Prostaglandin F2α analogue (topical IOP reduction) Pregnancy: Avoid — limited safety data; animal studies show adverse effects.

Latanoprost 0.005%

Brand names: Xalatan, Monoprost

Adult dose

Dose: 1 drop in affected eye(s) once daily

Route: Ophthalmic (eye drops)

Frequency: Once daily (evening — important: evening administration is superior)

Max: 1 drop per eye once daily

Glaucoma / ocular hypertension: 1 drop once daily in the evening. Wash hands before and after administration. Instil drop into conjunctival sac, close eye for 1–2 minutes. Press on lacrimal punctum to reduce systemic absorption. Remove contact lenses before instillation (reinsert after 15 minutes).

Paediatric dose

Route: Ophthalmic

Frequency: Once daily

Max: 1 drop per eye

Not fully evaluated in children but used under specialist care (paediatric glaucoma). Same instillation as adults. Congenital glaucoma: paediatric ophthalmology specialist.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

No dose adjustment required.

Clinical pearls

First-line for open-angle glaucoma and ocular hypertension
Evening administration gives better IOP reduction than morning
Iris colour change is permanent — warn patient, particularly those with mixed-colour irides
Punctal occlusion: press inner corner of eye for 1–2 min after instillation (reduces systemic absorption and side effects)
Fixed combination available: Xalacom (latanoprost + timolol)

Contraindications

Hypersensitivity to latanoprost
Periorbital inflammatory conditions (uveitis with macular oedema — relative)

Side effects

Iris pigmentation change (irreversible — increased brown pigmentation in iris, permanent)
Eyelash changes (increased length, thickness, pigmentation)
Periorbital skin hyperpigmentation (partially reversible on stopping)
Conjunctival hyperaemia
Macular oedema (risk in uveitis, aphakia)
Eye irritation and stinging

Interactions

Timolol eye drops — used in combination for enhanced IOP reduction
Non-steroidal anti-inflammatory eye drops — may reduce latanoprost efficacy

Monitoring

IOP (target reduction >20%)
Iris appearance
Eyelash/eyelid changes
Macular OCT (if uveitis/aphakia)

Reference: BNFc; BNF; NICE CG85 Glaucoma; EGS Glaucoma Guidelines 2020. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways