Bimatoprost is a medication primarily used to treat glaucoma and ocular hypertension. It is also marketed under the brand name Lumigan among others. While originally developed for these eye conditions, it was discovered that bimatoprost also stimulates eyelash growth and is now commonly used in the form of an eye drop for this purpose under the brand name Latisse.

A synthetic prostaglandin analogue called Lumigan (Bimatoprost) increases aqueous humour output, which lowers intraocular pressure. These conditions are treated with it:

• for the treatment of open-angle glaucoma or ocular hypertension patients with elevated intraocular pressure (Lumigan, Vistitan).
• (Latisse) a procedure for eyelash growth.

Lumigan (Bimatoprost) Dose in Adults

Bimatoprost Lumigan is used to treat high intraocular pressure.

• You apply one drop into the affected eye(s) once every evening.
• Make sure you only do it once a day, and don't use more drops as it might not work as well.
• If you're using other eye drops too, give at least 5 minutes between each one.

Bimatoprost Use in the treatment for the growth of eyelashes (Latisse):

• Bimatoprost is also used to treat sparse or thin eyelashes, a condition known as hypotrichosis.
• When it's sold under the brand name Latisse, you apply it to the skin of the upper eyelid at the base of the eyelashes using an applicator.
• Just use one drop on the applicator and spread it evenly along the eyelid once a day before bedtime.
• Remember to use a fresh applicator for each eye to avoid spreading any potential infection.

Lumigan (Bimatoprost) Dose in Children

Bimatoprost Use in the treatment of raised intraocular pressure (Lumigan):

• Adolescents older than 16 years:
  • Refer to adult dosing.

Bimatoprost Use in the treatment for the growth of eyelashes (Latisse):

• Children older than 5 years and Adolescents:
  • Refer to adult dosing.

Pregnancy Risk Factor: C

• The manufacturer states that using bimatoprost during pregnancy hasn't shown an increased risk of serious birth defects or miscarriages.
• However, if you need to use eye drops containing bimatoprost while pregnant, it's best to use the lowest effective dose.
• Also, consider using punctal occlusion, a method to block drainage of the eye drops into the tear ducts, to reduce potential exposure to the fetus.

Bimatoprost uses during breastfeeding:

• It's uncertain whether Bimatoprost passes into breast milk.
• The manufacturer advises considering the risks of infant exposure, the benefits of breastfeeding for the baby, and the benefits of treatment for the mother when deciding whether to continue or stop breastfeeding during therapy.

Lumigan (Bimatoprost) Dose in Renal Disease:

• The manufacturer hasn't recommended any dose adjustments for patients with kidney disease.

Lumigan (Bimatoprost) Dose in Liver Disease:

• According to the manufacturer, no dose adjustments are typically recommended for patients with liver disease when using bimatoprost.

Common Side Effects of Lumigan (Bimatoprost) Include:

• Ophthalmic:
  • Conjunctival hyperemia
  • Eye pruritus
• Dermatologic:
  • Increased growth in the number of eyelashes

Less Common Side Effects of Bimatoprost Include:

• Endocrine & metabolic:
  • Hirsutism
• Central nervous system:
  • Headache
  • Foreign body sensation of eye
• Dermatologic:
  • Local skin hyperpigmentation
  • Erythema of eyelid
  • Hyperpigmentation of eyelashes
• Infection:
  • Infection
• Neuromuscular & skeletal:
  • Asthenia
• Hepatic:
  • Abnormal hepatic function tests
• Ophthalmic:
  • Asthenopia
  • Blepharitis
  • Burning Sensation of Eyes
  • Cataract
  • Dry eye syndrome
  • Eye Irritation
  • Allergic Conjunctivitis
  • Conjunctival Edema
  • Conjunctival Hemorrhage
  • Iris Hyperpigmentation
  • Lacrimation
  • Photophobia
  • Eye Discharge
  • Eye Pain
  • Superficial Punctate Keratitis
  • Visual Disturbance

Contraindication to Bimatoprost Include:

• If someone is allergic to bimatoprost or any ingredient in the product, they shouldn't use it. That's what hypersensitivity means in this context.

Warnings and Precautions

Bacterial Keratitis

• Bacterial keratitis can occur if bacteria accidentally get into multi-dose eye solutions.
• This contamination can lead to an eye infection.
• It's essential to handle these solutions carefully and follow proper hygiene practices to prevent this from happening.

