What is the recommended dosage and treatment plan for Vyzulta (latanoprostene bunod) in patients with glaucoma?

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. 1

Standard Dosing Regimen

• The FDA-approved dose is latanoprostene bunod 0.024% ophthalmic solution, one drop once daily in the evening 1
• Do not administer more than once daily, as more frequent dosing of prostaglandin analogs may actually reduce the IOP-lowering effect 1
• The 0.024% concentration was identified as the optimal dose in dose-ranging studies, providing superior IOP reduction compared to latanoprost 0.005% 2

Expected IOP Reduction

• Vyzulta reduces IOP by approximately 27-30% from baseline (3.6-4.2 mmHg reduction) over 24 hours 3
• Peak IOP lowering occurs at 12 hours post-instillation (8 AM when dosed at 8 PM), with a mean reduction of 4.2 mmHg or 30% 3
• Trough effect at 24 hours (8 PM) still maintains a 2.8 mmHg or 20% reduction 3
• IOP reductions are evident as early as week 4 and maintained through 12 months of treatment 4

Combination Therapy Guidelines

• When using Vyzulta with other topical ophthalmic medications, wait at least 5 minutes between different eye drops to prevent washout 1, 5, 6
• This spacing ensures proper absorption and prevents dilution of the active medication 5

Mechanism and Rationale

• Vyzulta works through a dual mechanism: the latanoprost acid component increases uveoscleral outflow, while the nitric oxide component enhances trabecular meshwork outflow 4, 7
• This dual pathway provides superior IOP lowering compared to latanoprost alone and timolol 8, 2
• The nitric oxide component may also improve ocular blood flow and promote retinal ganglion cell survival 7

Monitoring Protocol

• Check IOP response within 2-4 weeks of initiation to confirm adequate pressure reduction 6
• Continue monitoring regularly, as IOP-lowering efficacy is maintained over 9-12 months without apparent tachyphylaxis 4

Common Adverse Effects

• Most common ocular adverse reactions (≥2% incidence) include conjunctival hyperemia (6%), eye irritation (4%), eye pain (3%), and instillation site pain (2%) 1
• Most adverse events are mild to moderate in severity and transient 4, 8

Critical Warnings and Precautions

Pigmentation Changes

• Vyzulta may cause permanent increased pigmentation of the iris, with brown pigmentation spreading concentrically from the pupil toward the periphery 1
• Periorbital tissue (eyelid) pigmentation is also possible but typically reversible upon discontinuation 1
• Inform patients that iris color changes may not be noticeable for several months to years 1

Eyelash Changes

• Gradual changes to eyelashes include increased length, thickness, and number of lashes 1
• These changes are usually reversible upon discontinuation 1

Intraocular Inflammation

• Use with caution in patients with history of iritis/uveitis 1
• Generally should not be used 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

Contraindications

• None listed in FDA labeling 1

Pitfalls to Avoid

• Do not dose more frequently than once daily—this reduces efficacy rather than enhancing it 1
• Do not administer multiple eye drops simultaneously without the 5-minute waiting period 1
• Do not use in patients with active intraocular inflammation without careful consideration 1