Latanoprost 0.05 Mg/ Ml Eye Drops Solution
SUMMARY OF PRODUCT CHARACTERISTICS
1 NAME OF THE MEDICINAL PRODUCT
Latanoprost 50 micrograms/ml, eye drops, solution
2 QUALITATIVE AND QUANTITATIVE COMPOSITION
1 ml eye drops, solution contains 50 micrograms of latanoprost.
One drop contains approximately 1.5 micrograms latanoprost.
Excipient: Benzalkonium chloride 0.2 mg/ml For a full list of excipients, see section 6.1.
3 PHARMACEUTICAL FORM
Eye drops, solution
Colourless or pale-yellow, clear solution.
The pH is between 6.6 and 6.9.
The osmolality is between 250 and 330 mOsm/kg.
4 CLINICAL PARTICULARS
4.1 Therapeutic indications
Reduction of elevated intraocular pressure in patients with open angle glaucoma and ocular hypertension.
4.2 Posology and method of administration
Ocular use
Recommended dosage for adults (including the elderly):
Recommended therapy is one eye drop in the affected eye(s) once daily. Optimal effect is obtained if Latanoprost 50 micrograms/ml, eye drops, solution is administered in the evening.
The dosage of Latanoprost 50 micrograms/ml, eye drops, solution should not exceed once daily since it has been shown that more frequent administration decreases the intraocular pressure lowering effect.
If one dose is missed, treatment should continue with the next dose as normal.
As with any eye drops, to reduce possible systemic absorption, it is recommended that the lachrymal sac be compressed at the medial canthus (punctal occlusion) for one minute. This should be performed immediately following the instillation of each drop.
Contact lenses should be removed before instillation of the eye drops and may be reinserted after 15 minutes.
If more than one topical ophthalmic medicinal product is being used, the medicinal products should be administered at least five minutes apart.
Children and adolescents:
Latanoprost 50 micrograms/ml, eye drops, solution is not recommended for the use in children/adolescents below 18 years due to a lack of data of safety and efficacy.
4.3 Contraindications
Hypersensitivity to latanoprost, benzalkonium chloride or to any of the excipients.
4.4 Special warnings and precautions for use
Latanoprost may gradually change eye colour by increasing the amount of brown pigment in the iris. Before treatment is instituted, patients should be informed of the possibility of a permanent change in eye colour. Unilateral treatment can result in permanent heterochromia.
This change in eye colour has predominantly been seen in patients with mixed coloured irides, i.e. blue-brown, grey-brown, yellow-brown and green-brown. In studies with latanoprost, the onset of the change is usually within the first 8 months of treatment, rarely during the second or third year, and has not been seen after the fourth year of treatment. The rate of progression of iris pigmentation decreases with time and is stable for five years. The effect of increased pigmentation beyond five years has not been evaluated. In an open 5-year latanoprost safety study, 33% of patients developed iris pigmentation (see section 4.8). The iris colour change is slight in the majority of cases and often not observed clinically. The incidence in patients with mixed colour irides ranged from 7 to 85%, with yellow-brown irides having the highest incidence. In patients with homogeneously blue eyes, no change has been observed and in patients with homogeneously grey, green or brown eyes, the change has only rarely been seen.
The colour change is due to increased melanin content in the stromal melanocytes of the iris and not to an increase in number of melanocytes. Typically, the brown pigmentation around the pupil spreads concentrically towards the periphery in affected eyes, but the entire iris or parts of it may become more brownish. No further increase in brown iris pigment has been observed after discontinuation of treatment. It has not been associated with any symptom or pathological changes in clinical trials to date.
Neither naevi nor freckles of the iris have been affected by treatment. Accumulation of pigment in the trabecular meshwork or elsewhere in the anterior chamber has not been observed in clinical trials. Based on 5 years clinical experience, increased iris pigmentation has not been shown to have any negative clinical sequelae and Latanoprost 50 micrograms/ml, eye drops, solution can be continued if iris pigmentation ensues. However, patients should be monitored regularly and if the clinical situation warrants, Latanoprost 50 micrograms/ml, eye drops, solution treatment may be discontinued.
There is limited experience of Latanoprost in chronic angle closure glaucoma, open angle glaucoma of pseudophakic patients and in pigmentary glaucoma. There is no experience of Latanoprost in inflammatory and neovascular glaucoma, inflammatory ocular conditions, or congenital glaucoma. Latanoprost has no or little effect on the pupil, but there is no experience in acute attacks of closed angle glaucoma. Therefore, it is recommended that Latanoprost 50 micrograms/ml, eye drops, solution should be used with caution in these conditions until more experience is obtained.
