Vyzulta (Latanoprostene bunod) eye drops are used to reduce the intraocular pressure in patients with open-angle glaucoma after it is activated into the active compound (latanoprost)

Latanoprostene bunod Uses:

• Elevated intraocular pressure:

  • It is used to reduce elevated intraocular pressure (IOP) in patients with open-angle glaucoma and ocular hypertension.

Vyzulta (Latanoprostene bunod) Dose in Adults:

Vyzulta (Latanoprostene bunod) Dose in the treatment of Elevated intraocular pressure:

• Ophthalmic:
  • Instill one drop into the affected eye(s) once a day in the evening.
  • Do not exceed the once a day dosage as it may reduce the efficacy of the drug in lowering the IOP.

Use in Children:

Refer to adults dosing.

Pregnancy Risk Category: C

• Animal reproduction studies have shown adverse pregnancy/fetal outcomes.
• You may also be able to take other medications during pregnancy.

Latanoprostene bunod use during breastfeeding:

• It is unknown whether the drug will be excreted into breastmilk after ocular administration.
• Manufacturers recommend that breastfeeding mothers use it with caution. This is to balance the potential benefits for the mother and any possible adverse effects for the infant.
• To minimize fetal exposure, it is recommended that you use the lowest effective dose and the punctum are occluded.

Dose in Kidney Disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Dose in Liver disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Less Common Side Effects of Latanoprostene bunod:

• Local:

  • Application site pain

• Ophthalmic:

  • Conjunctival hyperemia
  • Eye irritation
  • Eye pain

Contraindications to Vyzulta (Latanoprostene bunod):

The US manufacturer's labeling does not list any contraindications. Canadian labeling:

• Allergy reactions to any component of the drug or the drug itself

Warnings and precautions

• Bacterial Keratitis

  • Inadvertent drug contamination may cause bacterial keratitis.

• Ocular effects

  • It can cause a discoloration to the iris, the ocular structures, including the eyelashes and eyelids, as well as the skin around them. 
  • It can increase the size and number of eyelashes.
  • Although iris pigmentation can be permanent, it is not always obvious for many months or years. 
  • The treatment may cause the pigmentation of the eyelashes, eyelids, skin, and other ocular structures to reverse.
  • It is not known if the drug will have long-term effects on the eyes.

• Ocular inflammation:

  • It can trigger an inflammatory response, or worsen an existing ocular inflammation.
  • Patients with active inflammation of their eyes should avoid it. It should also be avoided by those who have had a history of ocular inflammation, such as uveitis or iritis.

• Ocular disease:

  • Patients with macular edema should not use it. Avoid it for patients with pseudophakia or those with a ruptured posterior capsule.

Latanoprostene bunod: Drug Interaction

Monitoring parameters:

• Monitor intraocular pressure;
• regularly examine patients for iris pigmentation

How to administer Vyzulta (Latanoprostene bunod)?

• It is intended for ophthalmic use only. Wash hands before administering the drug.
• Remove contact lenses if any. Instill the eye drops avoiding contamination by not allowing the dropper to touch the eyes or the surrounding surfaces.
• Concomitant medications may be used, however, they should be spaced at least five minutes apart.
• Contact lenses may be worn back after a minimum period of 15 minutes after instilling the eye drops.

Mechanism of action of Vyzulta (Latanoprostene bunod):

• Latanoprostene Bunod is a drug that is quickly metabolized by the eye to butanediol mononitrate and latanoprost acids. 
• Latanoprost is an F-2 alpha prostaglandin analog that lowers the intraocular pressure by increasing the outflow of aqueous humor through both the trabecular meshwork and via the uveoscleral routes.

The beginning of action:

• 1 to 3 hours
• Peak effect can be oabserved between 11 and 13 hours

Time to peak (plasma):

• Latanoprost acid: 5 minutes

Metabolism:

• Latanoprostene bunod when instilled into the eyes is metabolized to latanoprost acid (active moiety) and butanediol mononitrate.
• Latanoprost acid is then further metabolized in the liver to the 1,2-dinor and 1,2,3,4-tetranor metabolites via fatty acid beta-oxidation after it reaches the systemic circulation.
• Butanediol mononitrate is metabolized to 1,4-butanediol and nitric oxide;
• 1,4butanediol is further oxidized to succinic acid which enters the tricarboxylic acid cycle.

International Brands of Latanoprostene bunod:

• Vyzulta

Latanoprostene bunod Brand Names in Pakistan:

No Brands Available in Pakistan.