What is Xalatan (latanoprost) commonly used for?

Xalatan (Latanoprost) Uses in Clinical Practice

Xalatan (latanoprost) is primarily used for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension. 1

Mechanism of Action

• Latanoprost is a prostanoid selective FP receptor agonist that reduces intraocular pressure (IOP) by increasing the outflow of aqueous humor, primarily through the uveoscleral pathway 1
• The medication works as an ester prodrug that is hydrolyzed in the cornea to its biologically active acid form 1
• The IOP-lowering effect of latanoprost lasts for 20-24 hours after a single dose, allowing for a convenient once-daily dosing regimen 2

Clinical Efficacy

• Latanoprost 0.005% administered once daily reduces diurnal IOP by 22-39% over 1-12 months of treatment, with maintained efficacy for up to 2 years 3
• Comparative efficacy studies show that latanoprost is:
  • More effective than timolol 0.5% twice daily in 3 of 4 large clinical trials 3
  • More effective than dorzolamide and brimonidine in reducing IOP 3
  • Generally as effective as bimatoprost or travoprost, though bimatoprost may achieve slightly higher efficacy in IOP reduction 3, 4
• Latanoprost has a favorable tolerability profile compared to other prostaglandin analogs 4

Position in Treatment Algorithm

• Prostaglandin analogs, including latanoprost, are among the most efficacious first-line medications for lowering IOP in open-angle glaucoma and ocular hypertension 4
• When used as monotherapy, latanoprost provides significant IOP reduction with the convenience of once-daily dosing 3
• For patients inadequately controlled on beta-blockers, switching to latanoprost monotherapy is at least as effective as adding other agents like dorzolamide or pilocarpine 3
• Fixed combination therapy of latanoprost with timolol provides better IOP-lowering effects than either component alone for patients requiring multiple medications 4

Special Considerations

• Pregnancy: Latanoprost has a Pregnancy Category C rating. Most ophthalmologists avoid prostaglandins during pregnancy due to theoretical risk of premature labor, though they may be considered during breastfeeding 4
• The most common side effects include:
  • Conjunctival hyperaemia (3-15% of patients) 3
  • Increased iris pigmentation (2-9% of patients), which may be permanent 3
• Latanoprost does not produce the cardiopulmonary adverse effects associated with beta-blockers, making it suitable for patients with respiratory or cardiovascular conditions 3

Clinical Pearls

• When selecting between prostaglandin analogs, consider that bimatoprost may provide slightly greater IOP reduction, while latanoprost has a more favorable tolerability profile 4
• Latanoprost can be used effectively as adjunctive therapy in patients refractory to other glaucoma medications 3
• The medication should be applied once daily in the evening for optimal effect 2
• Patients should be counseled about potential iris color changes, particularly those with hazel-colored eyes 5
• Latanoprost has shown promising results in angle-closure glaucoma following iridotomy, though more clinical experience is needed in this population 3