Medicines Q&As
Q&A 201.1
Switching between travoprost and generic latanoprost eye drops
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals
Date prepared: 24th April 2012
Background
Three prostaglandin analogues (PA) (bimatoprost, latanoprost and travoprost) are licensed as firstline therapy for primary open angle glaucoma and ocular hypertension. They are generally
comparable in terms of efficacy [1] and safety [1,2] but latanoprost may offer greater ocular tolerability
[1,2]. Consequently cost has been the deciding factor in the choice of product for several healthcare
organisations [2].
The patent for Xalatan (latanoprost) 0.005% eye drops solution expired in the UK in 2012, and
licensed generic latanoprost 0.005% eye drops are now available in this country.
Answer
There are no published studies of switching from travoprost to latanoprost eye drops, but patients
have been systematically switched from latanoprost to travoprost eye drops.
The Singapore National Eye Centre pharmacy chose travoprost as their preferred PA. Approximately
900 patients previously treated with latanoprost were switched to travoprost. Of these, 93 patients
were enrolled in a prospective observational study. Nine were lost to follow-up and of the 84 included
in the 4 month study analysis, a total of 4 patients (4.8%) switched back to latanoprost. For the
remaining 80 patients who completed the 12 week evaluation, the mean intraocular pressure (IOP) at
baseline was not statistically different from that at week 6 or week 12 (p=0.99). The mean hyperemia
score was significantly different between baseline and week 6 (p=0.02), but there was no difference
between baseline and week 12 (p=0.09). Overall a high switch rate was noted with comparable IOPlowering effects and hyperemia scores [3].
A retrospective cohort analysis was performed on 578 patients who were switched from latanoprost or
bimatoprost to travoprost at six US Department of Veterans Affairs sites (VA)[4]. The majority (94%)
were previously treated with latanoprost. Of the 296 (51%) of patients with both baseline and 6-month
follow up IOP measurements, the mean IOP was significantly lower after conversion to travoprost
(p<0.0001) in patients converted from latanoprost (-1.34 mmHg) or bimatoprost (-2.84 mmHg). Of
those converted to travoprost, 147 (25.4%) discontinued travoprost, while 35 (6%) received treatment
with an alternative PA. Adverse events were the reason for discontinuation of travoprost in 29 (20%)
patients and lack of efficacy was the reason in 17 (12%) patients. The primary reasons for
discontinuation were hyperemia in 10 patients and eye pain in 12 patients. The rate of hyperemia was
2.2% in those converted to travoprost, which differed from the rates reported by Parrish et al. of 58%
[5].
Overall, the experiences reported of systematic switches between PAs appear to be positive. The
primary outcome of IOP-lowering was achieved with small percentages of patients reverting to their
prior therapy. The adverse effects noted were not unexpected, although the incidence of hyperemia
with travoprost in the VA investigation was much less than that reported in the literature [2].
As some patients have experienced lower IOP after switching from latanoprost (or bimatoprost) to
travoprost, patients switching from travoprost to latanoprost should have their IOP monitored
regularly.
Latanoprost appears to have a better adverse effect profile compared with bimatoprost or travoprost.
There is less conjunctival hyperemia, which may often lead to drug discontinuation, with latanoprost.
The incidence of ocular symptoms such as pruritus and discomfort appears to be similar for
From the NHS Evidence website www.evidence.nhs.uk
1
Medicines Q&As
latanoprost and travoprost, and they occur less frequently than with bimatoprost [2]. At present there
are no published studies comparing the tolerability and efficacy of generic latanoprost eye drops
produced in the UK, with Xalatan eye drops.
A randomised, crossover, open label pilot study in 30 patients with primary open angle glaucoma or
ocular hypertension compared the efficacy and tolerability of Xalatan with generic travoprost eye
drops manufactured in India. Although Xalatan achieved a statistically significant greater reduction in
IOP than generic latanoprost by week 12, at the end of the second 12 week study period the
difference in IOP between the two groups was not statistically significant. The generic product was
found to contain higher levels of particulate matter and the pH was higher than that of Xalatan. The
authors state that this may contribute to the higher incidence of ocular irritation that occurred in
patients using this product, but as there was no washout period this limits comparisons of tolerability.
[6]
Xalatan and generic latanoprost eye drops 0.005% eye drops contain benzalkonium chloride as a
preservative [7-12], whereas travoprost eye drops 40 micrograms/ml are preserved with
polyquaternium-1 [13]. Hypersensitivity to the preservative or other ingredients will need to be
considered.
The Summary of Product Characteristics for latanoprost eye drops should be consulted to ensure
suitability for individual patients.
Summary






Three prostaglandin analogues (bimatoprost, latanoprost and travoprost) are licensed as firstline therapy for primary open angle glaucoma and ocular hypertension.
They are generally comparable in terms of efficacy and safety; although latanoprost may offer
greater ocular tolerability. Consequently, cost has most often been the deciding factor in the
choice of product.
Licensed generic latanoprost 0.005% eye drops are now available in the UK. However, there
are no published data regarding the tolerability or efficacy of generic latanoprost eye drops,
produced in the UK, compared with the branded product.
There are no published studies of switching from travoprost to latanoprost eye drops, There
are several studies reporting successful switching from latanoprost to travoprost eye drops
Some patients have experienced a greater hypotensive effect with travoprost eye drops.
Patients’ intraocular pressure should be monitored when switching to latanoprost eye drops.
Latanoprost and travoprost eye drops contain different preservatives. Hypersensitivity to the
preservative and other ingredients needs to be considered during any switch.
Limitations



