[Side-effects and risk profile of latanoprost 0.005% (Xalatan)]

Latanoprost, a prostaglandin F(2alpha)-analogue, has been widely in use in clinical practice for a period of over 5 years. The side-effects of latanoprost are analyzed and the clinical relevance is discussed.

Hypertrichosis and increased pigmentation of eyelashes will develop in the majority of patients using latanoprost for more than 6 months. Increased pigmentation of the eyelids may also occur. Hyperpigmentation of the iris is seen in 12-18% of caucasians using latanoprost over a period of 1-2 years. Increased iris pigmentation seems more common in asian people and remains unchanged after discontinuation of therapy. Pigmentation of intra- and extraocular structures is caused by increased melanogenesis, not by melanocyte proliferation. Mild conjunctival hyperemia may develop in approximately 30% of patients, but is most often without clinical relevance. Further reported side-effects include anterior uveitis, reactivation of herpes-keratitis/-dermatitis and cystoid macular edema in pseudophakic and aphakic patients. A causal relationship has still not been proven for these side-effects. Systemic side-effects are rare (e.g. headache, facial rash, cardiovascular effects). No experience exists for treatment of glaucoma with latanoprost in childhood.

Latanoprost represents a highly effective antiglaucomatous drug, rarely associated with vision-threatening complications. The most common complications are hypertrichosis of eyelashes and increased pigmentation of extra- and intraocular structures. A careful lifetime evaluation of these patients is recommended. Systemic side-effects are rare, but may occur.