INDICATIONS     CONTRA-INDICATIONS     DOSAGE     SIDE-EFFECTS     PREGNANCY     OVERDOSE     IDENTIFICATION     PATIENT INFORMATION

Logo LUMIGAN 0,03% Eye drops


SCHEDULING STATUS
Schedule 4

PROPRIETARY NAME
(and dosage form)

LUMIGAN 0,03% Eye drops

COMPOSITION
Each mL of sterile solution contains
bimatoprost 0,3 mg.
Excipients:
Contains benzalkonium chloride 0,005% m/v as a preservative

Sodium chloride
Sodium phosphate dibasic heptahydrate
Citric acid monohydrate
Purified water

PHARMACOLOGICAL CLASSIFICATION
A. 15.4 Ophthalmological preparations. Others

PHARMACOLOGICAL ACTION
Pharmacodynamics
Bimatoprost is an ocular hypotensive agent. It is a synthetic prostamide, structurally related to prostaglandin F
2alpha, that does not act through any known prostaglandin receptors. Bimatoprost selectively mimics the effects of prostamides. The prostamide receptor, however, has not yet been structurally identified.
Bimatoprost reduces intraocular pressure (IOP) in humans by increasing aqueous humour outflow through the trabecular meshwork and enhancing uveoscleral outflow.
Reduction of the intraocular pressure starts approximately 4 hours after the first administration and maximum effect is reached within approximately 8 to 12 hours. The duration of effect is maintained for 24 hours.
Limited experience is available with the use of bimatoprost in patients with open-angle glaucoma with pseudoexfoliative and pigmentary glaucoma, and chronic angle-closure glaucoma with patent iridotomy and no recommendation can be made.
No clinically relevant effects on heart rate and blood pressure have been observed in clinical trials.

Pharmacokinetics
Bimatoprost penetrates the human cornea and sclera well in vitro. After ocular administration, the systemic exposure of bimatoprost is very low with no accumulation over time.
After once daily ocular administration of one drop of 0,03% bimatoprost to both eyes of 15 healthy subjects for two weeks, blood concentrations peaked within 10 minutes after dosing and declined to below the lower limit of detection (0,025 ng/mL) in most subjects within 1,5 hours after dosing. 
Mean C
max and AUC0-24hrs values were similar on days 7 and 14 at approximately 0,08 ng/mL and 0,09 ng•hr/mL respectively, indicating that a steady drug concentration was reached during the first week of ocular dosing. Bimatoprost is moderately distributed into body tissues and the systemic volume of distribution in humans at steady-state was 0,67L/kg.
In human blood, bimatoprost resides mainly in the plasma. The plasma protein binding of bimatoprost is approximately 88%.
Bimatoprost is not extensively metabolised in the human eye. Bimatoprost is the major circulating component in the blood once it reaches the systemic circulation following ocular dosing. Bimatoprost then undergoes oxidation, N-deethylation and glucuronidation to form a diverse variety of metabolites.
Bimatoprost is eliminated primarily by renal excretion, up to 67% of an intravenous dose administered to healthy volunteers was excreted in the urine, 25% of the dose was excreted via the faeces. The elimination half-life, determined after intravenous administration, was approximately 45 minutes, the total blood clearance was 1,5 L/hr/kg.
Characteristics in patients
Elderly patients:  After twice daily dosing, the mean AUC
0-24hrs value of 0,0634 ng•hr/mL bimatoprost in the elderly (subjects 65 years or older) were significantly higher than 0,0218 ng•hr/mL in young healthy adults. However, this finding is not clinically relevant as systemic exposure for both elderly and young subjects remained very low from ocular dosing. There was no accumulation of bimatoprost in the blood over time and the safety profile was similar in elderly and young patients.

INDICATIONS
Reduction of elevated intraocular pressure in chronic open-angle glaucoma and ocular hypertension (as monotherapy or as adjunctive therapy to beta-blockers).

CONTRA-INDICATIONS
Hypersensitivity to bimatoprost or to any of the excipients.

