Version May 2024
Ocular hypertension/glaucoma (open-angle):
Ocular implant: Intracameral: Insert 1 implant into affected eye(s); do not readminister.
Ocular solution: Ophthalmic: Instill 1 drop into affected eye(s) once daily in the evening; do not exceed once-daily dosing (may decrease intraocular pressure-lowering effect).
There are no dosage adjustments provided in the manufacturer's labeling; dosage adjustments are unlikely due to low systemic absorption.
There are no dosage adjustments provided in the manufacturer's labeling; dosage adjustments are unlikely due to low systemic absorption.
Refer to adult dosing.
(For additional information see "Travoprost: Pediatric drug information")
Elevated intraocular pressure (IOP): Ophthalmic: Infants ≥2 months, Children, and Adolescents: Limited data available: 1 drop into affected eye(s) once daily in the evening (Ref). Note: Do not exceed once-daily dosing (may decrease IOP-lowering effect).
There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustments are unlikely due to low systemic absorption.
There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustments are unlikely due to low systemic absorption.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%: Ophthalmic: Ocular hyperemia (30% to 50%)
1% to 10%:
Cardiovascular: Angina pectoris (1% to 5%), bradycardia (1% to 5%), chest pain (1% to 5%), hypertension (1% to 5%), hypotension (1% to 5%)
Central nervous system: Foreign body sensation of eye (5% to 10%), anxiety (1% to 5%), depression (1% to 5%), headache (1% to 5%), pain (1% to 5%)
Dermatologic: Hyperpigmentation of eyelashes, increased growth in number of eyelashes
Endocrine & metabolic: Hypercholesterolemia (1% to 5%)
Gastrointestinal: Dyspepsia (1% to 5%), gastrointestinal distress (1% to 5%)
Genitourinary: Prostatic disease (1% to 5%), urinary incontinence (1% to 5%), urinary tract infection (1% to 5%)
Hypersensitivity: Hypersensitivity reaction (1% to 5%)
Infection: Infection (1% to 5%)
Neuromuscular & skeletal: Arthritis (1% to 5%), back pain (1% to 5%)
Ophthalmic: Decreased visual acuity (5% to 10%), eye discomfort (5% to 10%), eye pain (5% to 10%), eye pruritus (5% to 10%), blepharitis (1% to 4%), blurred vision (1% to 4%), cataract (1% to 4%), conjunctivitis (1% to 4%), corneal staining (1% to 4%), crusting of eyelid (1% to 4%), dry eye syndrome (1% to 4%), hyperpigmentation of eyelids (periorbital; 1% to 4%), iris discoloration (1% to 4%), keratitis (1% to 4%), lacrimation (1% to 4%), ophthalmic inflammation (1% to 4%), photophobia (1% to 4%), subconjunctival hemorrhage (1% to 4%), visual disturbance (1% to 4%), increased eyelash length, increased eyelash thickness
Respiratory: Bronchitis (1% to 5%), flu-like symptoms (1% to 5%), sinusitis (1% to 5%)
<1%, postmarketing, and/or case reports: Abdominal pain, arthralgia, asthma, bacterial keratitis (due to solution contamination), cardiac arrhythmia, chest discomfort, corneal edema, cystoid macular edema, diarrhea, dyspnea, dysuria, enophthalmos, epistaxis, erythema of skin, insomnia, iritis, macular edema, musculoskeletal pain, nausea, prostate specific antigen increase, pruritus, tachycardia, tinnitus, uveitis, vomiting
Ocular implant: Hypersensitivity to travoprost or any component of the formulation; active or suspected ocular or periocular infection; corneal endothelial cell dystrophy (eg, Fuch dystrophy, corneal guttata); prior corneal transplantation or endothelial cell transplants (eg, Descemet stripping automated endothelial keratoplasty).
Ocular solution: There are no contraindications listed in the US manufacturer's labeling.
Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to travoprost or any component of the formulation; pregnancy or women attempting to become pregnant.
Concerns related to adverse effects:
• Bacterial keratitis: Ocular solution: Inadvertent contamination of multiple-dose ophthalmic solutions has caused bacterial keratitis.
