Bimatoprost (Lumigan)

Generic Name

Bimatoprost ophthalmic solution

Brand Names

Lumigan

Latisse (for eyelash growth)

Generic bimatoprost available in many countries

Drug Class

Prostaglandin analog

Ophthalmic intraocular pressure-lowering agent

Mechanism of Action

Bimatoprost is a synthetic prostamide analog that mimics the effects of naturally occurring prostaglandins

It increases aqueous humor outflow via both uveoscleral and trabecular meshwork pathways

This dual mechanism lowers elevated intraocular pressure (IOP), a critical factor in glaucoma and ocular hypertension

Unlike some prostaglandin analogs that predominantly act through the uveoscleral route, bimatoprost also enhances trabecular outflow, leading to greater IOP reduction in some patients

Indications

Approved Ophthalmic Uses

Elevated intraocular pressure in patients with open-angle glaucoma

Ocular hypertension

Cosmetic Use (Different Product Name: Latisse)

Hypotrichosis of eyelashes (inadequate or not enough eyelashes)

Used to increase eyelash length, thickness, and darkness

Off-label/Clinical Practice Uses

Adjunct to other ocular hypotensive agents when monotherapy is inadequate

Use in normal tension glaucoma

Management of steroid-induced ocular hypertension

Dosing and Administration

Ocular Hypertension or Open-Angle Glaucoma

Instill one drop into the affected eye(s) once daily in the evening

More frequent administration is not recommended due to risk of reduced effectiveness

Do not administer to both eyes if only one eye is affected unless prescribed

Contact lenses must be removed prior to instillation and reinserted after 15 minutes

Latisse (Cosmetic Use)

Apply once nightly to the upper eyelid margin using sterile applicator

Do not apply to lower lash line

Effects typically begin in 8 weeks and peak at 16 weeks

Discontinuation results in gradual loss of enhanced eyelash growth

Contraindications

Hypersensitivity to bimatoprost or any component of the formulation

Precautions

May permanently increase brown pigmentation of the iris, more noticeable in light-colored eyes

May cause darkening of eyelid skin and increase eyelash growth in unintended areas with repeated exposure

Use with caution in patients with history of uveitis or macular edema

Post-surgical patients (aphakia or pseudophakia with torn posterior lens capsule) at increased risk for macular edema

Use cautiously in patients with active intraocular inflammation

Avoid contamination of the dropper tip and do not touch the eye surface

Adverse Effects

Ocular (Most Common)

Conjunctival hyperemia (red eyes)

Ocular pruritus

Dry eye

Foreign body sensation

Eye irritation

Visual disturbance

Eyelash growth

Cosmetic/Local Effects

Eyelid skin darkening

Increased iris pigmentation

Eyelash thickening and elongation

Periocular fat atrophy with long-term use

Reversible upon discontinuation, except for iris color changes

Systemic Effects (Rare)

Headache

Hypertension

Upper respiratory tract infection

Dizziness

Rare but Serious Effects

Macular edema, particularly in high-risk individuals

Iritis or uveitis (in predisposed patients)

Cystoid macular edema in pseudophakic eyes

Periorbital changes such as sunken eyes due to orbital fat atrophy

Pregnancy and Lactation

Pregnancy

Animal studies suggest potential teratogenicity at high systemic doses

No adequate human data available

Use only when clearly necessary and prescribed by an ophthalmologist

Lactation

Unknown if excreted in human breast milk

Use with caution in breastfeeding women due to potential systemic absorption

Use in Special Populations

Pediatric Use

Safety and efficacy not established in children

Not recommended in patients under 16 years

Elderly

Well tolerated; no dosage adjustment required

Hepatic or Renal Impairment

No dose adjustments required

Systemic exposure is minimal with ocular use

Drug Interactions

Ophthalmic Prostaglandin Analogs (e.g., latanoprost, travoprost)

Concurrent use may reduce the efficacy of both agents

Avoid combination unless prescribed with specific intent

Ocular Corticosteroids

May antagonize bimatoprost's effect on IOP

Monitor IOP when used concurrently

Contact Lenses

Contains benzalkonium chloride which may be absorbed by soft lenses

Remove lenses before instillation and wait 15 minutes before reinsertion

Monitoring Parameters

Intraocular pressure (baseline and periodically during therapy)

Iris and eyelid pigmentation changes

Signs of ocular inflammation or macular edema

Eyelash growth or local skin changes

Ocular surface integrity and tolerability in long-term users

Patient Counseling Points

Use one drop in the affected eye(s) in the evening

Do not use more than once per day

If using other eye drops, separate administration by at least 5 minutes

Avoid contact with skin to prevent unwanted hair growth

Do not touch the dropper tip to eye or surfaces

May cause gradual darkening of the iris, usually permanent

Eyelashes may grow longer, thicker, and darker

Darkening of the eyelid skin may occur and is usually reversible

Report visual changes, eye pain, swelling, or discharge

Do not use if solution becomes discolored or cloudy

Store at room temperature, protect from light, and tightly cap the bottle after use

Missed doses should be skipped and not doubled

Storage

Store at 2°C to 25°C (36°F to 77°F)

Protect from light and avoid contamination

Use within 4 weeks of opening the bottle if advised by manufacturer or pharmacist