"Xalatan" is a medicinal pharmaceutical product. This eye drops to lower intraocular pressure. It is sold in this form in pharmacies. The drug is very popular on the Russian market.
The drug is prescribed by the attending ophthalmologist to people with increased intraocular pressure, primary and secondary open-angle and pseudoexfoliative forms of glaucoma.
This is one of the most effective medicines to improve fluid outflow and reduce pressure. The drug is quite expensive. Cheap analogues of Xalatan are available for sale.
Compound
The main ingredient is latanoprost 0.05 mg. Additional substances: sodium chloride - 4.1 mg, sodium dihydrogen phosphate (monohydrate) - 4.6 mg, sodium hydrogen phosphate (anhydrous) - 4.74 mg, benzalkonium chloride - 0.2 mg, water for injection - 995 mg. Eye drops 0.005% are sold in sterile instillation bottles of 2.5 ml with first opening control. Packed in cardboard boxes of one or three pieces.
pharmachologic effect
The active substance latanoprost is a substitute for natural prostaglandin F2a, which has a selective effect on eye receptors. A decrease in ophthalmonus is observed several hours after using the drug and reaches its greatest effect after twelve hours.
The antiglaucoma effect occurs due to the large outflow of fluid from the chambers of the eye. The drug does not affect the formation of intraocular fluid and vascular permeability. After use, the product takes effect within 24 hours.
Indications and contraindications
The drug "Xalatan" (analogues of the drug) is prescribed for the prevention and complex therapy treatment of open-angle glaucoma and increased ophthalmotonus.
The product must be used with great caution before surgical intervention for glaucoma.
Method and dose of application
Prescribed to patients over 1 year of age (including the elderly) once a day, 1 drop in the evening topically into the eyes. Used as a component of mixed or monotherapy. Immediately after instillation, apply pressure to the inner corner of the lower eyelid for 1 minute. Can be used for 2 years with subsequent replacement of the drug. Monitor the level of intraocular pressure after 2-3 weeks, then after 3 months once.
Side effects and overdose
The drug "Xalatan" (including analogues) has the following side effects:
Local reaction: possible appearance of a lung irritation, redness and inflammation of the mucous membrane of the eye. This side effect is observed in 10% of people, only 1% have an average severity. There may be pain, increased lacrimation, dryness, photophobia, decreased visual acuity, changes in pupil color, changes in eyelash growth, swelling of the center of the retina. 
Respiratory system: difficulty breathing, narrowing of the lumen of the bronchi due to muscle contraction (bronchospasm). Nervous system: feeling of pain in the head or fainting state (usually dizziness). Musculoskeletal system: pain in the joints and muscles. Skin: change in color (blackening ) eyelids, skin rashes, Lyell's syndrome (the appearance of blisters and erosions on the skin and mucous membranes). Invasions and infections: inflammation of the cornea caused by one or more types of herpes virus (herpetic keratitis). Others side effects: painful sensations V chest of a nonspecific nature. People with diabetes with damage to the retina (diabetic retinopathy) may experience blockage, detachment of the membrane, or hemorrhage in the vitreous area when using this medicine.IN childhood an increase in body temperature and inflammation of the mucous membrane of the nasopharynx are observed. In patients with obvious damage to the cornea, calcification is possible in exceptional cases. If the drug is accidentally taken orally, dizziness and pain in the area may occur. gastrointestinal tract and nausea. Treatment is symptomatic. It is necessary to rinse the stomach.
These are the side effects that Xalatan (eye drops) can have. Analogues have side effects to no lesser extent.
Precautionary measures
Doctors do not recommend increasing the dose of the drug. This leads to a decrease in the reduction effect intracranial pressure. May be used with other ophthalmic medications to reduce intraocular pressure.
If you miss a single instillation of the drug, then instill only one drop at the same time the next day to avoid unnecessary negative effects.
When using two types of medicines, the time interval between the administration of drops should be 5-10 minutes. But it’s better not to mix the drops, use them alone.
Mandatory withdrawal required contact lenses before instillation, otherwise benzalkonium chloride will be absorbed. Reinstalling the lenses is possible after 20 minutes.
Treatment should be continued if the color of the iris changes, but under the supervision of an ophthalmologist. The prescription of Xalatan can be canceled, but, as a rule, increased pigmentation is not accompanied by pathological changes.
When prescribing treatment in one eye, there is a possibility of developing unequal coloration of the iris of the left and right eyes (heterochromia).
"Xalatan" (analogs as well) is prescribed with caution to people driving vehicles and complex equipment, since there is a possibility of a quickly passing feeling of a veil before the eyes. It is better to install the drug outside of a hazardous activity. There is a possibility of temporary darkening of the eyelids.
The product may cause changes in the growth, color of eyelashes and vellus hair. After discontinuation of the drug, the effect goes away on its own. During pregnancy and lactation, Xalatan (analogs as well) is prescribed with caution.
During use, do not touch the bottle to your eyes or various objects. Prescribed with great caution for congenital or acquired absence of the lens (aphakia) and inflammation choroid(uveitis).
Concomitant use with drops containing thiomersal is not recommended. Strengthening the effect of Xalatan while taking pilocarpine and timolol.
Storage conditions and periods
The drug must be stored in a cool place, protected from light and inaccessible to children. Shelf life - 3 years. If the vial has already been opened, it can be stored for 4 weeks, avoiding exposure to the solution high temperatures(above 25 degrees Celsius). Dispensed on prescription form.
Xalatan drops: analogues
Substitutes for "Xalatan" are used when it is not available in the pharmacy, when getting used to this drug, if side symptoms are identified:
"Cosopt" (Netherlands) - 800-900 rubles. "Trusopt" (France, USA) - 450-470 rubles. "Travatan" (Belgium) - 660-700 rubles. "Azopt" (Belgium, USA) - 800 rubles. "Azarga" (Belgium) - 980 rubles. "Fotil" (Finland) - 300-350 rubles. "Betoptik" (Belgium) - 310-380 rubles. "Glauprost" (Romania) - 1440-1500 rubles.
"Xalatan" has the following Russian analogues:
"Xalacom" (Russia) - 700-900 rubles. "Glaumax" (Russia, Estonia) - 470-550 rubles. "Xalatamax" (Russia, Croatia) - 450-550 rubles.
For the drug "Xalatan", cheaper analogues can be found as follows:
"Arutimol" (Germany) - 46-72 rubles. "Ocumed" (India, Germany) - 52-79 rubles. "Timolol" (Finland, Germany) - 20-45 rubles.
Travatan ( Latin name Travatan)- an ophthalmic agent that is widely used to treat glaucoma and reduce intraocular pressure. As a result of the action of the drug, there is an increased outflow of intraocular fluid, which accumulates between the lens and cornea of the eye, which leads to a decrease in ophthalmotonus. The medicine is presented on the pharmaceutical market by the Belgian company ALCON - COUVREUR.
Composition and release form
Travatan eye drops - the composition includes the active component travoprost, which is a synthetic analogue of prostaglandin F-2 alpha, and contains excipients: sodium chloride, boric acid, mannitol, macrogol glyceryl, hydroxystearate, trometamol, disodium edetate, purified water.
The drug is a sterile transparent or light yellow solution. The drug is packaged in bottles with a dropper dispenser.
Effect of the drug
Eye drops have antiglaucoma properties. The active substance has a selective effect on receptors ciliary body and activates the outflow of intraocular fluid, which is located between the lens and the cornea.
After using the drug, trapoprost enters the blood plasma, where it breaks down to free acid.
Maximum concentration active substance achieved 30 minutes after instillation. The therapeutic effect of the drug begins 120 minutes after instillation and lasts for 12 hours. The remains of the drug are eliminated from the body after one hour.
