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Prostaglandin analogue (topical IOP reduction) Pregnancy: §4.6 Pregnancy: 'There are no adequate data from the use of bimatoprost in pregnant women. Animal studies have shown reproductive toxicity at high maternotoxic doses (see section 5.3). LUMIGAN should not be used during pregnancy unless clearly necessary.' Breast-feeding: 'It is unknown whether bimatoprost is excreted in human breast milk. Animal studies have shown excretion of bimatoprost in breast milk. A decision must be made whether to discontinue breast-feeding or to discontinue from LUMIGAN therapy taking into account the benefit of breast feeding for the child and the benefit of therapy for the woman.' Fertility: 'There are no data on the effects of bimatoprost on human fertility.'

Bimatoprost 0.03% Eye Drops (Lumigan)

Brand names: Lumigan

Bimatoprost 0.03% eye drops are a topical prostaglandin analogue (prostamide) used to reduce intraocular pressure in ocular hypertension and open-angle glaucoma.

Adult dose

Dose: One drop of bimatoprost 0.3 mg/mL eye drops, solution, in the affected eye(s)
Route: Ophthalmic (topical, to the eye)
Frequency: Once daily, administered in the evening
Max: One drop per affected eye once daily — 'The dose should not exceed once daily as more frequent administration may lessen the intraocular pressure lowering effect' (§4.2)
The strength is pinned by the SPC product name — 'LUMIGAN 0.3 mg/mL eye drops, solution' — so the one-drop count is quantified. STRENGTH EQUIVALENCE (arithmetic, not a figure printed in the SPC): 0.3 mg/mL is the same strength as the 0.03% in the page title — 0.3 mg per mL is 0.03 g per 100 mL. Verbatim posology: 'The recommended dose is one drop in the affected eye(s) once daily, administered in the evening.' INDICATION SCOPE: the fetched bundle does not include §4.1, so the licensed indication wording was not retrieved; §4.4 refers to 'studies of bimatoprost 0.3 mg/ml in patients with glaucoma or ocular hypertension' and to the IOP-lowering effect throughout, which is this page's primary use (topical IOP reduction in open-angle glaucoma / ocular hypertension). Handling (single-dose container): 'For single use only, one container is sufficient to treat both eyes. Any unused solution should be discarded immediately after use.' Concomitant eye drops: 'If more than one topical ophthalmic medicinal product is being used, each one should be administered at least 5 minutes apart.' Contact lenses (§4.4): 'LUMIGAN 0.3 mg/mL single-dose has not been studied in patients wearing contact lenses. Contact lenses should be removed prior to instillation and may be reinserted 15 minutes following administration.' Skin contact (§4.4): 'There is a potential for hair growth to occur in areas where LUMIGAN solution comes repeatedly in contact with the skin surface. Thus, it is important to apply LUMIGAN as instructed and avoid it running onto the cheek or other skin areas.' Untested populations (§4.4): 'LUMIGAN has not been studied in patients with inflammatory ocular conditions, neovascular, inflammatory, angle-closure glaucoma, congenital glaucoma or narrow-angle glaucoma', nor in 'patients with compromised respiratory function', nor in 'patients with heart block more severe than first degree or uncontrolled congestive heart failure'.

Dose adjustments

Renal

§4.2: 'LUMIGAN has not been studied in patients with renal or moderate to severe hepatic impairment and should therefore be used with caution in such patients.' No dose adjustment is specified.

Hepatic

§4.2: 'LUMIGAN has not been studied in patients with renal or moderate to severe hepatic impairment and should therefore be used with caution in such patients. In patients with a history of mild liver disease or abnormal alanine aminotransferase (ALT), aspartate aminotransferase (AST) and/or bilirubin at baseline, bimatoprost 0.3 mg/mL eye drops (multi-dose formulation), solution had no adverse effect on liver function over 24 months.' No dose adjustment is specified.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients listed in section 6.1 (§4.3 — this is the only contraindication stated in the SPC)
  • Caution rather than contraindication (§4.4): known risk factors for macular oedema, 'e.g. aphakic patients, pseudophakic patients with a torn posterior lens capsule'
  • Caution rather than contraindication (§4.4): 'patients with a prior history of significant ocular viral infections (e.g. herpes simplex) or uveitis/iritis'
  • Caution rather than contraindication (§4.4): 'Patients with COPD, asthma or compromised respiratory function due to other conditions should be treated with caution', and 'patients predisposed to low heart rate or low blood pressure'

