in animal milk; unknown in humans. Use caution due to potential for systemic effects in infant. |
| Lactation Rating |
■ FDA Black Box Warning
None.
| Common Effects | Eye pain Foreign body sensation Eye discomfort Eye itching Ocular hyperemia Decreased vision |
| Serious Effects |
Hypersensitivity to travoprost or any componentActive herpes simplex keratitis
| Precautions | Pigmentation changes (iris, periorbital tissue, eyelashes), Eyelash changes (increased length, thickness, number), Potential for intraocular inflammation (iritis/uveitis), Macular edema, especially in aphakic/pseudophakic patients with torn posterior lens capsule, Contamination risk from multiple-dose container, Bacterial keratitis if tip touches eye, Use with caution in patients with active intraocular inflammation, May increase rebound IOP if discontinued abruptly |
| Food/Dietary | No clinically significant food interactions. Grapefruit juice does not interact. Avoid alcohol if it causes flushing or hypotension. |
Loading safety data…
| L3 (Moderately Safe) |
| Teratogenic Risk | FDA Pregnancy Category C. No adequate studies in pregnant women. In animal studies, intravenously administered travoprost caused teratogenic effects (e.g., skeletal abnormalities, hydrocephalus) at doses 1.2-6 times the clinical ocular dose. Risk cannot be ruled out; use only if potential benefit justifies risk. First trimester: theoretical risk of teratogenicity due to prostaglandin analog activity. Second and third trimesters: potential for increased uterine contractility; avoid use during labor due to possible augmentation. |
| Fetal Monitoring | Monitor intraocular pressure (IOP) regularly. Assess for ocular adverse effects (e.g., iris pigmentation changes, eyelash changes). No specific fetal monitoring required; however, consider fetal ultrasound if systemic exposure suspected. |
| Fertility Effects | No human data. In animal studies, travoprost did not impair fertility at doses up to 1.2 times the clinical ocular dose. Theoretical risk of disruption of tubal motility due to prostaglandin analog activity; avoid in women attempting conception if unexplained infertility. |
| Clinical Pearls | Travatan (travoprost) is a prostaglandin analogue used for reducing intraocular pressure (IOP) in open-angle glaucoma or ocular hypertension. It is typically dosed once daily in the evening. Patients should be monitored for gradual iris color change (heterochromia), eyelash changes, and potential for intraocular inflammation or macular edema. Systemic absorption is minimal, but caution in patients with compromised airways (e.g., asthma). |
| Patient Advice | Use exactly as prescribed, usually one drop in the affected eye(s) once daily in the evening. · Do not touch the dropper tip to your eye or any surface to avoid contamination. · Wait at least 5 minutes between different eye medications. · You may experience temporary blurred vision; avoid driving until clear. · Report any eye pain, redness, vision changes, or signs of infection promptly. · Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding. · Your eye color may gradually change (increase in brown pigment) – this is permanent. · Eyelashes may become longer, thicker, darker, or increase in number. · Remove contact lenses before instillation and wait 15 minutes before reinserting. · Store at room temperature, away from light and moisture. |