Vyzulta (Latanoprostene Bunod) Dosing and Treatment Protocol for Glaucoma
Administer one drop of Vyzulta 0.024% in the conjunctival sac of the affected eye(s) once daily in the evening only. 1
Dosing Specifications
Standard dose: One drop of 0.024% solution (0.24 mg/mL latanoprostene bunod) once daily in the evening 1
Critical timing: Evening administration only—do not dose more than once daily, as more frequent administration of prostaglandin analogs reduces IOP-lowering efficacy 1
When using multiple eye drops: Wait at least 5 minutes between different topical ophthalmic medications to prevent washout and ensure proper absorption 1, 2, 3
Expected Efficacy
IOP reduction: Vyzulta achieves superior IOP lowering compared to both latanoprost 0.005% and timolol 0.5%, with the greatest reduction among these agents 4, 5
Time to effect: IOP reductions occur as early as week 4 and are maintained over 12 months of treatment 6
24-hour coverage: Mean 24-hour IOP reduction of 3.6 mmHg (27% from baseline), with peak effect at 12 hours post-instillation (4.2 mmHg or 30% reduction) and trough at 24 hours (2.8 mmHg or 20% reduction) 7
Dual mechanism: Works through both uveoscleral pathway (via latanoprost acid) and trabecular meshwork pathway (via nitric oxide donation), providing enhanced aqueous humor outflow 6, 8
Follow-Up Monitoring
Initial response check: Assess IOP within 2-4 weeks of initiation to confirm adequate pressure reduction 9
Long-term monitoring: No loss of IOP-lowering effect has been observed over 9-12 months of continuous use 6
Critical Warnings and Precautions
Pigmentation Changes (Permanent)
Iris pigmentation: Increased brown pigmentation may occur and is likely permanent after discontinuation; typically spreads concentrically from pupil toward iris periphery over months to years 1
Periorbital pigmentation: Eyelid darkening can occur but is usually reversible upon discontinuation 1
Patient counseling required: Inform all patients about the possibility of permanent iris color changes before initiating therapy 1
Eyelash Changes (Reversible)
- Gradual increases in eyelash length, thickness, and number are common and usually reversible upon discontinuation 1
Intraocular Inflammation
Use with caution in patients with history of iritis/uveitis 1
Generally avoid in patients with active intraocular inflammation, as it may exacerbate the condition 1
Macular Edema Risk
Use with caution in aphakic patients, pseudophakic patients with torn posterior lens capsule, or those with known risk factors for macular edema 1
Cystoid macular edema has been reported with prostaglandin analogs 1
Common Adverse Effects
Most frequent (≥2% incidence): Conjunctival hyperemia (6%), eye irritation (4%), eye pain (3%), and instillation site pain (2%) 1
Severity: Most ocular adverse events are mild to moderate 6
Tolerability: Well tolerated over 12 months of continuous use 6, 8
Contraindications
- None listed in FDA labeling 1
Clinical Context
First-line positioning: Vyzulta is a prostaglandin analog, and prostaglandin analogs are recommended as first-line medical therapy for glaucoma by the American Academy of Ophthalmology, demonstrating superior IOP reduction compared to all other drug classes 3
Superiority evidence: Vyzulta demonstrated superiority over timolol 0.5% in phase III trials (APOLLO and LUNAR) and was superior to both latanoprost and timolol in comparative studies 6, 4