Bimatoprost

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.
  • 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 NameManufacturerPrice (USD)
LumiganAllergan$100–120 (2.5 mL, 0.01%)
LatisseAllergan$125–150 (3 mL, 0.03%)
Generic OptionsVarious$20–50 (2.5 mL, 0.03%)

18. FAQs (15 Questions)

  1. What is bimatoprost used for?
    Bimatoprost is used to lower intraocular pressure in glaucoma or ocular hypertension and to enhance eyelash growth.
  2. How does bimatoprost work?
    It increases the outflow of aqueous humour from the eye, reducing intraocular pressure. It also stimulates eyelash growth.
  3. Can bimatoprost change the colour of my eyes?
    Yes, it may cause permanent darkening of the iris, especially in patients with light-coloured eyes.
  4. Can I use bimatoprost with contact lenses?
    Yes, but remove lenses before use and wait 15 minutes before reinserting them.
  5. What are the common side effects of bimatoprost?
    Redness, itching, and changes in pigmentation of the eyes or skin.
  6. Can children use bimatoprost?
    It is not recommended for children unless prescribed by a specialist.
  7. Is bimatoprost safe during pregnancy?
    It should only be used if absolutely necessary and under medical supervision.
  8. 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.
  9. Can I stop using bimatoprost once my symptoms improve?
    No, continue use as prescribed to maintain the effects.
  10. What happens if I miss a dose?
    Apply the missed dose as soon as you remember, but do not double the next dose.
  11. Can bimatoprost cause allergic reactions?
    Rarely, hypersensitivity reactions such as swelling or rash may occur.
  12. How should bimatoprost be stored?
    Store at room temperature, away from moisture and heat.
  13. Can I use bimatoprost with other eye drops?
    Yes, but wait at least 5 minutes between applications of different eye drops.
  14. Does bimatoprost interact with other medications?
    It has no significant drug interactions but should not be used with other prostaglandin analogues.
  15. How long do I need to use bimatoprost for eyelash growth?
    Continued use is required to maintain results, as the effects are not permanent.