• Eye color changes: May change/increase brown pigmentation of the iris, the eyelid skin, and eyelashes; length and/or number of eyelashes may also be increased. Pigmentation of the iris is likely to be permanent although iris color change may not be noticeable for months to years; pigmentation of the periorbital tissue and eyelash changes may be reversible following discontinuation of therapy. Long-term consequences and potential injury to eye are not known.
• Ocular inflammation: Intraocular inflammation and exacerbation of inflammation may occur; use with caution in patients with a history of intraocular inflammation (eg, iritis/uveitis) and generally avoid use in patients with active intraocular inflammation.
Disease-related concerns:
• Aphakia or pseudoaphakia: Topical prostaglandin analogues have been associated with the occurrence/exacerbation of macular edema, including cystoid macular edema. Carefully examine the macula in these patients especially those with an open posterior capsule.
• Herpetic keratitis: Use with caution in patients with a history of herpes simplex keratitis; reactivation may occur. Avoid use in patients with active herpes simplex keratitis.
• Iridocorneal angles: Ocular implant: Use with caution in patients with narrow iridocorneal angles (Shaffer grade <3) or other angle abnormalities (eg, peripheral anterior synechia, rubeosis iridis); may impair proper placement of implant.
• Uveitis: Use cautiously in patients with intraocular inflammation as topical prostaglandins may worsen inflammation.
Special populations:
• Contact lens wearers: Ocular solution: Remove contact lens prior to instillation; may reinsert 15 minutes following administration.
• Pediatric: Use ocular solution in pediatric patients (<16 years of age) is not recommended by the manufacturer due to possible safety issues of increased pigmentation following long-term chronic use. Safety and efficacy of ocular implant has not been established in pediatrics.
Dosage form specific issues:
• Ocular implant: Dislocation has occurred; surgically remove if implant becomes dislocated. Endophthalmitis has occurred with intraocular surgical procedures and injections; ensure proper aseptic technique is used during administration. Implant is MRI conditional; patients should inform health care providers of implant prior to MRI.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Implant, Intraocular:
iDose TR: 75 mcg (1 ea)
Solution, Ophthalmic:
Travatan Z: 0.004% (2.5 mL, 5 mL) [contains propylene glycol]
Travatan Z: 0.004% (2.5 mL [DSC], 5 mL [DSC]) [benzalkonium free; contains polyoxyl/peg-35 castor oil(cremophor el), propylene glycol]
Generic: 0.004% (2.5 mL, 5 mL)
May be product dependent
Implant (iDose TR Intraocular)
75 mcg (per each): $16,740.00
Solution (Travatan Z Ophthalmic)
0.004% (per mL): $107.44
Solution (Travoprost (BAK Free) Ophthalmic)
0.004% (per mL): $79.34 - $83.84
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Ophthalmic:
Izba: 0.003% (2.5 mL, 5 mL) [contains propylene glycol]
Travatan Z: 0.004% (2.5 mL, 5 mL) [contains propylene glycol]
Generic: 0.004% (2.5 mL, 5 mL)
Ophthalmic:
Ocular implant: Anesthetize eye using general, retrobulbar, peribulbar, or topical anesthesia prior to inserting; may administer an intracameral miotic to deepen the angle prior to implant insertion. Administer from the temporal side, using a temporal clear corneal incision; implant intracamerally through the angle and the trabecular meshwork into the sclera on the nasal side. Once implanted, apply slight pressure to the sides of the implant with the tip of the inserter to ensure the implant is fully anchored into scleral tissue. If the initial implant is loose or disengaged, remove and reimplant a minimum of ½ clock hour to either side of initial implant try; do not reimplant at the same location. Perform a high magnification examination to confirm the implant is in proper position. Refer to manufacturer's prescribing information for additional administration instructions.
Ocular solution: May be used with other eye drops to lower intraocular pressure. If using more than one ophthalmic product, wait at least 5 minutes in between application of each medication. Remove contact lenses prior to administration and wait 15 minutes (after administration) before reinserting. Minimize contamination by not touching the eyelids or surrounding areas with the dropper tip; keep bottle tightly closed when not in use. Use eyelid closure or nasolacrimal occlusion when applying topical medications to reduce systemic absorption.
