ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Rho-kinase (ROCK) Inhibitor — Glaucoma Pregnancy: Avoid — insufficient data

Netarsudil 0.02% Eye Drops

Brand names: Rhokiinsa

Adult dose

Dose: 1 drop once daily in the evening
Route: Topical (ophthalmic)
Frequency: Once daily at bedtime
Max: 1 drop per dose once daily (more frequent dosing does not improve efficacy)
Newest mechanism class of glaucoma treatment. Reduces IOP by enhancing trabecular meshwork (conventional) outflow — distinct mechanism from all other glaucoma drugs. Also reduces episcleral venous pressure. Available as fixed combination with latanoprost (Roclanda — in EU, not yet UK licensed at time of writing).

Paediatric dose

Route:
Not licensed for paediatric use — seek specialist opinion

Dose adjustments

Renal

No adjustment — topical use; negligible systemic absorption

Hepatic

No adjustment

Clinical pearls

  • Novel mechanism — trabecular meshwork outflow enhancement: ALL other glaucoma drugs reduce aqueous production or increase uveoscleral (unconventional) outflow; netarsudil is the first approved drug to specifically enhance trabecular (conventional) outflow — the mechanistic target of most surgical glaucoma procedures (trabeculectomy, MIGS)
  • ROCKET trials: netarsudil 0.02% once daily reduced IOP by 3–4 mmHg in POAG — non-inferior to timolol 0.5% BD in several studies; approved by MHRA
  • Cornea verticillata: the whorl-like corneal deposits are benign and reversible — important to distinguish from other causes of whorl keratopathy (amiodarone, hydroxychloroquine, Fabry disease); netarsudil deposits resolve within weeks of stopping
  • Combination with latanoprost: Roclanda (netarsudil/latanoprost fixed combination) complements both conventional and uveoscleral outflow enhancement — additive IOP reduction ~8 mmHg; not yet approved in UK at time of writing (available in EU)
  • Hyperaemia management: conjunctival hyperaemia is the main tolerability issue — reassure patients that it is not harmful; bedtime dosing may reduce daytime cosmetic concern

Contraindications

  • Hypersensitivity to netarsudil or excipients
  • Contact lens wear during instillation (remove; wait 15 minutes)

Side effects

  • Conjunctival hyperaemia — most common (up to 50%); often limiting for patient acceptance
  • Cornea verticillata (whorl-like corneal deposits) — visible on slit-lamp; dose-dependent; not associated with visual loss; reversible on stopping
  • Conjunctival haemorrhage
  • Instillation discomfort
  • Blurred vision (transient)

Interactions

  • Minimal systemic absorption — no clinically significant drug interactions

Monitoring

  • IOP at 4–8 weeks after initiation
  • Slit-lamp examination — cornea verticillata (benign; document)
  • Conjunctival hyperaemia — tolerance assessment

Reference: BNFc; BNF 90; ROCKET Trials (JAMA Ophthalmol 2018); MHRA Approval Rhokiinsa; EGS Glaucoma Guidelines 2020; SPC Rhokiinsa. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways