Prostaglandin analogue + Rho kinase inhibitor Pregnancy: SPC §4.6: there are no or limited data in pregnant women. No effects during pregnancy are anticipated from netarsudil (systemic exposure negligible), but latanoprost has potentially harmful pharmacological effects during pregnancy and/or on the fetus/newborn — therefore latanoprost + netarsudil should not be used during pregnancy. Breast-feeding: latanoprost and its metabolites may pass into human milk; a decision must be made whether to discontinue breast-feeding or to discontinue/abstain from therapy.

Latanoprost with netarsudil

Brand names: Roclanda

This is a topical ophthalmic fixed combination of latanoprost, a prostaglandin analogue, and netarsudil, a Rho kinase inhibitor, used to lower intraocular pressure in open-angle glaucoma and ocular hypertension.

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 use (eye drops, solution — latanoprost + netarsudil fixed combination, Roclanda). Treatment should only be initiated by an ophthalmologist or a healthcare professional qualified in ophthalmology.

Frequency: Once daily in the evening

Max: Patients should not instil more than one drop in the affected eye(s) each day

SPC §4.2. If one dose is missed, treatment should continue with the next dose in the evening. If used concomitantly with other topical ophthalmic medicinal products, each product should be administered at least five minutes apart; due to netarsudil's vasodilating properties, other eye drops should be administered BEFORE latanoprost + netarsudil, and eye ointments should be administered last. Contact lenses should be removed prior to instillation and may be reinserted 15 minutes afterwards. As with any eye drops, to reduce possible systemic absorption it is recommended that the lachrymal sac be compressed at the medial canthus (punctal occlusion) for one minute immediately following instillation of each drop. The tip of the dispensing container should avoid contacting the eye, surrounding structures, fingers or any other surface — serious damage to the eye and subsequent loss of vision may result from using contaminated solutions. Paediatric population: the safety and efficacy in children below the age of 18 years have not been established; no data are available. No dose adjustment for renal or hepatic impairment is stated in the fetched sections. Dose quote — SPC §4.2: 'The recommended dose is one drop in the affected eye(s) once daily in the evening. Patients should not instil more than one drop in the affected eye(s) each day.'

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 substances or to any of the excipients (SPC §4.3)

Side effects

Conjunctival hyperaemia — very common (46% of patients in clinical studies)
Instillation site pain — very common (14%)
Cornea verticillata — very common (12%)
Eye pruritus (7%) and other very common effects: iris hyperpigmentation, eyelash and vellus hair changes of the eyelid (increased length, thickness, pigmentation and number of eyelashes)
Common: conjunctival haemorrhage, vision blurred, increased lacrimation, erythema of eyelid, eye irritation, reduced visual acuity, eyelid oedema, punctate keratitis, allergic conjunctivitis, eye pain, dry eye, blepharitis

Interactions

Other topical ophthalmic medicinal products — administer at least five minutes apart; give other eye drops before latanoprost + netarsudil (netarsudil is vasodilating) and eye ointments last (SPC §4.2)
The SPC §4.5 interaction section was not present in the fetched bundle — §4.2 states that data on potential interactions specific to latanoprost + netarsudil are described in §4.5; clinician to consult it

Clinical monograph

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.

Reference: NICE TA890; SmPC; 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).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways