- Reduction of intraocular pressure (IOP) in patients with open angle glaucoma and ocular hypertension who are insufficiently responsive to topical beta-blockers or prostaglandin analogues.
Pharmacist - M.B.A. (Public Health) D.I.C.
What is it used for? Raised pressure in the…
What is it used for?
- Raised pressure in the eye (ocular hypertension).
- Open angle glaucoma.
How does it work?
- Xalacom eye drops contain two active ingredients, latanoprost and timolol maleate. These are both medicines that decrease raised pressure within the eye. They work in different ways to produce a combined effect greater than either medicine produces on its own.
The pressure within the eyeball is naturally maintained by a continuous flow of liquid called aqueous humour through the eyeball. Aqueous humour is produced by a part of the eye called the ciliary body. It drains out of the eyeball through channels called the trabecular meshwork. If the outflow of aqueous humour is blocked, the aqueous humour builds up inside the eye, increasing the pressure within the eyeball. This pressure needs to be reduced, as otherwise it can damage the optic nerve and impair vision as a result.
Latanoprost is a type of medicine called a prostaglandin analogue. It reduces the pressure in the eye by mimicking the action of a naturally-occuring prostaglandin. Prostaglandins are a group of natural body chemicals found in many places in the body. In the eye, they increase the drainage of the aqueous humour out of the eyeball. Latanoprost is a synthetic prostaglandin that acts on the same receptors in the eye as the natural prostaglandins. It therefore causes an increase in the drainage of aqueous humour out of the eyeball. This decreases the pressure within the eye.
Timolol is a type of medicine called a beta-blocker. These medicines block beta-receptors in various parts of the body. Blocking the beta receptors in the eye reduces the amount of aqueous humour that is produced. Timolol therefore reduces the inflow of aqueous humour into the eyeball and so decreases the pressure within the eye in a different way.
The combination of these two medicines is used to lower the pressure in the eye when a beta-blocker or a prostaglandin analogue eye drop does not lower the pressure enough on its own.
How do I use it?
- Xalacom eye drops contain the preservative benzalkonium chloride, which can be absorbed by contact lenses and cause eye irritation. If you wear contact lenses, you should remove them before putting in these eye drops. You should wait at least 15 minutes after using the drops before putting your contact lenses back in.
- Wash your hands before using the eye drops.
- One drop should be put into the affected eye(s) once a day. The medicine is most effective if the drops are applied in the evening. Click here for instructions on how to put in the eye drops.
- Immediately after administering the eye drops, close the eye and press on the tear duct (at the corner of the eye closest to your nose) for about two minutes. This is to minimise the amount of medicine that may be absorbed into the bloodstream, which will increase the local effect in the eye and minimise any adverse effects elsewhere in the body.
- When using these eye drops you should take care to not touch the dropper tip to any surface, or to your eye, in order to avoid contaminating the eye drops.
- If you miss a dose just apply your next dose as usual. Don't use the drops twice in one day to make up for a missed dose.
- You should not exceed the recommended dose, as using the drops more frequently than once a day can actually make them less effective.
- This medicine is not to be taken by mouth.
- These eye drops may cause your vision to blur temporarily after you have put them in your eye. Do not drive or operate machinery until this has worn off. You should also take into account that this medicine can sometimes cause other visual disturbances, eg double vision, and dizziness or fatigue, all of which may affect your ability to drive or operate machinary.
- Xalacom eye drops should be stored in a refrigerator at 2-8°C before opening. After opening the eye drops may kept outside of the fridge, but do not store them above 25°C. Keep the container in the outer carton in order to protect from light.
- Xalacom eye drops are sterile until opened. The bottles contain a preservative that helps keep the eye drops sterile once they are in use. However, any medicine remaining in the bottle after it has been open for four weeks or more is likely to be contaminated with germs and should no longer be used. Dispose of carefully, preferably by returning to your pharmacy. You may find it helpful to write the date of first opening on the packet.
- Latanoprost can cause your eye colour to gradually change, by increasing the amount of brown pigment in your iris. This is not associated with any symptoms and is not harmful. It predominately happens in people with green-brown, yellow-brown or blue/grey-brown eyes. If these eye drops are only used in one eye, this may cause your eyes to permanently become different colours. The drops may also cause changes in the eyelashes of the treated eye(s) (increased number, length, thickness or pigmentation of eyelashes). Ask your doctor, eye specialist or pharmacist for more information.
- While using this medicine you should have regular eye examinations.
- If you go into hospital or to the dentist to have an operation you should tell the person treating you that you are using these eye drops. This is because your blood pressure may fall too low if you are given certain types of anaesthetics in combination with beta-blockers.
Use with caution in
- Closed angle glaucoma.
- Glaucoma caused by accumulation of pigment particles in the drainage channels of the eye (pigmentary glaucoma).
- Glaucoma caused by inflammation inside the eye (inflammatory glaucoma).
- Glaucoma caused by the growth of new blood vessels over the iris (neovascular glaucoma).
- Glaucoma present from birth (congenital glaucoma).
- Inflammatory conditions of the eye such as conjunctivitis.
- People with an artificial lens in the eye (pseudophakia).
