Prostaglandin analogues are the first line medical treatment option in chronic open angle glaucoma. They are also the first line option in certain categories of ocular hypertension.

There is no consistent evidence to favour one drug over another. In some studies bimatoprost and travoprost lower intra occular pressure (IOP) more than latanoprost, but conjunctival hyperaemia is more common with bimatoprost. Tafluprost has been shown to be less effective than latanoprost at reducing IOP.

If there are no clinical factors to direct choice the product of lowest acquisition cost should be prescribed. Although all treatments for glaucoma are listed as specialist initiated drugs it is expected that the first-line treatment to be with generic latanoprost.

Side effects are primarily ocular but systemic side effects can occur. Breathlessness has been reported as a side effect of latanoprost. These drugs may darken the colour of the iris.

Due to the increased cost preservative-free preparations should only be used in patients who have a proven sensitivity to preservatives.

The optimal effect is obtained if the dose of prostaglandin analogue (without timolol) is administered in the evening.

One bottle of prostaglandin analogue contains enough drops to treat both eyes for 28 days.

Combination products (with timolol) cost more than the individual ingredients. Where patients require treatment with a prostaglandin analogue and a beta blocker or a sympathomimetic, combination products may be used if this will aid compliance and may be useful in patients with poor manual dexterity, and those who experience local irritation due to increased exposure to preservatives.

Monotherapy eye preparations

Latanoprost

• Eye drops 50micrograms/ml (£1.56 = 2.5ml)
• Single unit dose eye drops 50micrograms/ml (preservative-free) (£8.49 = 30 x 0.2ml, £25.47 = 90 x 0.2ml)

Dose

• Apply once daily, preferably in the evening

Travoprost

• Eye drops 40micrograms/ml (£2.17 = 2.5ml)

Dose

• Apply once daily, preferably in the evening

Bimatoprost

• Eye drops 100micrograms/ml (£4.04 = 3ml)
• Single unit dose eye drops 300micrograms/ml (preservative-free) (£13.75 = 30 x 0.4ml)

Dose

• Apply once daily, preferably in the evening

Tafluprost

• Single unit dose eye drops 15micrograms/ml (preservative-free) (£12.20 = 30 x 0.3ml)

Dose

• Apply once daily, preferably in the evening

Combination eye preparations

Latanoprost/ Timolol

• Eye drops latanoprost 50micrograms/ timolol 5mg/ml (£4.75 = 2.5ml)
• Single unit dose eye drops latanoprost 50micrograms/ timolol 5mg/ml (preservative-free) (£13.49 = 30 x 0.2ml)

Dose

• Apply once daily, preferably in the evening

Travoprost/ Timolol

• Eye drops travoprost 40micrograms/ timolol 5mg/ml (£4.86 = 2.5ml)

Dose

• Apply once daily, preferably in the evening

Bimatoprost/ Timolol

• Eye drops bimatoprost 300micrograms/ timolol 5mg/ml (£4.08 = 3ml)
• Single unit dose eye drops bimatoprost 300micrograms/ timolol 5mg/ml (preservative-free) (£17.94 = 30 x 0.4ml)

Dose

• Apply once daily, preferably in the evening

Tafluprost/ Timolol

• Single unit dose eye drops tafluprost 15micrograms/ timolol 5mg/ml (preservative-free) (£14.50 = 30 x 0.3ml)

Dose

• Apply once daily