WARNINGS
LUMIGAN
® 0,03% contains the preservative benzalkonium chloride, which may be absorbed by soft contact lenses. Contact lenses should be removed prior to instillation of LUMIGAN® 0,03% and may be reinserted 15 minutes following administration. LUMIGAN® 0,03% should not be administered while wearing contact lenses.
Due to the possibility of corneal permeability and the danger of disruption of the corneal epithelium with prolonged or repeated usage of benzalkonium chloride, regular ophthalmological examinations are required.
Caution should be exercised in the use of benzalkonium chloride over an extended period in patients with extensive ocular surface disease.

INTERACTIONS
Bimatoprost is biotransformed by multiple enzymes and pathways, and no effects on hepatic drug metabolising enzymes were observed in pre-clinical studies. Therefore, specific interaction studies with other medicinal products have not been performed with LUMIGAN
® 0,03%.
In clinical studies, LUMIGAN
® 0,03% was used concomitantly with a number of different ophthalmic beta-blocking agents without evidence of drug interactions.
Concomitant use of LUMIGAN
® 0,03% and anti-glaucomatous agents other than topical beta-blockers has not been evaluated during adjunctive glaucoma therapy.

PREGNANCY AND LACTATION
The safety of LUMIGAN
® 0,03% during pregnancy and lactation has not been established. LUMIGAN® 0,03% should not be used during pregnancy unless clearly necessary. It is recommended that it not be used in breastfeeding mothers as it is not known if LUMIGAN® 0,03% is excreted in human milk.

DOSAGE AND DIRECTIONS FOR USE
When used as monotherapy or as adjunctive therapy, the recommended dose is one drop of LUMIGAN
® 0,03% in the affected eye(s) once daily, administered in the evening.
The dose should not exceed once daily as more frequent administration may lessen the intraocular pressure lowering effect.
To prevent contamination of the dropper tip and solution, care should be taken not to touch the eyelids, surrounding areas or other surfaces with the dropper tip of the bottle.
If more than one topical ophthalmic medication is being used, the medicines should be administered at least 5 minutes apart.
Use in elderly
No dosage adjustment in elderly patients is necessary.
Use in children and adolescents (under the age of 18)
LUMIGAN
® 0,03% has only been studied in adults and therefore its use is not recommended in children or adolescents.
Use in hepatic and renal impairment
LUMIGAN
® 0,03% has not been studied in patients with renal or moderate to severe hepatic impairment and should therefore be used with caution in such patients. In patients with a history of mild liver disease or abnormal ALT, AST and/or bilirubin at baseline, LUMIGAN® 0,03% had no adverse effect on liver function over 24 months.

SIDE-EFFECTS AND SPECIAL PRECAUTIONS
Side-effects
The most frequently reported treatment-related adverse events reported in clinical trials with LUMIGAN
® 0,03% were: growth of eyelashes in up to 45% in the first year with the incidence of new reports decreasing to 7% at 2 years and 2% at 3 years, conjunctivalhyperaemia (mostly trace to mild and thought to be of a non-inflammatory nature) in up to 44% in the first year with the incidence of new reports decreasing to 13% at 2 years and 12% at 3 years, and ocular pruritus in up to 14% of patients in the first year with the incidence of new reports decreasing to 3% at 2 years and 0% at 3 years.
Less than 9% of patients discontinued due to any adverse event in the first year with the incidence of additional patient discontinuations being 3% at both 2 and 3 years.
The following undesirable effects definitely, probably or possibly related to treatment were reported during clinical trials with LUMIGAN
® 0,03%. Most were ocular, mild to moderate, and none was serious. With each frequency grouping, undesirable effects are presented in order of decreasing seriousness.
Infections and infestations
Uncommon (>1/1000 to <1/100):  Infection (primarily colds and upper respiratory tract infections)
Nervous system disorders
Common (>1/100 to <1/10):  Headache
Uncommon (>1/1000 to <1/100):  Dizziness
Eye disorders
Very common (>1/10):  Conjunctival hyperaemia, growth of eyelashes, ocular pruritus
Common (>1/100 to <1/10):  Allergic conjunctivitis, asthenopia, blepharitis, cataract, conjunctival oedema, corneal erosion, eye discharge, eyelash darkening, eye pain, foreign body sensation, increased iris pigmentation, ocular burning, ocular dryness, ocular irritation, photophobia, superficial punctate keratitis, tearing, visual disturbance and worsening of visual acuity
Uncommon (>1/1000 to <1/100):  Blepharospasm, cystoid macular oedema, eyelid retraction, iritis, retinal haemorrhage, uveitis
Vascular disorders
Common (>1/100 to <1/10):  Hypertension
Skin and subcutaneous tissue disorders
Common (>1/100 to <1/10):  Eyelid erythema, eyelid pruritus, pigmentation of periocular skin
Uncommon (>1/1000 to <1/100):  Eyelid oedema, hirsutism
General disorders and administration site conditions
Uncommon (>1/1000 to <1/100):  Asthenia, peripheral oedema
Investigations
Common (>1/100 to < 1/10):  Liver function test abnormal