Ocular effects

• Using bimatoprost might cause permanent changes in the color of the iris (the part of the eye that gives it color), as well as in the skin of the eyelids and the tissue around the eyes.
• It can also make your eyelashes longer, thicker, and possibly increase their number, but this might vary between your eyes.
• These changes happen slowly and might not be noticeable for months or even years.
• The color change in the iris is likely to be permanent, while the changes in the eyelid skin and eyelashes might go away once you stop using the medication.
• However, the long-term effects of these pigmentation changes aren't fully understood yet.

Ocular inflammation:

• Bimatoprost can sometimes cause inflammation inside the eye, and it might even make existing inflammation worse.
• So, if someone already has inflammation inside their eye, like with uveitis, they should be careful when using this medication.
• It's best to use it under the guidance of a healthcare professional who can monitor the situation closely.

Ocular disease:

• If someone doesn't have their natural lens (aphakic), or if they've had surgery to replace their lens (pseudophakic) and there's a tear in the capsule behind the lens, or if they have a risk of macular edema, they should be careful when using Lumigan for their eye condition.
• Lumigan's safety and effectiveness haven't been confirmed for certain types of glaucoma, like angle-closure, inflammatory, or neovascular glaucoma.

Bimatoprost: Drug Interaction

Monitoring Parameter:

Keep an eye on the intraocular pressure (IOP).

How to administer bimatoprost

Latisse:

• Preparation: Before applying Latisse, remove any makeup and contact lenses. Make sure your face is clean.
• Application: Use the sterile applicator provided with Latisse. Don't use any other brushes or applicators. Apply the solution along the upper eyelid margin using the provided applicator. Avoid applying it to the lower eyelash line.
• Excess Solution: If there's any excess solution on the outside of the upper eyelid margin, blot it gently with a tissue or cloth.
• Applicator Use: Don't reuse the applicators. Use a new one for each eye.
• Frequency: Applying Latisse more than once nightly won't make your eyelashes grow faster. When you stop using Latisse, your eyelash growth is expected to return to its original state.
• Contact Lenses: You can reinsert contact lenses 15 minutes after applying Latisse.

Lumigan; Vistitan [Canadian product]:

• Combination Use: Lumigan or Vistitan can be used with other eye drops to reduce intraocular pressure.
• Timing with Other Medications: If you're using more than one eye drop, wait at least 5 minutes between each application.
• Contact Lens Removal: Take out your contact lenses before using Lumigan or Vistitan. Wait for 15 minutes before putting them back in.

Mechanism of action of Lumigan (bimatoprost):

• Bimatoprost works like a synthetic version of a natural body substance called prostaglandin.
• It helps to lower the pressure inside the eye by increasing the drainage of fluid called aqueous humor.
• Additionally, bimatoprost might make eyelashes grow longer and thicker by extending the time and increasing the number of hairs in the growth phase.

Onset of Action:

• It starts reducing intraocular pressure (IOP) in about 4 hours after administration.

Peak Effect:

• The maximum reduction of IOP occurs around 8 to 12 hours after taking it.

Distribution:

• Bimatoprost has a volume of distribution (Vd) of about 0.67 liters per kilogram.

Protein Binding:

• Around 88% of bimatoprost binds to proteins in the body.

Metabolism:

• After it enters the bloodstream, bimatoprost undergoes various metabolic processes, including oxidation, N-deethylation, and glucuronidation, forming metabolites.

Half-life Elimination:

• The half-life of elimination for intravenous administration is approximately 45 minutes.

Time to Peak:

• It reaches its peak concentration in the body in less than 10 minutes.

Excretion:

• Bimatoprost and its metabolites are primarily excreted through urine (up to 67%) and to a lesser extent through feces (about 25%).

International Brands of Lumigan (Bimatoprost):

• Latisse
• Lumigan
• Lumigan RC
• Vistitan
• Bimagan
• Bimaprost
• Bimast
• Bimat
• Bimato-Vision
• Bimatoswix
• Bimican
• Careprost
• Glamigan
• Glash Vista
• Lumiprox
• Matrocond
• Sturiban
• Vizibim

Bimatoprost brands in Pakistan: