Posted by Paul Fletcher
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Lumigan is a prostaglandin F2α analogue used to lower intraocular pressure (IOP) in patients with open‑angle glaucoma or ocular hypertension. Its active ingredient, bimatoprost, increases uveoscleral outflow, delivering a 25‑30% IOP reduction in most users.
The prostaglandin pathway is the cornerstone of modern glaucoma treatment. By binding to FP receptors in the ciliary body, bimatoprost remodels extracellular matrix, allowing fluid to exit the eye more easily. This mechanism is shared with other prostaglandin analogues but varies slightly in receptor affinity, which explains the subtle differences in side‑effect profiles.
Below are the most frequently prescribed drops that compete with Lumigan. Each belongs to a different therapeutic class, which matters when patients have contraindications or need additive effects.
Latanoprost (Xalatan) is a prostanoid FP receptor agonist with a 0.005% concentration. It reduces IOP by 25‑30% and is the most widely used prostaglandin analogue worldwide.
Travoprost (Travatan) is another FP‑receptor agonist, available in a preservative‑free formulation for patients sensitive to benzalkonium chloride.
Tafluprost (Taflotan) is a synthetic prostaglandin analogue that offers similar efficacy with a marginally lower rate of hyperemia.
Brimonidine (Alphagan) is an α‑2 adrenergic agonist. By decreasing aqueous humor production, it reduces IOP about 20‑25% and can be combined with prostaglandins for additive effect.
Dorzolamide (Trusopt) belongs to the carbonic anhydrase inhibitor (CAI) class. It blocks fluid production in the ciliary processes, delivering a modest 15‑20% IOP drop.
Timolol is a non‑selective beta‑blocker that reduces aqueous humor formation; often paired with prostaglandins when a single‑drop regimen isn’t enough.
Omidenepag isopropyl (Eyiku) is an EP2 receptor agonist, a newer class that bypasses FP receptors entirely. Early trials show comparable IOP reductions with a different side‑effect spectrum.
Understanding tolerability helps decide which drop fits a patient’s lifestyle. Prostanoid drugs (Lumigan, Latanoprost, Travoprost, Tafluprost) share common issues: mild redness, eyelash lengthening, and possible iris darkening. Brimonidine can cause ocular allergy and systemic fatigue, while beta‑blockers may affect heart rate and respiratory function. CAIs like dorzolamide sometimes cause a metallic taste. Omidenepag’s notable adverse event is superficial punctate keratitis in a small subset.
Government subsidies (PBS) cover most branded prostaglandins, but the tiered co‑payment differs. Generic latanoprost and travoprost are typically cheaper than brand‑name Lumigan. Brimonidine and timolol remain low‑cost, especially in generic form. Omidenepag, being new, is priced higher and limited to specialist prescription.
| Drug | Class | Typical IOP Reduction | Key Side‑Effects | Cost (AU$) per 30drops |
|---|---|---|---|---|
| Lumigan | Prostaglandin analog | 25‑30% | Hyperemia, iris darkening, eyelash growth | ~45 |
| Latanoprost | Prostaglandin analog | 25‑30% | Redness, occasional iris change | ~30 |
| Travoprost | Prostaglandin analog | 25‑30% | Redness, mild ocular irritation | ~35 |
| Tafluprost | Prostaglandin analog | 24‑28% | Less hyperemia, rare iris change | ~40 |
| Brimonidine | α‑2 agonist | 20‑25% | Allergy, dry mouth, fatigue | ~25 |
| Dorzolamide | Carbonic anhydrase inhibitor | 15‑20% | Metallic taste, stinging | ~20 |
| Timolol | Beta‑blocker | 20‑25% | Bradycardia, bronchospasm | ~15 |
| Omidenepag | EP2 agonist | 24‑28% | Keratic precipitates, mild pain | ~55 |
Pick a medication based on three pillars: effectiveness, tolerance, and systemic safety.
Combination therapy (e.g., prostaglandin + timolol) is common when a single agent cannot achieve target IOP. A step‑wise approach-start with a prostaglandin, then add a beta‑blocker or CAI-matches most Australian treatment algorithms.
Understanding the broader glaucoma care landscape helps you make informed choices. Key related topics include:
If you experience sudden eye pain, blurry vision, or a rapid rise in IOP despite treatment, contact your ophthalmologist immediately. These could signal an acute angle‑closure event, which requires urgent intervention.
Clinical studies from 2023‑2024 show Lumigan provides a modest 1‑2% greater IOP reduction in patients who do not respond fully to latanoprost. The difference is statistically significant but may not be clinically relevant for everyone.
Yes. Many clinicians prescribe a prostaglandin analogue combined with a beta‑blocker or carbonic anhydrase inhibitor. Space the drops by at least five minutes to avoid dilution.
Mild redness is common and often resolves within weeks. If it persists, switch to a preservative‑free formulation like travoprost PF or discuss a change with your eye‑care professional.
Animal data suggest a risk of fetal eye development issues, and the Australian Medicines Handbook advises caution. Discuss alternatives with your obstetrician and ophthalmologist.
Bimatoprost stimulates the hair‑growth cycle in eyelash follicles, a side‑effect that has been marketed as a cosmetic benefit. The effect is reversible after stopping the medication.
Most ophthalmic solutions are stable for 28 days after opening. Mark the first use date on the bottle and discard any remaining solution after six weeks.
In Australia, generic latanoprost is widely available and considered therapeutically equivalent. Discuss with your pharmacist; bioequivalence is confirmed by the TGA.