Unoprostone is a medication primarily used to treat glaucoma and ocular hypertension. It belongs to a class of drugs known as prostaglandin analogs. Prostaglandins are natural substances in the body that regulate various functions, including inflammation and intraocular pressure (IOP) within the eye.

Unoprostone works by increasing the outflow of aqueous humor, the fluid inside the eye, which helps to lower intraocular pressure. By reducing intraocular pressure, unoprostone can help prevent damage to the optic nerve and preserve vision in individuals with glaucoma or ocular hypertension.

A prostaglandin analogue sold under the trade name Rescue is unoprostone. Raised intraocular pressure can be treated with it according to approval.

Unoprostone Uses:

• Open-angle glaucoma or ocular hypertension:
  • to lower intraocular pressure (IOP) in those with ocular hypertension or open-angle glaucoma

Unoprostone Dose in Adults

Treatment of open-angle glaucoma or ocular hypertension with unoprostone dosage:

• when treating open-angle glaucoma or ocular hypertension with unoprostone, you typically put one drop into the affected eye(s) two times a day.
• Just follow your doctor's instructions closely.

Unoprostone Dose in Children

Not indicated 

Pregnancy Risk Factor C

• Unoprostone has a Pregnancy Risk Factor C, meaning it might pose risks during pregnancy.
• In animal studies, problems occurred when given at doses higher than what's recommended for humans.
• However, when applied directly to the eyes, very little gets absorbed into the bloodstream.
• For unoprostone to affect the fetus, it would need to be absorbed systemically and cross the placenta, which is unlikely with eye drops.
• If you need eye medication while pregnant, your doctor might suggest using the lowest effective dose and possibly combining it with punctal occlusion to minimize any potential risk to the fetus.

Unoprostone use during breastfeeding:

• It's unclear if unoprostone passes into breast milk, but after applying it to the eyes, very little gets absorbed into the body.
• Still, the manufacturer suggests being cautious when giving unoprostone to breastfeeding mothers.

Rescula Dose in Kidney Disease:

• The manufacturer's instructions don't include dosage adjustments for renal impairment with unoprostone.
• This is likely because the medication is minimally absorbed into the bloodstream, so it's unlikely to affect kidney function.

Rescula Dose in Liver disease:

• The manufacturer's labeling for unoprostone doesn't mention any dosage adjustments for hepatic impairment.
• This is because the medication is minimally absorbed into the bloodstream, so it's unlikely to be affected by liver function.

Common Side Effects of Unoprostone (Rescula):

• Ophthalmic:
  • Burning Sensation Of Eyes
  • Stinging Of Eyes
  • Eye Pruritus
  • Eye Redness
  • Xerophthalmia
  • Increased Eyelash Length

Less Common Side Effects of Unoprostone (Rescula):

• Central Nervous System:
  • Headache
  • Foreign Body Sensation Of Eye
  • Dizziness
  • Insomnia
  • Pain
• Cardiovascular:
  • Hypertension
• Endocrine & Metabolic:
  • Diabetes Mellitus
• Neuromuscular & Skeletal:
  • Back Pain
• Hypersensitivity:
  • Hypersensitivity Reaction
• Ophthalmic:
  • Abnormal Lacrimation
  • Eyelid Disease
  • Visual Disturbance
  • Photophobia
  • Vitreous Disorder
  • Decreased Eyelash Length
  • Blepharitis
  • Cataract
  • Eye Irritation
  • Eye Pain
  • Conjunctivitis
  • Corneal Lesion
  • Eye Discharge
  • Hemophthalmos
  • Keratitis
• Respiratory:
  • Flu-Like Symptoms
  • Bronchitis
  • Cough
  • Pharyngitis
  • Rhinitis
  • Sinusitis
• Miscellaneous:
  • Accidental Injury

Contraindications to Unoprostone (Rescula):

• If someone has a hypersensitivity to unoprostone or any ingredient in the formulation, they shouldn't use it.
• Hypersensitivity means their body might react negatively to the medication or its components, leading to allergic reactions or other adverse effects.

Cautions and Alerts

Ocular pigmentation:

• Unoprostone can lead to ocular pigmentation, which means it may permanently change eye color by increasing the amount of brown pigment in the iris.
• This change might not be noticeable right away and could take months to years to become apparent.
• The long-term effects and potential harm to the eye from this pigmentation are not fully understood.
• Additionally, during use, it may also cause pigment changes to the skin around the eyes (periorbital tissues) and eyelashes.
• However, these changes are usually reversible when the medication is stopped, at least in most patients.

Infection:

• Bacterial keratitis, an eye infection, has been reported due to accidental contamination of multi-dose ophthalmic solutions like unoprostone.
• To minimize this risk, it's important not to touch the eyelids or surrounding areas with the dropper tip when applying the medication.
• Additionally, always keep the bottle tightly closed when it's not in use to prevent any potential contamination.

Ocular disease:

• It's important to exercise caution when using unoprostone in patients with certain ocular conditions.
• For example, in individuals with intraocular inflammation like uveitis, unoprostone should be used with care as it might worsen the inflammation.
• Additionally, there's a risk of developing macular edema, including cystoid macular edema, while using unoprostone.
• Therefore, it should be used cautiously in patients who are aphakic (lens removed) or pseudophakic (artificial lens implanted), especially those with torn posterior lens capsules, or in patients who are at risk for macular edema.

Unoprostone: Drug Interaction

Monitor:

• Intraocular pressure
• ocular infections (keratitis)

How to administer Unoprostone (Rescula)?

Using with Other Eye Drops:

• Unoprostone can be used alongside other eye drops to reduce intraocular pressure.
• If using more than one eye drop product, wait at least 5 minutes between applying each medication.

Contact Lens Use:

• Before applying unoprostone, remove contact lenses.
• Wait for at least 15 minutes before reinserting contact lenses after applying the medication.

Minimizing Contamination:

• To avoid contamination, do not touch the eyelids or surrounding areas with the dropper tip when administering unoprostone.
• Keep the bottle tightly closed when not in use to prevent contamination.

Mechanism of action of Unoprostone (Rescula):

• The precise way unoprostone works isn't fully understood, but it's believed to lower intraocular pressure (IOP) by boosting the outflow of aqueous humor, the fluid inside the eye.

Effects on Cardiovascular and Pulmonary Function:

• Clinical studies haven't shown any impact on cardiovascular or pulmonary function with unoprostone use.

Reduction in Intraocular Pressure (IOP):

• In patients with an average baseline IOP of 23 mm Hg, unoprostone decreased IOP by about 3-4 mm Hg.
• It's suggested that unoprostone may also lower IOP by enhancing the outflow through the trabecular meshwork via stimulation of certain channels, like calcium-activated BK and CIC-2 type channels.

Absorption:

• Unoprostone is absorbed through the cornea and conjunctival epithelium, but the amount that enters the bloodstream is minimal, resulting in low systemic exposure.

Metabolism:

• It undergoes metabolism by esterases, leading to the formation of unoprostone-free acid.

Half-life Elimination:

• The half-life of unoprostone elimination is approximately 14 minutes, indicating that it is rapidly cleared from the body.

Excretion:

• Metabolites of unoprostone are primarily excreted in the urine.

International Brands of Unoprostone:

• Rescula

Unoprostone Brand Names in Pakistan:

No Brands Available in Pakistan.