There are limited study data on the use of Latanoprost during the perioperative period of cataract surgery. Latanoprost 50 micrograms/ml, eye drops, solution should be used with caution in these patients.
Reports of macular oedema have occurred (see section 4.8) mainly in aphakic patients, in pseudophakic patients with torn posterior lens capsule or anterior chamber lenses, or in patients with known risk factors for cystoid macular oedema (such as diabetic retinopathy and retinal vein occlusion). Latanoprost 50 micrograms/ml, eye drops, solution should be used with caution in aphakic patients, in pseudophakic patients with torn posterior lens capsule or anterior chamber lenses, or in patients with known risk factors for cystoid macular oedema.
In patients with known predisposing risk factors for iritis/uveitis, Latanoprost 50 micrograms/ml, eye drops, solution can be used with caution.
There is limited experience from patients with asthma, but some cases of exacerbation of asthma and/or dyspnoea were reported in post marketing experience. Asthmatic patients should therefore be treated with caution until there is sufficient experience, see also section 4.8. Periorbital skin discolouration has been observed, the majority of reports being in Japanese patients. Experience to date shows that periorbital skin discolouration is not permanent and in some cases has reversed while continuing treatment with Latanoprost 50 micrograms/ml, eye drops, solution.
Latanoprost may gradually change eyelashes and vellus hair in the treated eye and surrounding areas; these changes include increased length, thickness, pigmentation, number of lashes or hairs and misdirected growth of eyelashes. Eyelash changes are reversible upon discontinuation of treatment.
Latanoprost 50 micrograms/ml, eye drops, solution contains benzalkonium chloride. May cause eye irritation. Avoid contact with soft contact lenses. Remove contact lenses prior application and wait at least 15 minutes before reinsertion. Known to discolour soft contact lenses.
Benzalkonium chloride may also cause punctate keratopathy and/or toxic ulcerative keratopathy. Close monitoring is required with frequent or prolonged use of Latanoprost 50 micrograms/ml, eye drops, solution in dry eye patients, or in conditions where the cornea is compromised.
4.5 Interaction with other medicinal products and other forms of interaction
No interaction studies have been performed.
There have been reports of paradoxical elevations in intraocular pressure following the concomitant ophthalmic administration of two prostaglandin analogues. Therefore, the use of two or more prostaglandins, prostaglandin analogues or prostaglandin derivatives is not recommended.
4.6 Pregnancy and lactation
Pregnancy
The safety of this medicinal product for use in human pregnancy has not been established. It has potential hazardous pharmacological effects with respect to the course of pregnancy, to the unborn or the neonate. Therefore, Latanoprost 50 micrograms/ml, eye drops, solution
should not be used during pregnancy. Lactation
Latanoprost and its metabolites may pass into breast milk and Latanoprost 50 micrograms/ml, eye drops, solution should therefore not be used in nursing women or breast feeding should be stopped.
4.7 Effects on ability to drive and use machines
No studies on the effects on the ability to drive and use machines have been performed.
Instillation of Latanoprost 50 micrograms/ml, eye drops, solution may cause transient blurring of vision. Do not drive as long as the blurred vision last.
4.8 Undesirable effects
The majority of adverse events relate to the ocular system. In an open 5-year latanoprost safety study, 33% of patients developed iris pigmentation (see section 4.4). Other ocular adverse events are generally transient and occur on dose administration.
Adverse events are categorized by frequency as follows:
Very common (>1/10)
Common (>1/100 to <1/10)
Uncommon (>1/1,000 to <1/100)
Rare (>1/10,0000 to <1/1,000)
Very rare (<1/10,000)
Not known (cannot be estimated from the available data).
Eye Disorders:
Very common: Increased iris pigmentation; mild to moderate conjunctival hyperaemia eye irritation (burning grittiness, itching, stinging and foreign body sensation); eyelash and vellus hair changes (increased length, thickness, pigmentation and number) (vast majority of reports in Japanese population).
Common: transient punctate epithelial erosions, mostly without symptoms; blepharitis; eye pain.
Uncommon: Eyelid oedema; dry eye; keratitis; vision blurred; conjunctivitis.