For ophthalmic use only. Travoprost may be used with other eye drops to lower intraocular pressure. If using more than one ophthalmic product, wait at least 5 minutes in between application of each medication. Apply gentle pressure to lacrimal sac immediately following instillation (1 minute) or instruct patient to gently close eyelid after administration to decrease systemic absorption of ophthalmic drops (Ref). Remove contact lenses prior to administration and wait 15 minutes (after administration) before reinserting. Avoid contact of bottle tip with skin or eye; ocular solutions can become contaminated by common bacteria known to cause ocular infections. Serious damage to the eye and subsequent loss of vision may occur from using contaminated solutions
Ocular hypertension/glaucoma (open-angle): Reduction of elevated intraocular pressure in adults (ocular implant, ocular solution) and pediatric patients ≥16 years of age (ocular solution) with open-angle glaucoma or ocular hypertension.
Travatan may be confused with Xalatan
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Latanoprost: The concomitant use of Prostaglandins (Ophthalmic) and Latanoprost may result in increased intraocular pressure. Risk X: Avoid combination
Nonsteroidal Anti-Inflammatory Agents: May diminish the therapeutic effect of Prostaglandins (Ophthalmic). Nonsteroidal Anti-Inflammatory Agents may also enhance the therapeutic effects of Prostaglandins (Ophthalmic). Risk C: Monitor therapy
Nonsteroidal Anti-Inflammatory Agents (Ophthalmic): May diminish the therapeutic effect of Prostaglandins (Ophthalmic). Nonsteroidal Anti-Inflammatory Agents (Ophthalmic) may enhance the therapeutic effect of Prostaglandins (Ophthalmic). Risk C: Monitor therapy
Ophthalmic prostaglandins, such as travoprost, have a theoretical risk of miscarriage. To decrease this risk, agents other than travoprost may be preferred for the treatment of glaucoma in patients planning to become pregnant (Strelow 2020).
Ophthalmic prostaglandins, such as travoprost, are generally avoided during pregnancy due to a theoretical risk of miscarriage and premature labor. Agents other than travoprost may be preferred for the treatment of glaucoma during pregnancy, especially during the first trimester. In general, if ophthalmic agents are needed in pregnancy, the minimum effective dose should be used in combination with punctal occlusion to decrease exposure to the fetus (Belkin 2020; Prum 2016; Strelow 2020).
It is not known if travoprost is present in breast milk.
According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother. Due to their short half-lives, ophthalmic prostaglandins such as travoprost are considered compatible with breastfeeding; administering after breastfeeding may help decrease potential exposure to the infant via breast milk (Belkin 2020; Prum 2016; Strelow 2020).
Ophthalmic exams (optic nerve and visual field assessment), serial measurement of intraocular pressure (IOP). Frequency of follow up based upon whether target IOP achieved, if there is any progression of damage, and how long disease has been controlled (AAO 2019); routinely confirm the location of the ocular implant.
A selective FP prostanoid receptor agonist which lowers intraocular pressure by increasing trabecular meshwork and outflow
Onset of action: Ocular solution: ~2 hours.
Peak effect: Ocular solution: 12 hours.
Absorption: Absorbed via cornea; plasma levels <10 pg/mL within 1 hour (ocular solution), 10 days (ocular implant).
Metabolism: Hydrolyzed by esterases in the cornea to active free acid; systemically; the free acid is metabolized to inactive metabolites.
Half-life elimination: Ocular solution: 45 minutes (range: 17 to 86 minutes).
Excretion: Urine (<2% as metabolites).
Race/ethnicity: The intraocular pressure (IOP)-lowering effect of travoprost was shown to be 7 to 8 mm Hg among patients with a baseline pressure of 25 to 27 mm Hg in clinical studies. The mean IOP reduction was up to 1.8 mm Hg greater in Black patients, although it is not known if this increase can be attributed to race or to heavily pigmented irides.
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