Latanoprost and timolol are both medications used to treat glaucoma, a condition characterized by increased pressure within the eye that can lead to optic nerve damage and vision loss if left untreated.

• Latanoprost: This medication belongs to a class of drugs called prostaglandin analogs. It works by increasing the outflow of aqueous humor (the fluid inside the eye) through the trabecular meshwork, a spongy tissue that acts as a drainage system for the eye. By enhancing the drainage of fluid, latanoprost helps to lower intraocular pressure (IOP). It is typically administered in the form of eye drops and is usually prescribed to be taken once daily in the evening. Common side effects may include eye irritation, blurred vision, darkening of the eyelashes or iris, and changes in the color of the iris.
• Timolol: Timolol belongs to a class of drugs known as beta-adrenergic blockers. It works by reducing the production of aqueous humor in the eye, thereby lowering intraocular pressure. Timolol is also administered in the form of eye drops and is typically used either once or twice daily. Common side effects of timolol eye drops may include burning or stinging in the eyes, blurred vision, dry eyes, and changes in heart rate or blood pressure.

Xalacom (Latanoprost and Timolol) is a combination of a non-selective beta-blocker and a prostaglandin analog. It is used to reduce intraocular pressure in patients with open-angle glaucoma.

Xalacom (Latanoprost and Timolol) Uses:

Note: It is not approved for use in the US

• Elevated intraocular pressure:
  • It is used to reduce intraocular pressure in patients with ocular hypertension or open-angle glaucoma who have an inadequate response to topical beta-blockers, prostaglandin analogs, or other treatments that reduce intraocular pressure.

Xalacom (Latanoprost and Timolol) Dose in Adults:

Xalacom (Latanoprost and Timolol) Dose in the treatment of Increased intraocular pressure:

• Latanoprost and timolol are eye drops used to treat high pressure inside the eye.
• For both, you usually put one drop into the affected eye(s) once a day.

Use in Children:

Not indicated.

Pregnancy Risk Category: N

• No studies on how this combination affects reproduction have been done.
• You should check the information for each medicine separately.

Breastfeeding: Latanoprost or timolol

• Timolol has been found in human breast milk after using eye drops.
• There's a possibility that Latanoprost might also get into breast milk.
• Check the information for each medicine separately.

Dose in Kidney Disease:

• The manufacturer's instructions don't give specific dose adjustments for people with kidney problems because it hasn't been studied enough.
• If you have kidney issues, be careful when using these medications.

Dose in Liver disease:

• The manufacturer's instructions don't provide specific dose adjustments for individuals with liver problems because it hasn't been studied thoroughly.
• If you have liver issues, be cautious when using these medications.

Side Effects of Xalacom (Latanoprost and Timolol):

• Ophthalmic:
  • Abnormal eyelash growth
  • Iris hyperpigmentation
  • Eye irritation

Less Common Side Effects of Xalacom (Latanoprost and Timolol):

• Cardiovascular:
  • Hypertension
  • Chest Pain
• Central Nervous System:
  • Depression
  • Headache
• Dermatologic:
  • Dermatological Disease
  • Skin Rash
• Endocrine & Metabolic:
  • Hypercholesterolemia
  • Diabetes Mellitus
• Infection:
  • Infection
• Neuromuscular & Skeletal:
  • Arthritis
  • Back Pain
• Ophthalmic:
  • Ocular Hyperemia
  • Visual Disturbance
  • Visual Field Defect
  • Blepharitis
  • Cataract
  • Conjunctivitis
  • Corneal Disorder
  • Eye Pain
  • Photophobia
  • Error Of Refraction
  • Conjunctival Abnormalities
  • Keratitis
• Respiratory:
  • Upper Respiratory Tract Infection
  • Flu-Like Symptoms
  • Sinusitis

Contraindications to Xalacom (Latanoprost and Timolol):

• Do not use these medications if you're allergic to latanoprost, timolol, benzalkonium chloride, or any other ingredient in them.
• They should also be avoided if you have certain breathing conditions like severe chronic obstructive pulmonary disease (COPD) or a history of asthma.
• Additionally, if you have certain heart conditions like sinus bradycardia, sick sinus syndrome, or certain types of heart blockages that aren't controlled with a pacemaker, or if you have heart failure or cardiogenic shock, you should not use these medications.