Special precautions
During treatment with LUMIGAN
® 0,03%,darkening of the eyelid skin and gradual increased eyelash growth (lengthening, darkening and thickening) with no consequent untoward ocular effects has been observed.
Increased iris pigmentation (darkening) has also been reported. The change in iris pigmentation occurs slowly and may not be noticeable for several months. The effect has been seen in up to 2% of patients treated with LUMIGAN
® 0,03% for up to 12 months and the incidence did not increase following 3 years treatment. The increased iris pigmentation appears to be caused by increased stimulation of melanin production in melanocytes and not by an increase in melanocyte number.
Before treatment is initiated, patients should be informed of the possibility of eyelash growth, darkening of the eyelid skin and increased iris pigmentation. Some of these changes may be permanent and may lead to differences in appearance between the eyes when only one eye is treated.
Benzalkonium chloride, which is commonly used as a preservative in ophthalmic products, has been reported to cause punctate keratopathy and/or toxic ulcerative keratopathy. Since LUMIGAN
® 0,03% contains benzalkonium chloride, monitoring is required with frequent or prolonged use in dry eye patients or where the cornea is compromised.
LUMIGAN
® 0,03% has not been studied in patients with compromised respiratory function and should therefore be used with caution in such patients. In clinical studies, in those patients with a history of compromised respiratory function, no significant untoward respiratory effects have been seen.
LUMIGAN
® 0,03% has not been studied in patients with heart block more severe than first degree or uncontrolled congestive heart failure.
LUMIGAN
® 0,03% has not been studied in patients with inflammatory ocular conditions, neovascular, inflammatory, angle-closure glaucoma, congenital glaucoma or narrow-angle glaucoma.
Cystoid macular oedema has been uncommonly reported (>1/1000 to <1/100) following treatment with LUMIGAN
® 0,03%, and should therefore be used with caution in patients with known risk factors for macular oedema (e.g. aphakic patients, pseudophakic patients with a torn posterior lens capsule).
Effects on the ability to drive and use machines
LUMIGAN
® 0,03% has negligible influence on the ability to drive and use machines. If transient blurred vision occurs at instillation, the patient should wait until the vision clears before driving or using machinery.

KNOWN SYMPTOMS OF OVERDOSAGE AND PARTICULARS OF ITS TREATMENT
No case of overdose has been reported, and is unlikely to occur after ocular administration. If overdosage occurs, treatment should be symptomatic and supportive.

IDENTIFICATION
A clear colourless to slightly yellow solution with no foreign particles.

PRESENTATION
White opaque low density polyethylene bottles with a polystyrene screw cap, packed into an outer carton. Each bottle is filled with 3 mL solution.

STORAGE INSTRUCTIONS
Store at or below 25°C.
Chemical and physical in-use stability has been demonstrated for 28 days at 25°C.
From a microbiological point of view, the in-use storage time and conditions are the responsibility of the user.
Do not use more than 28 days after opening at 25°C.
Keep bottle tightly closed when not in use.
KEEP OUT OF REACH AND SIGHT OF CHILDREN

REGISTRATION NUMBER
36/15.4/0157

NAME AND BUSINESS ADDRESS OF THE HOLDER OF THE CERTIFICATE OF REGISTRATION
Allergan Pharmaceuticals (Pty) Ltd
30 New Road (entrance off Bavaria Road)
Randjespark Ext 11, Midrand, 1682
Johannesburg, Gauteng
South Africa

DATE OF PUBLICATION OF THIS PACKAGE INSERT
21 June 2013

Updated on this site: March 2014
Source: Pharmaceutical Industry

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