There are no published studies on switching from travoprost to latanoprost eye drops;
therefore decisions to switch need to be based on data extrapolated from studies of switching
from latanoprost to travoprost.
There is no information available regarding the comparative tolerability or efficacy of generic
latanoprost eye drops produced in the UK.
The choice of prostaglandin analogue for an individual patient’s treatment is a clinical
decision. Individual Summary of Product Characteristics should be consulted for further
prescribing information.
Disclaimer



Medicines Q&As are intended for healthcare professionals and reflect UK practice.
Each Q&A relates only to the clinical scenario described.
Q&As are believed to accurately reflect the medical literature at the time of writing.
From the NHS Evidence website www.evidence.nhs.uk
2
Medicines Q&As



The authors of Medicines Q&As are not responsible for the content of external websites and
links are made available solely to indicate their potential usefulness to users of NeLM. You
must use your judgement to determine the accuracy and relevance of the information they
contain.
This document is intended for use by NHS healthcare professionals and cannot be used for
commercial or marketing purposes.
See www.ukmi.nhs.uk/activities/medicinesQAs/default.asp for full disclaimer.
References
1. Moorfields Eye Hospital NHS Foundation Trust Pharmacists Handbook. 2006 Edition
2. Tortorice K, Heron B. Drug Class Review: Ophthalmic Prostaglandin Analogs. VHA Pharmacy
Benefits Management Strategic Healthcare Group and the Medical Advisory Panel. June
2011. http://www.pbm.va.gov/DrugClassReviews.aspx
3. Kumar RS, Istiantoro VW, Hoh S-T et al. Efficacy and safety of a systematic switch from
latanoprost to travoprost in patients with glaucoma. J Glaucoma 2007;16(7):606-609. Cited in
Tortorice K, Heron B. Drug Class Review: Ophthalmic Prostaglandin Analogs. VHA Pharmacy
Benefits Management Strategic Healthcare Group and the Medical Advisory Panel. June
2011
4. Brooks TC, Burlingame M, Burk M et al. Travoprost; A prostaglandin analogue for the
treatment of glaucoma. Formulary 2009;44:322. Cited in Tortorice K, Heron B. Drug Class
Review: Ophthalmic Prostaglandin Analogs. VHA Pharmacy Benefits Management Strategic
Healthcare Group and the Medical Advisory Panel. June 2011
5. Parrish RK, Palmberg P, Sheu W-P. A comparison of latanoprost, bimatoprost and travoprost
in patients with elevated intraocular pressure: A 12-week, randomized, masked-evaluator
multicenter study. Am J Ophthalmol 2003;135:688-703 Cited in Brooks TC, Burlingame M,
Burk M et al. Travoprost; A prostaglandin analogue for the treatment of glaucoma. Formulary
2009;44:322
6. Narayanaswamy A, Neog A, Baskaran M, et al. A randomized, crossover, open label pilot
study to evaluate the efficacy and safety of Xalatan® in comparison with generic Latanoprost
(Latoprost) in subjects with primary open angle glaucoma or ocular hypertension. Indian J
Ophthalmol 2007;55:127-31
7. Summary of Product Characteristics – Xalatan 0.005% eye drops solution. Pfizer Ltd.
Accessed via http://www.medicines.org.uk/EMC/ on 09/01/2012 [date of revision of the text
March 2011, last updated on the eMC: 10/03/2011]
8. Summary of Product Characteristics – Latanoprost Pfizer 50 micrograms/ml eye drops,
solution. Pfizer Ltd. Accessed via http://www.medicines.org.uk/EMC/ on 08/02/2012 [date of
revision of the text 12/2011, last updated on the eMC: 23/01/2012]
9. Summary of Product Characteristics – Latanoprost 50microgram/ml eye drops solution.
Actavis UK Ltd. Accessed via http://www.medicines.org.uk/EMC/ on 08/02/2012 [date of
revision of the text 11/05/2011, last updated on the eMC: 18/01/2012]
10. Summary of Product Characteristics – Latanoprost 50mcg/ml eye drops. Beacon
Pharmaceuticals Accessed via http://www.medicines.org.uk/EMC/ on 08/02/2012 [date of
revision of the text 05/12/2011, last updated on the eMC: 30/01/2012]
11. Summary of Product Characteristics – Latanoprost 0.005%w/v eye drops solution.Zentiva
Accessed via http://www.medicines.org.uk/EMC/ on 08/02/2012 [date of revision of the text
20/04/2011, last updated on the eMC: 23/01/2012]
12. Summary of Product Characteristics – Latanoprost 0.005%w/v eye drops solution. Martindale
Pharma [date of revision of the text 21/05/2011]
13. Summary of Product Characteristics – Travatan. Alcon Laboratories (UK) Ltd. Accessed via
http://www.medicines.org.uk/EMC/ on 04/01/2012 [date of revision of the text 14.04.2011, last
updated on the eMC: 11/05/2011]
From the NHS Evidence website www.evidence.nhs.uk
3
Medicines Q&As
Quality Assurance
Prepared by
Gill Lewis. South West Medicines Information & Training. Bristol
Date Prepared
24th April 2012
Checked by
Julia Kuczynska, South West Medicines Information & Training, Bristol
Date of check
24th April 2012
Search strategy








Past enqueries – keyword: latanoprost
DRUGDEX: search term - latanoprost.
Medline: [travoprost.ti,ab; and latanoprost.ti,ab; Limited to publication year 2011-2012, and
human
Embase : TRAVOPROST/cm and LATANOPROST/cm Limit to: publication year 2011-2012 and
human and English
Electronic medicines compendium. Accessed via www.medicines.org.uk on 9/1/2012, 8/2/2012.
http://www.pbm.va.gov/DrugClassReviews.aspx Accessed on 10/1/2012
In-house database/ resources.
Google – Search terms: latanoprost, travoprost, switches, prostaglandin analogs/analogues
From the NHS Evidence website www.evidence.nhs.uk
4