Warnings and precautions

Anaphylactic reactions

• Be cautious if you have a history of allergies or severe reactions (anaphylaxis) to allergens when using these medications.
• If you're taking beta-blockers, you might become more sensitive to allergens over time.
• It's important to note that treating anaphylaxis (a severe allergic reaction) with epinephrine might not work well if you're also taking beta-blockers, and it could even cause unwanted effects.

Bacterial Keratitis

• Bacterial keratitis, an infection of the cornea, can occur if multiple-dose eye solutions become contaminated accidentally.

Ocular effects

• Using medications that reduce or suppress the production of aqueous humor in the eye can sometimes lead to choroidal detachment after certain eye procedures.
• If someone has chronic or recurrent choroidal detachment, they should stop using these medications.
• Prostaglandin analogs like latanoprost may cause macular edema, especially in people who have had their natural lenses replaced with artificial ones and have a tear in the posterior lens capsule.
• These drugs can also permanently change or increase the brown color of the iris, eyelid skin, and eyelashes.
• Regular eye check-ups are crucial, and treatment might need to be stopped if there's an increase in iris pigmentation.
• Additionally, these medications can make eyelashes longer, darker, and thicker, but the changes happen gradually and may not be noticed for months or years.
• The long-term effects and potential harm to the eye are not fully understood.
• Beta-blockers used in the eyes might cause dryness, so they should be used carefully in people with corneal diseases.

Cardiovascular disease

• Before starting these medications, it's important to consider any pre-existing conduction abnormalities in the heart.
• They shouldn't be used if certain conditions are present (see contraindications).
• If someone has a first-degree heart block, they should use these medications with caution.
• In cases of heart failure, there have been reports of fatalities, so it's crucial to have the heart failure under control before starting treatment.
• Watch out for signs and symptoms of heart failure, and if suspected, stop using these medications immediately.
• Additionally, in patients with orthostatic hypotension (a drop in blood pressure when standing up), the signs and symptoms of low blood pressure may be more pronounced, so caution is advised.

Closed-angle Glaucoma

• These medications should not be used alone to treat acute closed-angle glaucoma because the immediate goal in this situation is to reopen the angle by constricting the pupil.
• Latanoprost and timolol maleate don't have a significant effect on the pupil, so they are not effective for this purpose.

Diabetes:

• These medications should be used cautiously in patients with diabetes mellitus, especially those with labile (unstable) diabetes.
• They might increase the risk of low blood sugar (hypoglycemia) and could potentially mask the signs and symptoms of hypoglycemia.

Hepatic impairment

• It's important to be cautious when using these medications in individuals with hepatic impairment (liver problems) because their effects haven't been studied enough in this population.

Herpetic keratitis

• If you have a history of herpes simplex keratitis (a type of eye infection caused by the herpes simplex virus), use these medications cautiously because there's a risk of the infection reactivating.
• Avoid using them if you have an active herpes simplex keratitis infection or if you've had recurrent herpetic keratitis specifically linked to prostaglandin analogs in the past.

Uveitis/Iritis:

• Exercise caution when using these medications in patients who have active inflammation within the eye, such as iritis or uveitis.

Myasthenia gravis:

• Use these medications cautiously in patients with myasthenia gravis, as they may worsen the condition or other symptoms associated with myasthenia gravis such as double vision (diplopia), drooping of the eyelids (ptosis), or general weakness.

Raynaud and peripheral vascular disease (PVD).

