A Comprehensive Monograph on Latanoprost: Pharmacology, Clinical Efficacy, and Therapeutic Landscape

Executive Summary

Latanoprost, a prostaglandin F2α analog, represents a cornerstone in the modern therapeutic management of glaucoma and ocular hypertension. Its introduction in 1996 revolutionized treatment paradigms due to its potent intraocular pressure (IOP)-lowering efficacy, convenient once-daily dosing regimen, and a favorable systemic safety profile that set it apart from previous standards of care. As an isopropyl ester prodrug, Latanoprost is designed for optimal corneal penetration, where it is hydrolyzed into its active acid form to exert its therapeutic effect. It acts locally by selectively targeting the prostanoid FP receptor, which initiates a cascade of cellular changes that increase aqueous humor outflow primarily through the uveoscleral pathway, an alternative drainage route to the conventional trabecular meshwork.

While highly effective, the clinical profile of Latanoprost is characterized by a well-defined and predictable set of ocular side effects. The most notable of these are conjunctival hyperemia (ocular redness), gradual and permanent changes in iris pigmentation, and reversible changes to eyelashes, including increased length, thickness, and darkness. The therapeutic landscape of Latanoprost has evolved significantly from its initial launch as a single blockbuster brand (Xalatan®). It has matured into a competitive market featuring multiple generic versions, value-added formulations designed to improve tolerability, and strategic fixed-dose combinations aimed at enhancing efficacy. This evolution reflects a growing clinical focus on mitigating long-term ocular surface toxicity, leading to the development of benzalkonium chloride (BAK)-free (Xelpros®) and entirely preservative-free (Iyuzeh™) formulations. Furthermore, fixed-dose combinations with agents like timolol and the novel Rho kinase inhibitor netarsudil (Rocklatan®)