Prostaglandin Analogues (ocular)


Bimatoprost (Lumigan®), Latanoprost (Xalatan®), Tafluprost (Saflutan®), Travoprost (Travatan®) 

  Issues for Surgery


For primary open-angle glaucoma (topical) – increased risk of deterioration in eyesight if omitted for a prolonged period.  


  Advice in the Perioperative period


Elective and Emergency Surgery
Continue including the following combination products (unless the patient is undergoing ophthalmology surgery and the Ophthalmologist requests for them to be withheld): -
Confirm with patient if drops are prescribed for left eye, right eye or both eyes. Encourage correct application technique to reduce systemic absorption (see Further Information)

Post-operative Advice
Restart post-operatively when next dose is due (unless the patient has undergone ophthalmology surgery and the Ophthalmologist requests for them to be withheld).


   Interaction(s) with Common Anaesthetic Agents


None 1, 2, 3, 4, 5, 6 as systemic concentrations of prostaglandin analogues are extremely low following ocular dosing 3, 4

For combination products
Systemic absorption can follow topical application of beta-blockers to the eyes 1 – the advice and cautions as listed for systemic beta-blockers should be considered (see Beta-adrenoceptor Blockers (Beta-Blockers) (Systemic and Topical) monograph).

  Interaction(s) with other Common Medicines used in the Perioperative Period


None expected1, 3, 4, 5, 6 as systemic concentrations of prostaglandin analogues are extremely low following ocular dosing3, 4. However variable effects on the intraocular pressure-lowering effects of some ophthalmic prostaglandin analogues have been seen with various Non-Steroidal Anti-inflammatory Drugs (NSAIDs) in a small study. Whilst short term use post-operatively should not pose a problem, if long term use is necessary discuss with an Ophthalmologist as additional monitoring might be appropriate when an oral or ocular NSAID is stopped or started in a patient stabilised on an ophthalmic prostaglandin analogue 2

For combination products 
Systemic absorption can follow topical application of beta-blockers to the eyes 1 – the advice and cautions as listed for systemic beta-blockers should be considered (see Beta-adrenoceptor Blockers (Beta-Blockers) (Systemic and Topical) monograph).

  Further Information


Systemic Absorption
Nasolacrimal occlusion or gently closing the eyelid is recommended following ocular administration of any medication to reduce systemic absorption 4, 5, 6.

  References


  1. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 5th February 2021]
  2. Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 5th February 2021]
  3. Summary of Product Characteristics – LUMIGAN® (bimatoprost) 0.3 mg/mL eye drops, solution, in single-dose container. Allergan Ltd. Accessed via www.medicines.org.uk 05/02/2021 [date of revision of the text January 2019]
  4. Summary of Product Characteristics – Saflutan® (tafluprost) 15 micrograms/ml eye drops, solution. Santen UK Limited. Accessed via www.medicines.org.uk 05/02/2021 [date of revision of the text December 2020]
  5. Summary of Product Characteristics – TRAVATAN® (travoprost). Novartis Pharmaceuticals UK Ltd. Accessed via www.medicines.org.uk 05/02/2021 [date of revision of the text August 2018]
  6. Summary of Product Characteristics – Xalatan® (latanoprost) 50 micrograms/ml eye drops solution. Upjohn UK Limited. Accessed via www.medicines.org.uk 05/02/2021 [date of revision of the text December 2020]