• In patients with peripheral vascular disease (PVD) or Raynaud disease, these medications can potentially trigger or worsen symptoms of arterial insufficiency.
• Therefore, they should be used cautiously, and patients should be monitored for any progression of arterial obstruction.

Pulmonary disease

• In patients with mild or moderate chronic obstructive pulmonary disease (COPD), these medications should be used cautiously, and patients should be closely monitored.
• However, beta blockers, including timolol, should generally be avoided in patients with bronchospastic diseases like asthma or severe COPD due to the risk of worsening respiratory symptoms.

Renal impairment

• It's important to be cautious when using these medications in individuals with renal impairment (kidney problems) because their effects haven't been studied enough in this population.

Thyroid disease:

• In individuals with thyroid disease, these medications may hide signs of hyperthyroidism, such as rapid heartbeat (tachycardia).
• If thyrotoxicosis (excess thyroid hormone) is suspected, it should be carefully managed and monitored.
• Abruptly stopping these medications may worsen symptoms of hyperthyroidism or trigger a thyroid storm.
• Therefore, any changes in treatment should be done under close medical supervision.

Monitoring parameters:

Effect on Intraocular Pressure (IOP):

• These medications help lower the pressure inside the eye (intraocular pressure).
• They are used to treat conditions like glaucoma, where high eye pressure can damage the optic nerve.

Changes in Iris Color and Eyelashes:

• These medications might cause permanent changes in the color of the iris (the colored part of the eye), making it darker.
• They can also make eyelashes longer, thicker, and darker over time.

Systemic Effects of Beta Blockade:

• Beta blockers, like timolol, can have effects beyond the eye and affect the whole body.
• They can lower blood pressure and slow down the heart rate, which can be helpful in some conditions but may cause side effects in others.
• People with heart or lung conditions should use these medications cautiously, as they might worsen their symptoms.

How to administer Xalacom (Latanoprost and Timolol)?

Before Administration:

• Wash your hands thoroughly before using the eye drops.
• If you wear contact lenses, take them out before putting in the eye drops. Wait for at least 15 minutes before putting the lenses back in if the eye drops contain benzalkonium chloride.
• If you're using other eye medications as well, wait at least 5 minutes between administering different eye drops to allow each one to be absorbed properly.

Administration Technique:

• After putting in the eye drops, consider pressing on the inner corner of the eye (nasolacrimal occlusion) or closing your eye for about 2 minutes. This can help limit the amount of medication that gets absorbed into your bloodstream, reducing potential systemic effects.

Mechanism of action of Xalacom (Latanoprost and Timolol):

Latanoprost:

• It's a synthetic version of prostaglandin F-alpha, a type of hormone.
• Believed to lower eye pressure by increasing the drainage of fluid (aqueous humor) from the eye, thus reducing intraocular pressure.

Timolol:

• This medication blocks both beta-1 and beta-2 adrenergic receptors.
• It works by reducing the production of aqueous humor in the eye, which helps to lower intraocular pressure.
• It's also possible that timolol might increase the outflow of aqueous humor from the eye, contributing to its pressure-lowering effects.

See individual agents.

International Brands of Latanoprost and timolol:

• ACT Latanoprost/Timolol
• APO-Latanoprost-Timop
• GD-Latanoprost/Timolol
• MED-LatanoprostTimolol
• RIVA-Latanoprost/Timolol
• SANDOZ Latanoprost/Timolol
• Xalacom
• Astimol
• Lacoma T
• Lantocom
• Laprol
• Latamolol
• Lataneau Plus
• Latanocom
• Latiotim
• Latira
• Latochek-T
• Latof-T
• Latoncore
• Latoncure
• Latop-Comp
• Latoxap
• Lotensin Plus
• Louten T
• Timxal
• Xalacom
• Xalatrex Plus
• Xalavist Plus
• Xalcom
• Xalostplus
• Zakol T
• Zyclat

Latanoprost and Timolol Brand Names in Pakistan: