Rescula

(Unoprostone)

Only 15 years ago, we had three basic topical medications to treat glaucoma. How things have changed.

And our topical armamentarium to lower intraocular pressure in the treatment and management of primary open angle glaucoma and ocular hypertension continues to grow. Today we have at least six classes of medication and multiple options within each class—including non-selective beta blockers, selective beta-blockers, alpha-agonists, carbonic anhydrase inhibitors, miotic agents and prostaglandin analogs—that give us many choices in individualizing glaucoma treatment for our patients.

A New Option
One of the newest glaucoma agent is the second in the family of prostaglandin analogs to be approved in this country: Rescula (unoprostone isopropyl 0.15%), marketed by CIBA Vision. Like Xalatan (latanoprost), the FDA approved Rescula for use in patients who have open angle glaucoma or ocular hypertension but cannot tolerate or don’t respond to other IOP-lowering medications.

Rescula does not have approval as a first-line agent, although eye doctors have increasingly used prostaglandin analogs as such in their management of primary open angle glaucoma. This is particularly true in cases of normal tension glaucoma, where the issue of optic nerve head perfusion and blood flow have many doctors questioning the use of vasoactive drugs as first-line agents. 

What is Unoprostone?

Rescula (unoprostone isopropyl 0.15%) is a new option for treating open angle glaucoma and ocular hypertension.

Rescula’s unoprostone is a docosanoid, one of the products of the inflammatory process that regulates a variety of cellular functions. Like latanoprost, unoprostone seems to increase the facility of outflow in the eye to effectively reduce IOP.

Rescula is indicated for twice-daily instillation. That could be both bad and good. On one hand, bid dosing may create compliance issues. But on the other hand, it may help reduce significant diurnal variations.

The effectiveness of unoprostone in reducing IOP is somewhat less than timolol maleate, brimonidine and latanoprost as mono-therapy.  Unoprostone, when used as an adjunctive treatment to timoptic, achieves significant additional reduction in pressure. Also, unoprostone may be effective in patients who have otherwise not responded to latanoprost. The efficacy of unoprostone for IOP reduction doesn’t appear to change significantly over at least one year.

Rescula also has an excellent systemic safety profile, with little systemic absorption and few reported systemic side effects. And, this new drug does not compromise cardiopulmonary function. As with most topically applied medications, a significant number of patients reported burning and stinging upon instillation of the drug.

Rescula doesn’t contribute to dry eye either. In a recent study, unoprostone demonstrated no adverse effects on tear development when compared with timolol, which “caused significant impairments in tear production and turnover.

Rescula, like latanoprost, may cause increased pigmentation of the iris and periorbital skin as well as an increase in the length and number of eyelashes. If you plan to take Rescula for unilateral use, anticipate the possibility of eye color change in the eye.

Successful medical management of glaucoma is all about options. With the many options available to us today, we can tailor your treatment to achieve the lowest acceptable pressure, which will hopefully prevent the progression of glaucomatous optic atrophy. To that worthy goal, time (and use) will tell how unoprostone will fit within our armamentarium.

Special information if you are pregnant or breastfeeding:

The effects of Rescula during pregnancy and breastfeeding have not been adequately studied. If you are pregnant or plan to become pregnant, notify your doctor immediately. It is not known whether Rescula makes it way into breast milk. If you are nursing and need to use Rescula, your eye care doctor may advise you to discontinue breastfeeding while using the medication.

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