1. Introduction
Bimatoprost, marketed under brand names such as Lumigan and Latisse, is a prostaglandin analogue used to lower intraocular pressure (IOP) in glaucoma and ocular hypertension. It is also used cosmetically to enhance eyelash growth.
2. Indications
- Approved Indications:
- Reduction of elevated intraocular pressure in patients with:
- Open-angle glaucoma.
- Ocular hypertension.
- Treatment of hypotrichosis of the eyelashes (inadequate or insufficient eyelashes) to enhance growth.
- Reduction of elevated intraocular pressure in patients with:
- Off-Label Uses:
- Secondary glaucoma or IOP elevation associated with other eye conditions.
3. Dosage
- For Glaucoma or Ocular Hypertension:
- One drop in the affected eye(s) once daily in the evening.
- For Eyelash Hypotrichosis (Latisse):
- Apply a single drop to a sterile applicator and brush along the upper eyelid margin once daily in the evening.
4. Administration
- Ophthalmic Use:
- Wash hands before use.
- Tilt head back, pull down the lower eyelid, and instil one drop into the conjunctival sac.
- Avoid touching the dropper tip to the eye or any surface to prevent contamination.
- For Eyelash Growth:
- Apply only to the upper eyelid margin; do not apply to the lower lid.
- Blot any excess solution to prevent skin darkening.
5. Forms Available
- Ophthalmic solution: 0.01%, 0.03%.
6. Side Effects
6.1. Common Side Effects
- Conjunctival hyperaemia (eye redness).
- Eye itching or irritation.
- Increased pigmentation of the iris, eyelids, or eyelashes.
6.2. Less Common Side Effects
- Dry eyes.
- Eye discomfort or foreign body sensation.
- Blurred vision.
6.3. Rare but Serious Side Effects
- Macular oedema.
- Periorbital fat atrophy (sunken eyes).
- Hypersensitivity reactions.
7. Warnings
- Bimatoprost may cause permanent darkening of the iris and eyelid skin.
- Prolonged use may lead to changes in eyelash length, thickness, or pigmentation.
- Avoid use in patients with active ocular infections or inflammation.
8. Precautions
- Use with caution in patients with a history of macular oedema or uveitis.
- Advise patients to remove contact lenses before administration and wait at least 15 minutes before reinserting them.
- Avoid applying directly to the lower eyelid to minimise the risk of periorbital pigmentation or fat atrophy.
9. Interactions
- No significant drug-drug interactions reported.
- Avoid simultaneous use of other prostaglandin analogues, as it may alter the efficacy of bimatoprost.
10. Monitoring Parameters
- Regular monitoring of intraocular pressure (IOP) in glaucoma and ocular hypertension.
- Observe for changes in iris pigmentation and signs of macular oedema.
11. Use in Children
- Safety and efficacy have not been established in children.
- Use only under specialist guidance.
12. Use in Pregnancy
- Category C: Use only if the potential benefit justifies the risk to the foetus.
- Animal studies have shown adverse effects, but human data are limited.
13. Use in Elderly
- No specific dosage adjustments required.
- Monitor for increased susceptibility to side effects, such as ocular irritation.
14. Use in Kidney Disease
- No dosage adjustment necessary, as systemic absorption is minimal.
15. Use in Liver Disease
- Use with caution in patients with severe hepatic impairment due to limited data.
16. Patient Counselling Points
- Instruct proper application techniques to prevent contamination and minimise side effects.
- Inform patients about potential side effects, including permanent changes in iris colour and skin pigmentation.
- Advise patients to use the medication only as prescribed, avoiding excessive application.
- Highlight the importance of regular eye pressure monitoring in glaucoma or ocular hypertension.
- For cosmetic use, stress the importance of applying the solution only to the upper eyelid margin.
17. Table of Brand Names, Manufacturers, and Prices
Brand Name | Manufacturer | Price (USD) |
---|---|---|
Lumigan | Allergan | $100–120 (2.5 mL, 0.01%) |
Latisse | Allergan | $125–150 (3 mL, 0.03%) |
Generic Options | Various | $20–50 (2.5 mL, 0.03%) |
18. FAQs (15 Questions)
- What is bimatoprost used for?
Bimatoprost is used to lower intraocular pressure in glaucoma or ocular hypertension and to enhance eyelash growth. - How does bimatoprost work?
It increases the outflow of aqueous humour from the eye, reducing intraocular pressure. It also stimulates eyelash growth. - Can bimatoprost change the colour of my eyes?
Yes, it may cause permanent darkening of the iris, especially in patients with light-coloured eyes. - Can I use bimatoprost with contact lenses?
Yes, but remove lenses before use and wait 15 minutes before reinserting them. - What are the common side effects of bimatoprost?
Redness, itching, and changes in pigmentation of the eyes or skin. - Can children use bimatoprost?
It is not recommended for children unless prescribed by a specialist. - Is bimatoprost safe during pregnancy?
It should only be used if absolutely necessary and under medical supervision. - How long does it take for bimatoprost to work?
It may take 4–6 weeks to notice improvement in eyelash growth or a reduction in eye pressure. - Can I stop using bimatoprost once my symptoms improve?
No, continue use as prescribed to maintain the effects. - What happens if I miss a dose?
Apply the missed dose as soon as you remember, but do not double the next dose. - Can bimatoprost cause allergic reactions?
Rarely, hypersensitivity reactions such as swelling or rash may occur. - How should bimatoprost be stored?
Store at room temperature, away from moisture and heat. - Can I use bimatoprost with other eye drops?
Yes, but wait at least 5 minutes between applications of different eye drops. - Does bimatoprost interact with other medications?
It has no significant drug interactions but should not be used with other prostaglandin analogues. - How long do I need to use bimatoprost for eyelash growth?
Continued use is required to maintain results, as the effects are not permanent.