Side effects

  • Eye disorders — very common (≥1/10): conjunctival hyperaemia, prostaglandin analogue periorbitopathy. §4.8: 'conjuctival hyperaemia (mostly trace to mild and of a non-inflammatory nature) occurring in 24% of patients'
  • Eye disorders — common (≥1/100 to <1/10): punctate keratitis, eye irritation, foreign body sensation, dry eye, eye pain, eye pruritus (4% of patients), growth of eyelashes, eyelid erythema
  • Eye disorders — uncommon: asthenopia, conjunctival oedema, photophobia, lacrimation increased, iris hyperpigmentation, blurred vision, eyelid pruritus, eyelid oedema. Not known: eye discharge, ocular discomfort
  • Prostaglandin analogue periorbitopathy (§4.8): 'periorbital lipodystrophic changes which can lead to deepening of the eyelid sulcus, ptosis, enophthalmos, eyelid retraction, involution of dermatochalasis and inferior scleral show… can occur as early as one month after initiation… may cause impaired field of vision even in the absence of patient recognition… partially or fully reversible upon discontinuation'
  • Iris hyperpigmentation (§4.8): 'Increased iris pigmentation is likely to be permanent. The pigmentation change is due to increased melanin content in the melanocytes rather than to an increase in the number of melanocytes.'
  • Skin — common: skin hyperpigmentation (periocular); uncommon: hair growth abnormal; not known: skin discoloration (periocular)
  • Nervous system — uncommon: headache; not known: dizziness. Vascular — not known: hypertension
  • Respiratory — not known: 'asthma, asthma exacerbation, COPD exacerbation and dyspnoea'; §4.4 also records 'a limited number of spontaneous reports of bradycardia or hypotension' with the multi-dose formulation
  • Immune — not known: 'Hypersensitivity reaction including signs and symptoms of eye allergy and allergic dermatitis'
  • Cystoid macular oedema (§4.4): 'uncommonly reported (≥1/1,000 to <1/100) following treatment with bimatoprost 0.3 mg/mL eye drops (multi-dose formulation)'
  • This side-effect list may be incomplete — check the full SPC.

Monitoring

  • Intraocular pressure when combined with another prostaglandin (§4.4): 'Patients using LUMIGAN with other prostaglandin analogues should be monitored for changes to their intraocular pressure.' The same paragraph notes 'more frequent exposure of the eye to more than one dose of bimatoprost daily may decrease the IOP-lowering effect'
  • Counsel and then watch for periorbitopathy and iris pigmentation (§4.4): 'Before treatment is initiated, patients should be informed of the possibility of prostaglandin analogue periorbitopathy (PAP) and increased iris pigmentation… Some of these changes may be permanent, and may lead to impaired field of vision and differences in appearance between the eyes when only one eye is treated'
  • Visual field — PAP 'may cause impaired field of vision even in the absence of patient recognition' (§4.8)
  • Macular oedema in at-risk eyes (aphakia, pseudophakia with a torn posterior lens capsule) — §4.4 requires caution in these patients because of uncommonly reported cystoid macular oedema
  • Reactivation of ocular infection (§4.4): 'rare spontaneous reports of reactivation of previous corneal infiltrates or ocular infections' — use with caution and watch in patients with prior herpes simplex or uveitis/iritis
  • Respiratory and cardiovascular symptoms in susceptible patients (§4.4) — asthma/COPD exacerbation and bradycardia/hypotension have been reported

Clinical monograph

How it works

It lowers intraocular pressure by enhancing aqueous humour outflow, mainly via the uveoscleral route.

Prescribing in practice

  • Counsel that it can cause permanent iris darkening and darkening and increased growth of eyelashes and eyelid skin, with iris pigmentation change being irreversible.
  • Conjunctival hyperaemia is common, and it should be used cautiously where there is active intraocular inflammation or risk of macular oedema.
  • Blot excess solution from the skin to limit periocular pigmentation.

Monitoring

Monitor intraocular pressure to confirm efficacy and watch for pigmentary changes of the iris and periocular tissues, lash changes and conjunctival redness.

Counselling the patient

  • Expect possible changes to eye colour, lashes and eyelid skin, some of which may be permanent.
  • Use once at the recommended time of day and do not exceed the prescribed frequency, as more frequent use can reduce effectiveness.
  • Remove contact lenses before use and wait before reinserting.

Evidence & guidelines

Bimatoprost eye drops are an established prostaglandin analogue for glaucoma and ocular hypertension, a class recommended by NICE as first-line pressure-lowering therapy.

Reference: NICE CG85; EGS Glaucoma Guidelines 2020; Lumigan SPC; 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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