XALATAN
Clinical safety rating: caution
Comprehensive clinical and safety monograph for XALATAN (XALATAN).
Latanoprost is a prostaglandin F2α analogue that reduces intraocular pressure by increasing the outflow of aqueous humor through the uveoscleral pathway.
| Metabolism | Primarily hydrolyzed in the cornea to the active acid; further metabolism via beta-oxidation in the liver. |
| Excretion | Renal (approximately 50% as metabolites, <1% as unchanged drug); biliary/fecal (remainder). |
| Half-life | Terminal elimination half-life of latanoprost acid is approximately 17 minutes; clinically, intraocular pressure reduction persists for 24 hours due to long receptor residence time. |
| Protein binding | Latanoprost acid: >90% bound to plasma albumin. |
| Volume of Distribution | 0.15 L/kg (small Vd consistent with distribution into extracellular fluid). |
| Bioavailability | Topical ocular: approximately 10-15% (systemic absorption via nasolacrimal drainage). |
| Onset of Action | Ocular: 3-4 hours; maximum effect at 8-12 hours after topical administration. |
| Duration of Action | 24 hours; once-daily dosing achieves sustained intraocular pressure reduction with no nocturnal trough. |
One drop (1.5 mg/mL) in the affected eye(s) once daily in the evening.
| Dosage form | SOLUTION/DROPS |
| Renal impairment | No dosage adjustment required for renal impairment. |
| Liver impairment | No specific guidelines; use with caution in severe hepatic impairment. |
| Pediatric use | Safety and efficacy not established in pediatric patients. |
| Geriatric use | No specific dosage adjustment needed; monitor intraocular pressure. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for XALATAN (XALATAN).
| Breastfeeding | Excretion in human milk unknown; M/P ratio not available. Due to potential for ocular effects in nursing infant, caution advised; consider discontinuing breastfeeding or drug based on importance to mother. |
| Teratogenic Risk | First trimester: No adequate human studies; animal studies at high doses (0.36 mg/kg/day) showed increased fetal resorptions, delayed ossification, and reduced fetal weight. Second and third trimesters: Theoretical risk of increased uterine tone and reduced placental perfusion due to prostaglandin analogue activity; no adequate human data. Risk category C. |
■ FDA Black Box Warning
No FDA boxed warning.
| Common Effects | Eyelash changes Eye pain Increased sensitivity to light Burning sensation in eye Eye itching Foreign body sensation Itching Stinging in the eyes Conjunctival hyperemia |
| Serious Effects |
["Hypersensitivity to latanoprost or any component of the formulation"]
| Precautions | ["May cause increased pigmentation of the iris, eyelid, and eyelashes","Potential for cystoid macular edema, especially in aphakic patients","Caution in patients with intraocular inflammation or neovascular glaucoma"] |
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| Fetal Monitoring |
| Monitor intraocular pressure regularly; assess fetal growth and amniotic fluid volume during prolonged use; no specific maternal monitoring required beyond standard obstetrical care. |
| Fertility Effects | No adverse effects on human fertility reported; animal studies showed no impairment of fertility at doses up to 0.36 mg/kg/day. |