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Rho-kinase (ROCK) Inhibitor — Glaucoma Pregnancy: There are no available data on Rhopressa use in pregnant women to inform any drug associated risk; however, systemic exposure to netarsudil from ocular administration is low. Intravenous administration of netarsudil to pregnant rats and rabbits during organogenesis did not produce adverse embryofetal effects at clinically relevant systemic exposures. In animals, daily intravenous netarsudil caused abortions and embryofetal lethality in rats at doses >=0.3 mg/kg/day (126-fold the plasma exposure at the recommended human ophthalmic dose, based on Cmax) and, in rabbits, embryofetal lethality and decreased fetal weight at 5 mg/kg/day, with malformations at >=3 mg/kg/day. Lactation: there are no data on the presence of Rhopressa in human milk, the effects on the breastfed infant, or the effects on milk production; systemic exposure following topical ocular administration is low, and the developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for Rhopressa and any potential adverse effects on the breast-fed child. (US label)

Netarsudil 0.02% Eye Drops

Brand names: Rhokiinsa

Netarsudil eye drops are a topical Rho kinase inhibitor used to lower raised intraocular pressure in open-angle glaucoma and ocular hypertension.

Adult dose

Dose: Reduction of elevated intraocular pressure (IOP) in open-angle glaucoma or ocular hypertension: 1 drop of netarsudil 0.02% (0.2 mg/mL) ophthalmic solution in the affected eye(s)
Route: Ophthalmic — topical drop into the affected eye(s)
Frequency: Once daily in the evening
Label text (DOSAGE AND ADMINISTRATION): 'The recommended dosage is one drop in the affected eye(s) once daily in the evening. If one dose is missed, treatment should continue with the next dose in the evening. Twice a day dosing is not well tolerated and is not recommended. If RHOPRESSA is to be used concomitantly with other topical ophthalmic drug products to lower IOP, administer each drug product at least 5 minutes apart.' CONTACT LENSES: contact lenses should be removed prior to instillation and may be reinserted 15 minutes following administration. No maximum dose is printed in the label as a separate ceiling (none written). Children: safety and effectiveness in pediatric patients below the age of 18 years have not been established (no paediatric dose in the label). Elderly: no overall differences in safety or effectiveness between elderly and other adult patients. Storage (label): store at 2°C to 8°C until opened; after opening may be kept at 2°C to 25°C for up to 6 weeks. WARNINGS: epithelial corneal edema (honeycomb or bullous) in patients with pre-existing corneal stromal edema or after ocular procedures that could affect corneal endothelial function, typically resolving on discontinuation; bacterial keratitis has been reported with multiple-dose containers of topical ophthalmic products inadvertently contaminated by patients. No UK SPC for netarsudil is listed on eMC — this dose is from US prescribing information (Rhopressa) and must be verified against UK practice.

Dose independently re-sourced from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • None listed in the US prescribing information (Rhopressa: CONTRAINDICATIONS — None)

Side effects

  • Conjunctival hyperemia (53% of patients; 6% discontinued therapy because of it)
  • Corneal verticillata, instillation site pain and conjunctival hemorrhage (each approximately 20%); corneal verticillata first noted at 4 weeks of daily dosing, without apparent visual functional change, and most resolved on discontinuation
  • Instillation site erythema, corneal staining, blurred vision, increased lacrimation, erythema of eyelid and reduced visual acuity (5-10% of patients)
  • Postmarketing: epithelial corneal edema in some patients with pre-existing corneal stromal edema or after ocular procedures that could affect corneal endothelial function
  • Bacterial keratitis reported with contaminated multiple-dose containers of topical ophthalmic products

Interactions

  • Other topical ophthalmic drugs used to lower IOP: administer each product at least 5 minutes apart

Monitoring

  • Advise patients to notify their physician if they experience eye pain or decreased vision (possible epithelial corneal edema)
  • Extra attention in patients with pre-existing corneal stromal edema or recent ocular procedures (risk of epithelial corneal edema)
  • Advise on avoiding contamination of the multiple-dose container (bacterial keratitis risk)

Clinical monograph

How it works

It inhibits Rho kinase and noradrenaline transporter activity, increasing aqueous humour outflow through the trabecular meshwork and lowering episcleral venous pressure to reduce intraocular pressure.

Prescribing in practice

  • Conjunctival hyperaemia is the most common adverse effect and other characteristic effects include corneal verticillata (vortex keratopathy) and small conjunctival haemorrhages.
  • It is administered once daily, usually in the evening, and is intended for chronic pressure control rather than acute use.
  • Contact lenses should be removed before instillation and reinserted after a short interval.

Monitoring

Intraocular pressure and the corneal surface should be monitored periodically to confirm efficacy and detect characteristic ocular changes.

Counselling the patient

  • Use the drops once daily at the time advised, typically in the evening, and continue even though glaucoma usually causes no symptoms.
  • Redness of the eye is common and is not usually harmful, but report persistent discomfort or visual change.
  • Remove contact lenses before instilling and wait before putting them back in.

Evidence & guidelines

Netarsudil's intraocular-pressure-lowering efficacy was demonstrated in randomised controlled trials and is reflected in the SPC.

Reference: ROCKET Trials (JAMA Ophthalmol 2018); MHRA Approval Rhokiinsa; EGS Glaucoma Guidelines 2020; SPC Rhokiinsa; 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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