Latanoprost with netarsudil

How it works

Latanoprost increases uveoscleral outflow of aqueous humour, while netarsudil increases trabecular outflow and lowers episcleral venous pressure through Rho kinase inhibition, giving complementary intraocular pressure reduction.

Prescribing in practice

• Conjunctival hyperaemia (red eye) is very common, predominantly driven by the netarsudil component, and corneal verticillata (whorl-like deposits) can also occur; patients should be reassured these deposits are generally reversible on stopping.
• Latanoprost can cause permanent darkening and increased length and thickness of eyelashes and gradual, often irreversible, brown pigmentation of the iris, particularly in mixed-colour irides.
• Once-daily evening dosing is used, and nasolacrimal occlusion reduces periocular skin pigmentation and systemic absorption.

Monitoring

Monitor intraocular pressure to confirm response and examine for conjunctival hyperaemia, corneal deposits and iris or periocular pigment changes at review.

Counselling the patient

• Red eyes are common with this combination and are usually not harmful.
• Be aware your eyelashes may grow longer and darker, and the coloured part of the eye may slowly turn more brown, which can be permanent.
• Use once in the evening and press on the inner corner of the eye afterwards to reduce darkening of the surrounding skin.

Evidence & guidelines

The MERCURY trials demonstrated greater intraocular-pressure lowering with the fixed latanoprost-netarsudil combination than with either component alone.