Rare: Iritis/uveitis (the majority of reports in patients with concomitant predisposing factors); macular oedema; symptomatic corneal oedema and erosions; periorbital oedema; misdirected eyelashes sometimes resulting in eye irritation; extra row of cilia at the aperture of the meibomian glands (distichiasis).
Cardiac Disorders:
Very rare: Aggravation of angina in patients with pre-existing disease.
Respiratory, Thoracic and Mediastinal Disorders:
Rare: Asthma, asthma exacerbation and dyspnoea.
Skin and Subcutaneous Tissue Disorders:
Uncommon: Skin rash.
Rare: Localised skin reaction on the eyelids; darkening of the palpebral skin of the eyelids.
General Disorders and Administration Site Conditions:
Very rare: Chest pain.
There have been additional post-marketing spontaneous reports of the following:
Nervous System Disorders:
Headache, Dizziness.
Cardiac Disorders:
Palpitations.
Musculoskeletal and Connective Tissue Disorders:
Myalgia; Arthralgia.
4.9 Overdose
Apart from ocular irritation and conjunctival hyperaemia, no other ocular adverse reactions are known if Latanoprost 50 micrograms/ml, eye drops, solution is overdosed.
If Latanoprost 50 micrograms/ml, eye drops, solution is accidentally ingested the following information may be useful: One bottle contains 125 micrograms latanoprost. More than 90% is metabolised during the first pass through the liver. Intravenous infusion of 3 micrograms/kg in healthy volunteers induced no symptoms, but a dose of 5.5-10 micrograms/kg caused nausea, abdominal pain, dizziness, fatigue, hot flushes and sweating. In monkeys, latanoprost has been infused intravenously in doses of up to 500 micrograms/kg without major effects on the cardiovascular system.
Intravenous administration of latanoprost in monkeys has been associated with transient bronchoconstriction. However, in patients with moderate bronchial asthma, bronchoconstriction was not induced by latanoprost when applied topically on the eyes in a dose of seven times the clinical dose of Latanoprost 50 micrograms/ml, eye drops, solution.
If overdose with Latanoprost 50 micrograms/ml, eye drops, solution occurs, treatment should be symptomatic.
5 PHARMACOLOGICAL PROPERTIES
5.1 Pharmacodynamic properties
Pharmacotherapeutic group: Anti glaucoma preparations and miotics, prostaglandin analogues; ATC code: S 01 E E 01
The active substance latanoprost, a prostaglandin F2aanalogue, is a selective prostanoid FP receptor agonist which reduces the intraocular pressure by increasing the outflow of aqueous humour. Reduction of the intraocular pressure in man starts about three to four hours after administration and maximum effect is reached after eight to twelve hours. Pressure reduction is maintained for at least 24 hours.
Studies in animals and man indicate that the main mechanism of action is increased uveoscleral outflow, although some increase in outflow facility (decrease in outflow resistance) has been reported in man.
Pivotal studies have demonstrated that Latanoprost is effective as monotherapy. In addition, clinical trials investigating combination use have been performed. These include studies that show that latanoprost is effective in combination with beta-adrenergic antagonists (timolol). Short-term (1 or 2 weeks) studies suggest that the effect of latanoprost is additive in combination with adrenergic agonists (dipivalyl epinephrine), oral carbonic anhydrase inhibitors (acetazolamide) and at least partly additive with cholinergic agonists (pilocarpine).
Clinical trials have shown that latanoprost has no significant effect on the production of aqueous humour. Latanoprost has not been found to have any effect on the blood-aqueous barrier.
Latanoprost has no or negligible effects on the intraocular blood circulation when used at the clinical dose and studied in monkeys. However, mild to moderate conjunctival or episcleral hyperaemia may occur during topical treatment.
Chronic treatment with latanoprost in monkey eyes, which had undergone extracapsular lens extraction, did not affect the retinal blood vessels as determined by fluorescein angiography.
Latanoprost has not induced fluorescein leakage in the posterior segment of pseudophakic human eyes during short-term treatment.
Latanoprost in clinical doses has not been found to have any significant pharmacological effects on the cardiovascular or respiratory system.
5.2 Pharmacokinetic properties
Latanoprost (mw 432.58) is an isopropyl ester prodrug which per se is inactive, but after hydrolysis to the acid of latanoprost becomes biologically active.
The prodrug is well absorbed through the cornea and all active substance that enters the aqueous humour is hydrolysed during the passage through the cornea.