- People with no lens in the eye (aphakia).
- People with a history of herpetic keratitis, which is inflammation of the front of the eye (cornea) caused by infection with the herpes simplex virus (these eye drops should be avoided in people with active herpes simplex keratitis).
- People having surgery for cataracts.
- People with a history or risk of inflammation of the middle layer of the eyeball (uveitis) or the iris (iritis).
- People with dry eyes.
- People with risk factors for swelling of the back of the eye (cystoid macular oedema), such as a closed or blocked retinal vein or diabetes affecting the eyes (diabetic retinopathy).
- Diabetes. (Timolol can be absorbed into the bloodstream after being applied into the eye and may mask the symptoms of low blood sugar, such as increased heart rate and tremor. For this reason, people with diabetes should carefully monitor their blood sugar while using these eye drops.)
- People with a history of sudden drops in blood sugar levels (hypoglycaemia).
- People with heart disease, such as heart failure or a severe form of angina pectoris, not caused by exertion (Prinzmetal's angina).
- People with slowed conduction of electrical messages between the chambers of the heart (1st degree heart block).
- People with low blood pressure (hypotension).
- People with severe conditions involving poor blood circulation in the arteries of the extremities, eg hands and feet (peripheral arterial disorders such as Raynaud's syndrome or intermittent claudication).
- People with an overactive thyroid gland (this medicine may mask the symptoms of a thyroid storm or thyrotoxicosis).
- People with a history of allergies (beta-blockers may increase sensitivity to allergens and result in more serious allergic reactions; they may also reduce the response to adrenaline used to treat anaphylactic shock).
- Abnormal muscle weakness (myaesthenia gravis).
Not to be used in
- People with asthma or a history of asthma.
- People with severe chronic obstructive pulmonary disease (COPD).
- People with a slow heart rate caused by the pacemaker of the heart (sinus bradycardia).
- People with a serious defect in the heart's electrical message pathways, resulting in decreased function of the heart (sino-atrial block, or 2nd or 3rd degree heart block not controlled with a pacemaker).
- A problem common in the elderly, related to poor control of the working of the heart (sick sinus syndrome).
- Uncontrolled heart failure.
- Failure of the heart to maintain adequate circulation of blood (cardiogenic shock).
This medicine is not recommended for children and adolescents, as there is no information regarding its safety and efficacy in this age group.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
- This medicine should not be used during pregnancy, as it may be absorbed into the bloodstream and could be harmful to the unborn baby. Seek further medical advice from your doctor.
- This medicine can pass into breast milk after being applied into the eye. The manufacturer states that it should not be used by women who are breastfeeding. Mothers who need to use this medicine should not breastfeed and bottlefeed instead. Seek further medical advice from your doctor.
- Change in colour of the iris
- Eye irritation including stinging, burning and itching.
- Eye pain.
- Red eye(s) due to increased blood supply (hyperaemia).
- Inflammation of the membrane covering the eyeball (conjunctivitis).
- Blurred vision.
- Watery eyes.
- Disorders of the front layer of the eye (cornea).
- Inflammation of the eyelid(s) (blepharitis).
- Skin rashes or itching.
Other side effects reported with the individual components of these eye drops
- Darkening, thickening and lengthening of the eyelashes.
- Misdirected eyelashes, sometimes resulting in eye irritation.
- Inflammation of the front of the eye (cornea) caused by infection with the herpes virus (herpetic keratitis).
- Inflammation of the iris (iritis).
- Swelling of the area at the back of the eye responsible for seeing fine detail (macular oedema).
- Dry eye(s).
- Double vision.
- Drooping of the upper eyelid (ptosis).
- Chest pain.
- Slowed heart rate (bradycardia).
- Low blood pressure (hypotension).
- Shortness of breath.
- Difficulty sleeping (insomnia).
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
If you are using more than one type of eye drop you should administer them at least five minutes apart, to prevent the second drop washing away the first. Use eye gels or ointments last.
Eye drops can be absorbed into the bloodstream from the eye, and once in the bloodstream they have the potential to interact with other medicines. For this reason you should be aware of the following:
In people with diabetes, timolol can prolong the lowering of blood sugar (hypoglycaemia) caused by insulin or other antidiabetic medicines. People with diabetes should monitor their blood sugar, as timolol can also mask the signs of hypoglycaemia.
The timolol in these eye drops may enhance the effects of the following medicines taken by mouth, which may result in low blood pressure and/or a slowed heart rate:
- beta-blockers, eg atenolol
- calcium-channel blockers, eg nifedipine, verapamil, diltiazem
- medicines for abnormal heart rhythms (antiarrhythmics), eg amiodarone.
If the medicine clonidine is suddenly stopped it can cause an increase in blood pressure. This increase in blood pressure may be worse in people taking beta-blockers, including eye drops such as this one.
Beta-blockers oppose the action of medicines for asthma that open the airways, which is why these eye drops should not be used by people with asthma or other breathing difficulties.
Xalacom eye drops should not be used in combination with other prostaglandin analogue eye drops, because the combination may actually increase the pressure in the eye.
Other beta-blocker eye drops are not recommended for use in combination with Xalacom eye drops.