Indications for use
The use of Travatan drops for the eyes is possible only as prescribed by the attending physician, since the drug can cause irreversible changes in damaged organs of vision.
The drug is used as part of complex treatment of the following diseases:
- open-angle glaucoma, which is accompanied by impaired outflow of fluid inside the eye and increased pressure;
- increased intraocular pressure.
Instructions for use
Travatan eye drops instructions for use recommend using topically in the form of instillations of one drop twice a day into the conjunctival cavity of the affected eye.
The duration of treatment is determined by the attending physician, taking into account individual characteristics body and the severity of the patient’s condition.
Experts recommend instillation in evening time. It is strictly forbidden to independently increase the dosage and frequency of instillations, as this may cause the development side effects and cause irreparable harm to health.
Treatment of the disease must be carried out under the supervision of an ophthalmologist, who should be visited once every 3 months. To avoid addiction to the medicine, you need to replace the drug annually.
If for some reason the instillation was missed, treatment continues according to the prescribed regimen. The maximum daily dose should not exceed one drop.
Travatan drops are used as part of complex treatment together with other antiglaucoma drugs. If several drugs are used, the time interval between instillations should be 5-7 minutes.
Due to lack of data clinical trials about the effect of the drug on the body, the drug is not used during pregnancy and lactation. In case of use eye drops during breastfeeding lactation is stopped during treatment.
Travatan eye drops are not used in pediatric ophthalmology to avoid the risk of harm to children's health.
If the patient uses contact lenses, it should be remembered that the medicine contains the preservative benzalkonium chloride, which can accumulate on the surface contact means and reduce their transparency. In this regard, it is recommended to remove lenses before instillation. Their reuse is permitted no earlier than 25-30 minutes after instillation.
After using the drug, some patients may experience a short-term decrease in visual acuity. This symptom goes away on its own and does not require additional treatment or cessation of use of the product.
If Travatan is used as an analogue of another medication, then the previously used drug is discontinued, Travatan is started to be instilled only the next day.
For patients suffering from chronic hepatic or renal failure, the dose is adjusted on an individual basis.
Contraindications and side effects
Travatan eye drops instructions for use prohibit use if the patient has increased sensitivity to individual components of the drug.
In some cases, after using Travatan, patients may experience discomfort which are accompanied by irritation, pain, development of dry eye syndrome, and itching.
In rare cases, the development of corneal erosion, uevit, erythema of the eyelids, decreased visual acuity or blurred vision, erosion or erythema of the eyelids, clouding of the lens, increased lacrimation, conjunctival folliculosis, macular edema, retraction may occur. eyeball.
Some patients complain of impaired color perception, the appearance of rainbow circles around light sources, and discoloration of eyelashes.
From the outside of cardio-vascular system You may experience rapid heartbeat, abnormal heart rate, increased blood pressure, and chest pain.
Very rarely, the use of eye drops is accompanied by severe headaches and muscle pain, bronchospasm, increased cholesterol levels in the blood, bowel dysfunction, increased body temperature, weakness and fatigue.
Experts usually associate the occurrence of side effects with exposure to active component into the bloodstream.
Before starting therapy, the attending physician must notify the patient that long-term use of the medication may cause changes in the color of the iris, impaired pigmentation of the skin of the eyelids, the appearance of dark circles around the eyes, and growth and thickening of eyelashes.
Changes in eye color are more often observed in people with a mixed color of the iris: brown-green, brown-yellow or gray-blue. This phenomenon is associated with an increase in the amount of melanin. When using the drug to treat one eye, different colors of the surface of the eye membranes may be observed.
Travatan is not used for the treatment of congenital or neovascular glaucoma, since there is insufficient experience in using the drug.
To lower intraocular pressure, Travatan can be used with other drugs from the group of adrenergic agonists and beta blockers.
