Contraindications to Latanoprost
Latanoprost has no absolute contraindications listed in the FDA label, but should be avoided or used with extreme caution in patients with active intraocular inflammation (uveitis), aphakic or pseudophakic patients with torn posterior lens capsule, and those with known risk factors for macular edema. 1
Relative Contraindications and High-Risk Situations
Active or History of Uveitis
- Latanoprost may precipitate or exacerbate anterior uveitis and should be avoided in patients with active inflammation 2, 3
- The prostaglandin mechanism of action is inherently pro-inflammatory, making it problematic in inflammatory conditions 3
- Case reports demonstrate that uveitis can occur unilaterally in the treated eye and recurs upon rechallenge with the medication 2
- Patients with a history of prior uveitis or incisional ocular surgery are at particularly high risk for developing latanoprost-associated uveitis 2
Aphakic and Pseudophakic Patients
- Latanoprost should be used with extreme caution in aphakic patients, pseudophakic patients with torn posterior lens capsule, or patients with known risk factors for macular edema 1
- Cystoid macular edema has been reported in pseudophakic and aphakic patients using latanoprost 3, 4
- Close monitoring is essential if latanoprost must be used in these populations 3
Herpes Simplex Keratitis
- Reactivation of herpes keratitis and herpes dermatitis has been reported with latanoprost use 4
- Exercise caution in patients with a history of herpetic eye disease 4
Pregnancy and Lactation Considerations
Pregnancy (Category C)
- Latanoprost is Pregnancy Category C and should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus 1
- Animal studies in rabbits showed embryocidal effects at approximately 80 times the maximum human dose 1
- The American Academy of Ophthalmology notes theoretical concerns about prostaglandins causing premature labor, though a small case series of 11 pregnant women showed no adverse effects 5
- Most ophthalmologists avoid prostaglandins during pregnancy due to theoretical risks, favoring beta-blockers instead 5
Breastfeeding
- It is unknown whether latanoprost is excreted in human milk; caution should be exercised when administering to nursing women 1
- Prostaglandin analogs may be considered for use in breastfeeding mothers more readily than during pregnancy 5
Important Precautions
Contact Lens Wear
- Contact lenses must be removed prior to latanoprost administration and may be reinserted 15 minutes after application 1
- Latanoprost contains benzalkonium chloride, which can be absorbed by contact lenses 1
Bacterial Contamination Risk
- Patients must avoid allowing the dropper tip to contact the eye or surrounding structures to prevent bacterial contamination 1
- Bacterial keratitis has been reported with contaminated multi-dose containers, particularly in patients with concurrent corneal disease 1