Xalacom (Latanoprost and Timolol) is a combination of a non-selective beta-blocker and prostaglandin analog. It is used to reduce the intraocular pressure in patients with open-angle glaucoma.

Xalacom (Latanoprost and Timolol) Uses:

Note: It is not approved for use in the US

• Elevated intraocular pressure:

  • It is used to reduce the intraocular pressure in patients with ocular hypertension or open-angle glaucoma who have an inadequate response to topical beta-blockers, prostaglandin analogs, or other treatments that reduce the intraocular pressure.

Xalacom (Latanoprost and Timolol) Dose in Adults:

Xalacom (Latanoprost and Timolol) Dose in the treatment of Elevated intraocular pressure:

• Ophthalmic:
  • Instill one drop into the affected eye(s) once a day.

Use in Children:

Not indicated.

Pregnancy Risk Category: N

• Pregnant women and animals have not been tested on the combination of Timolol and Latanoprost.

Breastfeeding: Latanoprost or timolol

• Timolol, a beta-blocker, has been found in human breastmilk after ophthalmic administration.
• Latanoprast may enter breastmilk.

Dose in Kidney Disease:

• In the manufacturer's labeling, adjustments in the dose have not been provided in patients with kidney disease.
• It should be used with caution (the drug combination has not been studied in patients with kidney disease).

Dose in Liver disease:

• In the manufacturer's labeling, dosage adjustments have not been provided in patients with liver disease.
• It has not been studied and should be used with caution.

Side Effects of Xalacom (Latanoprost and Timolol):

• Ophthalmic:

  • Abnormal eyelash growth
  • Iris hyperpigmentation
  • Eye irritation

Less Common Side Effects of Xalacom (Latanoprost and Timolol):

• Cardiovascular:

  • Hypertension
  • Chest Pain

• Central Nervous System:

  • Depression
  • Headache

• Dermatologic:

  • Dermatological Disease
  • Skin Rash

• Endocrine & Metabolic:

  • Hypercholesterolemia
  • Diabetes Mellitus

• Infection:

  • Infection

• Neuromuscular & Skeletal:

  • Arthritis
  • Back Pain

• Ophthalmic:

  • Ocular Hyperemia
  • Visual Disturbance
  • Visual Field Defect
  • Blepharitis
  • Cataract
  • Conjunctivitis
  • Corneal Disorder
  • Eye Pain
  • Photophobia
  • Error Of Refraction
  • Conjunctival Abnormalities
  • Keratitis

• Respiratory:

  • Upper Respiratory Tract Infection
  • Flu-Like Symptoms
  • Sinusitis

Contraindications to Xalacom (Latanoprost and Timolol):

• Allergy reactions to the drug (latanoprost, timolol), or to any component of its formulation
• Bronchial hyperreactivity, including severe chronic obstructive lung disease (COPD), and bronchial asthma.
• Sinus bradycardia
• Sick sinus syndrome,
• Sinoatrial block
• A pacemaker is not able to control second- or third-degree atrioventricular blocks.
• If you have a severe cardiac condition,
• Cardiogenic shock

Warnings and precautions

• Anaphylactic reactions

  • Patients who have had severe allergic reactions or a history of atopy should be cautious about taking the drug.
  • Patients may develop sensitivity to the drug if they are exposed to it repeatedly.
  • Epinephrine, when used to treat patients with anaphylaxis, may not be effective and may promote undesirable side effects.

• Bacterial Keratitis

  • Multiple-dose ophthalmic solution contamination can inadvertently lead to bacterial keratitis.

• Ocular effects

  • After filtration, it has been observed that drugs that lower the production of aqueoushumor may cause choroidal detachment.
  • Patients suffering from choroidal detachment, whether chronic or recurrent, should be cautious about taking the drug.
  • Prostaglandin analogs such as latanoprost have been linked to macular edema, including cystic macular swelling. 
  • Patients with pseudophakia and aphakia with a tear in the posterior lens capsule are at particular risk.
  • Prostaglandins can also cause permanent brownish discoloration to the eyelids, iris, and eyelashes. If pigmentation is detected, patients should be checked regularly.
  • Prostaglandins can also lengthen, thicken or darken eyelashes. Pigmentation can occur slowly and may not be visible for many months or years.
  • Beta-blockers can cause dryness of the eyes and should not be used by patients with corneal disease.

