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Prostaglandin analogue Pregnancy: Should not be used during pregnancy unless clearly necessary — no adequate data in pregnant women; animal studies show reproductive toxicity at high maternotoxic doses. Breast-feeding: excretion in human milk unknown (excreted in animal milk) — decide whether to discontinue breast-feeding or bimatoprost (SPC 4.6).

Bimatoprost

Brand names: Lumigan

Bimatoprost is a topical prostaglandin analogue (prostamide) used to lower intraocular pressure in ocular hypertension and open-angle glaucoma.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One drop in the affected eye(s)
Route: Ocular (topical eye drops)
Frequency: Once daily, administered in the evening
Max: The dose should not exceed once daily, as more frequent administration may lessen the intraocular pressure lowering effect
Source is the eMC SPC for 'Bimatoprost 0.1 mg/ml eye drops, solution' (0.01%) — confirm the strength actually prescribed, as the 0.3 mg/ml (0.03%) product has its own SPC. Method of administration: if more than one topical ophthalmic medicinal product is being used, each one should be administered at least 5 minutes apart. Renal/hepatic impairment: bimatoprost has not been studied in patients with renal or moderate to severe hepatic impairment and should be used with caution in such patients. Paediatric population: the safety and efficacy of bimatoprost in children aged 0 to 18 years has not yet been established (SPC 4.2). US labelling for bimatoprost ophthalmic solution 0.03% states the same regimen (one drop in the affected eye(s) once daily in the evening) and that use in patients below the age of 16 years is not recommended because of potential safety concerns related to increased pigmentation with long-term chronic use.

Dose adjustments

Renal

Not studied in renal impairment (or moderate to severe hepatic impairment) — use with caution in such patients (SPC 4.2).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients
  • Bimatoprost 0.1 mg/ml is contraindicated in patients who have had a suspected previous adverse reaction to benzalkonium chloride that has led to discontinuation

Side effects

  • Conjunctival hyperaemia — very common (29% of patients in the 12-month study; mostly trace to mild)
  • Prostaglandin analogue periorbitopathy — very common (deepening of the eyelid sulcus, ptosis, enophthalmos, eyelid retraction; may impair field of vision)
  • Punctate keratitis, eye irritation, eye pruritus, eye pain, erythema of eyelid, eyelid pruritus — common
  • Growth of eyelashes; skin hyperpigmentation and hypertrichosis — common
  • Iris hyperpigmentation — uncommon and likely permanent; macular oedema and blurred vision also reported

Clinical monograph

How it works

It increases aqueous humour outflow, predominantly through the uveoscleral pathway, thereby reducing intraocular pressure.

Prescribing in practice

  • Warn patients that it can cause permanent darkening of the iris and eyelid skin and increased growth and pigmentation of eyelashes, with iris colour change being irreversible.
  • It can cause conjunctival hyperaemia and may reactivate or worsen ocular inflammation, so use with caution in active uveitis or a history of macular oedema.
  • Wipe away any excess to reduce darkening of periocular skin.

Monitoring

Monitor intraocular pressure for response and observe for iris and periocular pigmentation changes, eyelash changes and conjunctival hyperaemia.

Counselling the patient

  • Be aware that eye colour, eyelid skin and eyelash appearance can change, and iris colour change may be permanent.
  • If treating one eye, this can cause a difference in appearance between the eyes.
  • Remove contact lenses before instillation and wait before reinserting.

Evidence & guidelines

Bimatoprost is an established first-line prostaglandin analogue for open-angle glaucoma and ocular hypertension, with NICE recommending this class as initial therapy.

Reference: NICE NG81; RCOphth; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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