Usage
- Travoprost is prescribed for the reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. It can be used as first-line monotherapy or as adjunctive therapy. In pediatric patients, it’s used to decrease elevated IOP in those aged 2 months to <18 years with ocular hypertension or pediatric glaucoma.
- Pharmacological Classification: Prostaglandin analog, Antiglaucoma agent.
- Mechanism of Action: Travoprost is a selective FP prostanoid receptor agonist. It increases the outflow of aqueous humor from the eye, primarily through the uveoscleral pathway and, to a lesser extent, the trabecular meshwork, thereby lowering IOP.
Alternate Names
- International Nonproprietary Name (INN): Travoprost
- Brand Names: Travatan Z, Izba, Travatan
How It Works
- Pharmacodynamics: Travoprost lowers IOP by increasing uveoscleral outflow.
- Pharmacokinetics:
- Absorption: Following ocular administration, travoprost is absorbed through the cornea.
- Metabolism: Travoprost is hydrolyzed in the cornea to the biologically active free acid. Systemic metabolism occurs via fatty acid β-oxidation.
- Elimination: Travoprost and its metabolites are primarily eliminated through hepatic metabolism and renal excretion.
- Mode of Action: Travoprost binds to the FP prostanoid receptor, which increases the formation of matrix metalloproteinases in the ciliary muscle, ultimately increasing uveoscleral outflow.
Dosage
Standard Dosage
Adults:
- One drop in the affected eye(s) once daily in the evening.
- Do not administer more than once daily, as more frequent administration may reduce the IOP-lowering effect.
Children:
- 2 months to <18 years: One drop in the affected eye(s) once daily in the evening. Data is limited for the age group 2 months to <3 years.
- Safety and efficacy have not been established in children below the age of 2 months.
Special Cases:
- Elderly Patients: No dose adjustment is necessary.
- Patients with Renal Impairment: No dose adjustment is necessary.
- Patients with Hepatic Dysfunction: No dose adjustment is necessary.
- Patients with Comorbid Conditions: Diabetes or prior eye surgery should be discussed with the physician before starting treatment.
Clinical Use Cases
Travoprost is specifically indicated for open-angle glaucoma or ocular hypertension. It’s not typically employed for:
- Intubation
- Surgical Procedures
- Mechanical Ventilation
- Intensive Care Unit (ICU) Use
- Emergency Situations (e.g., status epilepticus, cardiac arrest)
Dosage Adjustments
No dose adjustments are typically required based on renal or hepatic dysfunction. However, dose modification may be considered by the physician in specific situations or if used with other IOP-lowering medications.
Side Effects
Common Side Effects:
- Ocular hyperemia (eye redness)
- Eye discomfort/irritation/itching/pain
- Blurred vision
- Dry eyes, tearing
- Foreign body sensation
- Eyelid crusting
- Increased eyelash growth (length, thickness, number, pigmentation)
- Darkening of the eyelids
- Increased sensitivity to light
Rare but Serious Side Effects:
- Iritis, Uveitis
- Macular edema
- Severe allergic reactions (e.g., angioedema, rash, itching, hives)
- Permanent darkening of the iris
Long-Term Effects:
- Permanent darkening of the iris
- Potentially permanent changes in eyelash growth and eyelid skin color
Adverse Drug Reactions (ADR)
- Severe allergic reactions requiring urgent medical attention
- Worsening of pre-existing eye conditions (e.g., uveitis, macular edema)
Contraindications
- Hypersensitivity to travoprost or any component of the formulation.
- Pregnancy or women attempting to become pregnant.
Drug Interactions
- No clinically significant drug interactions have been reported. However, inform your healthcare provider about all medications, including OTC drugs and supplements.
- If using other topical ophthalmic medications, administer them at least 5 minutes apart.
Pregnancy and Breastfeeding
- Pregnancy: Contraindicated. Travoprost may interfere with the maintenance of pregnancy and has been shown to be teratogenic in animal studies.
- Breastfeeding: Not recommended unless there are no safer alternatives. It is unknown whether travoprost is excreted in human milk.
Drug Profile Summary
- Mechanism of Action: FP prostanoid receptor agonist, increases uveoscleral outflow of aqueous humor.
- Side Effects: Ocular hyperemia, eye irritation, blurred vision, changes in eyelashes/eyelids.
- Contraindications: Hypersensitivity, pregnancy.
- Drug Interactions: No significant known interactions.
- Pregnancy & Breastfeeding: Contraindicated in pregnancy, not recommended while breastfeeding.
- Dosage: One drop in affected eye(s) once daily in the evening.
- Monitoring Parameters: IOP, eye color, eyelash and eyelid changes.
Popular Combinations
- Travoprost is sometimes used in combination with timolol, a beta-blocker, for additive IOP-lowering effects.
Precautions
- General Precautions: Monitor for eye inflammation, changes in eye pigmentation, and allergic reactions.
- Specific Populations: Contraindicated in pregnancy. Use with caution during breastfeeding. Safety not established below 2 months of age.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Travoprost?
A: One drop in the affected eye(s) once daily in the evening for adults and children 2 months to <18 years.
Q2: What are the common side effects of Travoprost?
A: The most common side effect is ocular hyperemia (eye redness). Other common side effects include eye discomfort, blurred vision, increased eyelash growth, and darkening of the eyelids/iris.
Q3: Is Travoprost safe during pregnancy?
A: No, Travoprost is contraindicated in pregnancy due to potential teratogenic effects.
Q4: Can I use Travoprost while breastfeeding?
A: Travoprost is not recommended during breastfeeding unless no safer alternatives exist.
Q5: How does Travoprost work to lower eye pressure?
A: Travoprost primarily increases uveoscleral outflow of aqueous humor, leading to reduced IOP.
Q6: Are there any drug interactions I should be aware of with Travoprost?
A: No clinically significant drug interactions have been reported. However, inform your physician about all medications you are taking.
Q7: How long does it take for Travoprost to start working?
A: Reduction in IOP begins approximately 2 hours after administration, with the maximum effect achieved after 12 hours.
Q8: Can Travoprost permanently change eye color?
A: Yes, Travoprost can cause increased brown pigmentation of the iris, which is often permanent. It may also cause darkening of the eyelids and eyelashes, which may be reversible in some patients.
Q9: What should I do if I miss a dose of Travoprost?
A: Continue with the next dose as planned. Do not administer a double dose.
A: Remove contact lenses before administering Travoprost and wait at least 15 minutes before reinserting them. The preservative benzalkonium chloride (if present in the specific formulation used) can be absorbed by soft contact lenses.
