What is the recommended use and dosage of Vyzulta (latanoprostene bunod) for patients with glaucoma or ocular hypertension?

Vyzulta (Latanoprostene Bunod) Dosage and Use for Glaucoma/Ocular Hypertension

Vyzulta (latanoprostene bunod ophthalmic solution 0.024%) should be administered as one drop in the conjunctival sac of the affected eye(s) once daily in the evening for the reduction of intraocular pressure in patients with open-angle glaucoma or ocular hypertension. 1

Mechanism of Action and Efficacy

Latanoprostene bunod is a novel nitric oxide (NO)-donating prostaglandin F2α analog that works through a dual mechanism:

• Increases aqueous humor outflow through the uveoscleral pathway (mediated by latanoprost acid)
• Increases facility of aqueous humor outflow through the trabecular meshwork pathway (mediated by nitric oxide) 2

This dual mechanism provides significant IOP reduction:

• Clinical studies demonstrate 22-27% reduction in IOP from baseline 3, 4
• Effects begin within 4 weeks and are maintained long-term (up to 52 weeks) 4
• Superior IOP-lowering efficacy compared to timolol 0.5% in phase III studies 5

Administration Guidelines

• Apply one drop in the affected eye(s) once daily in the evening
• Do not administer more than once daily as more frequent administration may decrease effectiveness 1
• If used with other topical ophthalmic medications, administer at least 5 minutes apart 1
• Consistent evening administration is important for optimal efficacy

Warnings and Precautions

Several important considerations when prescribing Vyzulta:

1. Pigmentation changes:

   • May cause increased pigmentation of iris and periorbital tissue
   • Iris pigmentation changes are likely permanent
   • Periorbital tissue and eyelash changes are usually reversible 1

2. Eyelash changes:

   • May gradually increase length, thickness, and number of eyelashes
   • Usually reversible upon discontinuation 1

3. Special populations:

   • Use with caution in patients with history of intraocular inflammation
   • Use with caution in aphakic patients or those with risk factors for macular edema 1

Common Adverse Effects

The most common ocular adverse reactions include:

• Conjunctival hyperemia (6%)
• Eye irritation (4%)
• Eye pain (3%)
• Instillation site pain (2%) 1

Most ocular adverse events are mild to moderate in severity and rarely lead to discontinuation 4.

Clinical Pearls

• Latanoprostene bunod has demonstrated sustained 24-hour IOP control in clinical studies 3
• The nitric oxide component may provide additional benefits for ocular blood flow and retinal ganglion cell survival 2
• Once-daily dosing promotes better adherence compared to medications requiring multiple daily doses
• If monotherapy is insufficient, consider fixed combination with timolol, though this should only be used if monotherapy fails to achieve target IOP 6

Monitoring

• Regular monitoring of IOP response is essential
• Periodic examination for pigmentation changes and eyelash growth
• Patients should be informed about potential for iris color changes and eyelash growth 1

Vyzulta represents an effective first-line treatment option for patients with open-angle glaucoma or ocular hypertension with a convenient once-daily dosing regimen and proven efficacy for long-term IOP control.