Studies in man indicate that the peak concentration in the aqueous humour is reached about two hours after topical administration. After topical application in monkeys, latanoprost is distributed primarily in the anterior segment, the conjunctivae and the eyelids. Only minute quantities of the active substancereach the posterior segment.
There is practically no metabolism of the acid of latanoprost in the eye. The main metabolism occurs in the liver. The half life in plasma is 17 minutes in man. The main metabolites, the 1,2-dinor and 1,2,3,4-tetranor metabolites, exert no or only weak biological activity in animal studies and are excreted primarily in the urine.
5.3 Preclinical safety data
The ocular as well as systemic toxicity of latanoprost has been investigated in several animal species. Generally, latanoprost is well tolerated with a safety margin between clinical ocular dose and systemic toxicity of at least 1000 times. High doses of latanoprost, approximately 100 times the clinical dose/kg body weight, administered intravenously to unanaesthetised monkeys have been shown to increase the respiration rate probably reflecting bronchoconstriction of short duration. In animal studies, latanoprost has not been found to have sensitising properties.
In the eye, no toxic effects have been detected with doses of up to 100 micrograms/eye/day in rabbits or monkeys (clinical dose is approximately 1.5 micrograms/eye/day). In monkeys, however, latanoprost has been shown to induce increased pigmentation of the iris.
The mechanism of increased pigmentation seems to be stimulation of melanin production in melanocytes of the iris with no proliferative changes observed. The change in iris colour may be permanent.
In chronic ocular toxicity studies, administration of latanoprost 6 micrograms/eye/day has also been shown to induce increased palpebral fissure. This effect is reversible and occurs at doses above the clinical dose level. The effect has not been seen in humans.
Latanoprost was found negative in reverse mutation tests in bacteria, gene mutation in mouse lymphoma and mouse micronucleus test. Chromosome aberrations were observed in vitro with human lymphocytes. Similar effects were observed with prostaglandin F2(1, a naturally occurring prostaglandin, and indicates that this is a class effect.
Additional mutagenicity studies on in vitro/in vivo unscheduled DNA synthesis in rats were negative and indicate that latanoprost does not have mutagenic potency. Carcinogenicity studies in mice and rats were negative.
Latanoprost has not been found to have any effect on male or female fertility in animal studies. In the embryotoxicity study in rats, no embryotoxicity was observed at intravenous doses (5, 50 and 250 micrograms/kg/day) of latanoprost. However, latanoprost induced embryolethal effects in rabbits at doses of 5 micrograms/kg/day and above.
The dose of 5 micrograms/kg/day (approximately 100 times the clinical dose) caused significant embryofetal toxicity characterised by increased incidence of late resorption and abortion and by reduced fetal weight.
No teratogenic potential has been detected.
6.1 List of excipients
Sodium chloride
Benzalkonium chloride
Sodium dihydrogen phosphate monohydrate
Anhydrous disodium phosphate
Water, purified
6.2 Incompatibilities
In vitro studies have shown that precipitation occurs when eye drops containing thiomersal are mixed with Latanoprost 50 micrograms/ml, eye drops, solution. If such medicinal productsare used, the eye drops should be administered with an interval of at least five minutes.
6.3 Shelf life
Shelf life: 24 months
Shelf life after opening of container: 4 weeks
6.4 Special precautions for storage
Store and transport refrigerated (2°C - 8°C).
Keep the bottle in the outer carton in order to protect from light.
After first opening the bottle: Do not store above 25°C.
6.5 Nature and contents of container
Low density polyethylene bottle and dropper with high density polyethylene cap.
Each bottle contains 2.5 ml eye drops, solution corresponding to approximately 80 drops of solution.
Latanoprost 50 micrograms/ml, eye drops, solution is available in the follwing pack sizes: one bottle of 2.5 ml, 3 bottles of 2.5 ml and 6 bottles of 2.5 ml.
Not all pack sizes may be marketed.
6.6 Special precautions for disposal
No special requirements.
7 MARKETING AUTHORISATION HOLDER
Dr. Gerhard Mann Chem.-pharm. Fabrik GmbH Brunsbutteler Damm 165-173 13581 Berlin Germany
Telephone:+49 (0)30 33093-0 Fax:+49 (0)30 33093-350
8 MARKETING AUTHORISATION NUMBER(S)
PL 13757/0004
9 DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
27/07/2010
10 DATE OF REVISION OF THE TEXT
27/07/2010