TRAVATAN Z
Clinical safety rating: caution
Comprehensive clinical and safety monograph for TRAVATAN Z (TRAVATAN Z).
Selective FP prostanoid receptor agonist; increases uveoscleral outflow of aqueous humor by binding to FP receptors in the ciliary muscle and trabecular meshwork, leading to matrix metalloproteinase activation and remodeling of extracellular matrix.
| Metabolism | Primarily hydrolyzed by esterases in the cornea and other ocular tissues to the active acid form; subsequent metabolism via beta-oxidation and reduction reactions; minimal hepatic metabolism. |
| Excretion | Primarily eliminated via hepatic metabolism; renal excretion of metabolites accounts for approximately 20% of the dose; fecal excretion is minimal. |
| Half-life | Terminal elimination half-life is 45 minutes; due to rapid hydrolysis to active acid, the clinical effect duration is longer than the half-life suggests. |
| Protein binding | Approximately 99% bound to human plasma proteins, primarily albumin. |
| Volume of Distribution | 0.26 L/kg; indicates distribution into total body water, consistent with hydrophilic nature. |
| Bioavailability | Ocular: Systemic bioavailability is low due to extensive ocular and hepatic first-pass metabolism; precise ocular bioavailability not determined. |
| Onset of Action | Ocular: Reduction of intraocular pressure begins within 2-4 hours after instillation. |
| Duration of Action | Ocular: Intraocular pressure reduction persists for at least 24 hours following a single dose, supporting once-daily dosing. |
| Molecular Weight | 500.6 |
One drop in the affected eye(s) once daily in the evening. Ophthalmic solution 0.004% (travoprost 0.04 mg/mL).
| Dosage form | SOLUTION/DROPS |
| Renal impairment | No dose adjustment required for renal impairment. Travoprost is extensively metabolized and renal clearance is minimal. |
| Liver impairment | No dose adjustment required for mild to moderate hepatic impairment (Child-Pugh A or B). Not studied in severe hepatic impairment (Child-Pugh C); use with caution. |
| Pediatric use | Safety and efficacy not established. Use in pediatric patients is not recommended. |
| Geriatric use | No dose adjustment necessary. Elderly patients may have increased risk of ocular adverse effects; monitor intraocular pressure and ocular surface status. |
| 1st trimester | Avoid. No adequate studies in pregnant women; animal studies show reproductive toxicity. |
| 2nd trimester | Avoid. Potential fetal harm; prostaglandin analog may increase uterine tone. |
| 3rd trimester | Avoid. Risk of premature labor or uterine hyperstimulation. |
Clinical note
Comprehensive clinical and safety monograph for TRAVATAN Z (TRAVATAN Z).
| Placental transfer | Limited data; prostaglandin analogs may cross placenta. Animal studies show transfer. |
| Breastfeeding | Excretion in human milk unknown; caution due to potential adverse effects in nursing infants. Consider alternative treatments. |
| Lactation Rating |
■ FDA Black Box Warning
None
| Serious Effects |
Hypersensitivity to travoprost or any componentActive intraocular inflammation (e.g., iritis)
| Precautions | May gradually change eyelashes and periocular pigmentation (reversible upon discontinuation), May cause iris pigmentation changes (likely permanent), Use with caution in patients with intraocular inflammation (e.g., iritis/uveitis), May reactivate herpetic keratitis; contraindicated in patients with active herpes simplex keratitis, Risk of macular edema, especially in aphakic, pseudophakic with torn posterior lens capsule, or with known risk factors for macular edema, Contains benzalkonium chloride which may be absorbed by soft contact lenses; remove lenses before administration |
| Food/Dietary | No known food interactions. Avoid excessive alcohol consumption as it may reduce intraocular pressure control. Maintain adequate hydration and a balanced diet. No specific dietary restrictions required. |
Loading safety data…
| L3 - Moderately Safe |
| Teratogenic Risk | Travoprost (TRAVATAN Z) is classified as FDA Pregnancy Category C. In animal studies, fetal toxicity including skeletal abnormalities and malformations occurred at doses 5-10 times the human dose. There are no adequate and well-controlled studies in pregnant women. The drug should be used during pregnancy only if potential benefit justifies potential risk to the fetus. First trimester: caution due to potential teratogenic effects. Second and third trimesters: increased risk of preterm labor and uterine contractions due to prostaglandin analog activity. |
| Fetal Monitoring | Monitor intraocular pressure (IOP) regularly. Assess for adverse effects including increased iris pigmentation, eyelash changes, and ocular inflammation. In pregnancy, monitor for any signs of uterine hyperstimulation or preterm labor. For breastfeeding, observe infant for ocular or systemic effects such as apnea or bradycardia if accidental exposure. |
| Fertility Effects | No specific human data on fertility effects. In animal studies, there was no impairment of fertility at doses up to 8 times the human dose. Theoretical concern due to prostaglandin analog activity; may affect uterine contractility and implantation, but clinical significance unknown. |
| Clinical Pearls | Travatan Z (travoprost ophthalmic solution) is a prostaglandin analog used for reducing intraocular pressure (IOP) in open-angle glaucoma or ocular hypertension. Store at 2-25°C (36-77°F) to maintain stability. Contains benzalkonium chloride as preservative; avoid contact with soft contact lenses. Remove contact lenses before instillation and wait 15 minutes before reinserting. Administer once daily in the evening as nocturnal administration maximizes IOP reduction. Avoid contamination of the dropper tip. Do not administer concurrently with other prostaglandin analogs due to additive effects. Monitor for iris pigmentation changes, eyelash changes, and periorbital tissue darkening. Use with caution in patients with intraocular inflammation (e.g., uveitis) or macular edema (e.g., aphakic/pseudophakic). Systemic absorption is minimal but can occur in severe hepatic impairment. |
| Patient Advice | Use exactly as prescribed: one drop in the affected eye(s) once daily in the evening. · Wash hands before use. Remove contact lenses before instillation and wait at least 15 minutes before reinserting. · Tilt head back, pull down lower lid, and place drop into the pocket. Avoid touching the dropper tip to any surface. · After instillation, close eyes and press the inner corner of the eye (nasolacrimal occlusion) for 1 minute to reduce systemic absorption. · Do not use more than once daily; more frequent use reduces efficacy. · If you are using other eye drops, wait at least 5 minutes between medications. · Report any eye pain, redness, vision changes, or signs of infection (e.g., discharge) immediately. · Note that this medication may cause gradual change in eye color (brownish), darkening of eyelid skin, and increased length/thickness of eyelashes. These are usually permanent. · Store the bottle upright at room temperature (2-25°C). Do not freeze. Keep bottle tightly closed when not in use. · Dispose of any unused solution 4 weeks after first opening. |