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Conditions page or Glaucoma
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
selective beta-blockers, alpha-agonists, carbonic anhydrase
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
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
What is Unoprostone?
isopropyl 0.15%) is a new option for treating open angle glaucoma and ocular
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
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.