How netarsudil works to lower IOP
The problem of reduced outflow
In open-angle glaucoma patients, IOP becomes elevated when the trabecular meshwork becomes fibrotic and aqueous humor outflow is reduced.1
- The trabecular meshwork is integral to the regulation of aqueous humor outflow and IOP2
- Cellular damage due to glaucoma (eg, oxidative stress) may result in stiffness of the trabecular meshwork3
- This may impede the outflow of aqueous humor and result in persistently high IOP3
RHOPRESSA® (netarsudil ophthalmic solution) 0.02% reduces IOP by increasing the outflow of aqueous humor through the trabecular meshwork4
The exact mechanism is unknown.
IOP=Intraocular pressure;
MOA=Mechanism of action.
REFERENCES
1. Winkler NS, Fautsch MP. Effects of prostaglandin analogues on aqueous humor outflow pathways. J Ocul Pharmacol Ther. 2014;30(2-3):102-109.
2. Saccà SC, Pulliero A, Izzotti A. The dysfunction of the trabecular meshwork during glaucoma course. J Cell Physiol. 2014;230:510-525.
3. Ren R, Li G, Duong Le T, Kopczynski C, Stamer WD, Gong H. Netarsudil increases outflow facility in human eyes through multiple mechanisms. Invest Ophthalmol Vis Sci. 2016;57(14):6197-6209.
4. Rhopressa® (netarsudil ophthalmic solution) 0.02% Prescribing Information, Aerie Pharmaceuticals, Inc., Irvine, CA. 2019.
IMPORTANT SAFETY INFORMATION
Warnings and Precautions
Bacterial Keratitis: There have been reports of bacterial keratitis associated with the use of multiple-dose containers of topical ophthalmic products. These containers had been inadvertently contaminated by patients who, in most cases, had a concurrent corneal disease or a disruption of the ocular epithelial surface.
INDICATIONS AND USAGE
Rhopressa® (netarsudil ophthalmic solution) 0.02% is indicated for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension.
Contact Lenses: Contact lenses should be removed prior to instillation of Rhopressa® and may be inserted 15 minutes following its administration.
Adverse Reactions
The most common ocular adverse reaction observed in controlled clinical studies with Rhopressa® dosed once daily was conjunctival hyperemia, reported in 53% of patients. Six percent of patients discontinued therapy due to conjunctival hyperemia. Other common (approximately 20%) adverse reactions were: corneal verticillata, instillation site pain, and conjunctival hemorrhage. Instillation site erythema, corneal staining, blurred vision, increased lacrimation, erythema of eyelid, and reduced visual acuity were reported in 5-10% of patients.
The corneal verticillata seen in Rhopressa®- treated patients were first noted at 4 weeks of daily dosing. This reaction did not result in any apparent visual functional changes. Most corneal verticillata resolved upon discontinuation of treatment.
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DOSAGE AND ADMINISTRATION
The recommended dosage is one drop in the affected eye(s) once daily in the evening.