• Cardiovascular disease

  • Beta-blockers should not be prescribed to patients with conduction defects. Patients must be assessed before initiating treatment.
  • It can be used for patients suffering from first-degree heartblock.
  • It should be used cautiously in patients suffering from heart failure. The medications for heart disease should be optimized before treatment can begin.
  • The patient should be stopped immediately if they experience shortness of breath or other signs of heart disease.
  • Patients with orthostatic hypotension should avoid beta-blockers. It can further lower blood pressure.

• Closed-angle Glaucoma

  • Patients with acute angle-closure vision impairment should not take the drug.
  • The effects of timolol maleate and latanoprost on pupil size are not significant.

• Diabetes:

  • Diabetes patients should be cautious about taking the drug as it can cause hypoglycemia.

• Hepatic impairment

  • Patients with liver disease should not use the drug.

• Herpetic keratitis

  • Patients who have had herpes simplex keratitis in the past may experience a reactivation, especially if they are taking prostaglandin analogs.
  • Patients with a history or active herpes simplex should not use it.

• Uveitis/Iritis:

  • Patients suffering from active intraocular inflammation need to be cautious when taking the drug.

• Myasthenia gravis:

  • Beta-blockers can worsen myasthenia symptoms such as muscle weakness, diplopia and ptosis.
  • It can exacerbate an underlying condition and should be avoided.

• Raynaud and peripheral vascular disease (PVD).

  • Beta-blockers can cause peripheral arterial vasoconstriction.
  • This may precipitate or aggravate arterial insufficiency signs and symptoms in patients with peripheral arterial disease.
  • This is to prevent the development of peripheral vascular diseases.

• Pulmonary disease

  • Patients with hyper-reactive airways should avoid beta-blockers
  • It may be prescribed with caution in patients suffering from mild to moderately severe chronic obstruction pulmonary disease.
  • Patients with this condition should be closely monitored for signs of exacerbation.

• Renal impairment

  • It should not be used in patients with impaired renal function.

• Thyroid disease:

  • Beta-blockers can mask symptoms of hyperthyroidism such as tachycardia.
  • Thyrotoxicosis patients should be closely monitored and treated.
  • Rapid withdrawal of beta-blockers can exacerbate hyperthyroidism symptoms and lead to thyroid storm.

Monitoring parameters:

• Monitor intraocular pressure
• iris color changes,
• eyelash changes;
• Also, monitor for systemic effects of beta blockade

How to administer Xalacom (Latanoprost and Timolol)?

Ophthalmic:

• Before administering the eye drops, patients should wash hands and remove contact lenses.
• If the patient is on concomitant medications or eye products that contain benzalkonium chloride, an interval of 15 minutes should lapse before administering the drug.
• For other ophthalmic solution, an interval of at least 5 minutes is enough.
• To limit the systemic absorption, the eyes should be closed or the nasolacrimal duct should be blocked for two minutes after administering the drug.

Mechanism of action of Xalacom (Latanoprost and Timolol):

Latanoprost:

• It lowers intraocular pressure and acts as an analog to the prostaglandin F2-alpha receptors, which results in increased outflow of the liquid humor.

Timolol:

• It blocks both beta-1 as well as beta-2 adrenergic receptors.
• The production of aqueous humor is reduced by blocking beta-receptors. This reduces intraocular pressure and increases outflow.

See individual agents.

International Brands of Latanoprost and timolol:

• ACT Latanoprost/Timolol
• APO-Latanoprost-Timop
• GD-Latanoprost/Timolol
• MED-LatanoprostTimolol
• RIVA-Latanoprost/Timolol
• SANDOZ Latanoprost/Timolol
• Xalacom
• Astimol
• Lacoma T
• Lantocom
• Laprol
• Latamolol
• Lataneau Plus
• Latanocom
• Latiotim
• Latira
• Latochek-T
• Latof-T
• Latoncore
• Latoncure
• Latop-Comp
• Latoxap
• Lotensin Plus
• Louten T
• Timxal
• Xalacom
• Xalatrex Plus
• Xalavist Plus
• Xalcom
• Xalostplus
• Zakol T
• Zyclat

Latanoprost and Timolol Brand Names in Pakistan: