Bimatoprost Dosing for Open-Angle Glaucoma and Ocular Hypertension
Bimatoprost 0.03% should be administered once daily in the evening, and there is no role for the 0.01% concentration or twice-daily dosing, as once-daily 0.03% provides superior IOP reduction compared to both twice-daily 0.03% and represents the most effective prostaglandin analog monotherapy available. 1, 2
Initial Dose Selection
Start with bimatoprost 0.03% once daily in the evening (8 PM) as this concentration and frequency provides the greatest IOP-lowering efficacy among all prostaglandin analogs 1, 2
Do not use bimatoprost 0.01%—this lower concentration is not mentioned in treatment guidelines and lacks evidence supporting its use in the clinical trial literature 3, 1
Avoid twice-daily dosing of bimatoprost 0.03%, as it is paradoxically less effective than once-daily administration, reducing IOP by only 7.78 mmHg (30.4%) compared to 9.16 mmHg (35.2%) with once-daily dosing at 3 months 2
Expected Efficacy
Bimatoprost 0.03% once daily reduces IOP by approximately 8-9 mmHg (32-35%) from baseline, which is 2-3 mmHg greater than timolol and 1.2-2.2 mmHg greater than latanoprost at various time points 2, 4, 5
At 6 months, bimatoprost achieves target IOP ≤15 mmHg in a significantly higher percentage of patients compared to latanoprost (69-82% vs 50-62% achieving ≥20% IOP reduction) 4
The superior IOP-lowering effect is consistent across all measurement times (8 AM, 12 PM, 4 PM) and persists throughout 6-month follow-up 4, 5
Titration Strategy
No dose titration is needed or recommended—bimatoprost is initiated and maintained at 0.03% once daily 2, 5
If inadequate IOP control occurs after 4-6 weeks, add a second agent (such as timolol) rather than increasing bimatoprost frequency, as fixed combination therapy provides better IOP-lowering than either component alone 1
Reassess IOP at 2 weeks, 6 weeks, and 3 months to confirm adequate response 2
Common Pitfalls to Avoid
Do not prescribe twice-daily dosing—this is a critical error, as once-daily evening dosing is both more effective and better tolerated than twice-daily administration 2, 5
Counsel patients about expected conjunctival hyperemia and eyelash growth, which occur more frequently with bimatoprost than other prostaglandin analogs but rarely lead to discontinuation 4, 6
Avoid bimatoprost in patients with active uveitis, macular edema, or history of herpetic keratitis 7
Consider alternative agents in patients with asthma or COPD only if beta-blockers are being considered—prostaglandin analogs including bimatoprost are preferred in these populations 7