Patients who have a missing or damaged lens require special attention. posterior capsule lens In these cases, the medicine is used only under the supervision of a specialist.
Analogues and price of the drug
If the use of Travatan eye drops is impossible for some reason, they should be replaced with a drug similar in action. However, it should be remembered that the analogue can only be prescribed by a doctor.
Currently, manufacturers of ophthalmic drugs offer a wide selection of cheap, but no less effective and high-quality analogues.
Similar therapeutic effect provide the following means:
- Xalatamax is a solution for the treatment of open-angle glaucoma and the reduction of intraocular pressure. The drug improves metabolism in the tissues of the eye and enhances microcirculation for a short time.
average price medicine is 200 rubles.
Similar therapeutic effect provide medications: Azarga, Cosopt, Okumed, Pilocarpine, Timolol, Fotil, Betoptik, Xalatan.
You can buy Travatan eye drops at a pharmacy with a doctor's prescription. The average price for a package of medicine is from 700 rubles.
Xalatan has a competitor
The speakers reminded 150 ophthalmologists from the Kharkov, Poltava and Sumy regions of this scientific-practical conference“Modern aspects of the treatment of primary open-angle glaucoma (POAG)”, held in Kharkov on April 23 by the Association of Ophthalmologists/Neuroophthalmologists/Glaucomatologists of Ukraine with the sponsorship of Alcon. All presentations were, to one degree or another, dedicated to travatan (travoprost), a synthetic analogue of prostaglandin F2, produced by this company.
Travatan, a drug for controlling intraocular pressure (IOP), was introduced to the world market in 2001, and was registered in Ukraine at the end of 2002, i.e. later than the drug from Pharmacia, which is part of the same group of prostaglandins (now Pfizer) xalatan (latanoprost). In Russia, where the choice is even wider, there is a real battle between the giants of the pharmaceutical market regarding the promotion of antiglaucoma drugs of the prostaglandin series (Xalatan, Xalacom, Travatan, Lumigan). Companies use the maximum of “administrative and advertising resources” to create a common opinion about the quality, cost, and effectiveness of their products. While Alcon (travatan) lags somewhat behind Allergan (lumigan bimatoprost) and Pharmacia (xalatan and xalacom); This is evidenced by the financial results of companies related to this section of sales.
But in Ukraine, Travatan is 8 UAH cheaper than its competitor (the wholesale price, according to the price list of the Provisor magazine, is 106 and 114 UAH per bottle, respectively). To convince the provincials of its other advantages, a powerful metropolitan landing of associate professors and assistants of the Department of Eye Diseases of the National medical university them. Bogomolets, headed by its head prof. G. D. Zhaboedov (by the way, a former Kharkov resident), supported by the leaders of the departments of KhSMU and KhMAPO (Prof. P. A. Bezdetko and Prof. I. A. Soboleva) and the Moscow guest - chief ophthalmologist of the Ministry of Railways of the Russian Federation I. A. Loskutov. We must give the lecturers their due - they all already have some personal experience in using Travatan in the treatment of POAG, so they presented the subject not only from foreign sources.
Glaucoma today is interpreted as atrophy optic nerve(ON), and increased IOP is considered only one of the risk factors (doctors do not always know why “accelerated aging” of the ON occurs - apoptosis of its fibers). In the world therefore great attention began to focus on neuroprotective agents. But since IOP is available for measurement (and for understanding by our doctor and even the patient), then in Ukrainian practice, which inherited Soviet concepts, drug treatment of POAG comes down to its normalization.
There is another difference between Ukrainian realities and global realities: this is a sharp increase in the share surgical treatment POAG compared with conservative. Abroad, the exact opposite dynamics are observed, because although operations reduce IOP to the “target” level, visual function deteriorates due to a host of complications. Therefore, S. Fedorov’s initiative to treat glaucoma only surgically was not successful in the West.
Prostaglandin analogues, which have made a revolution in the drug treatment of POAG, activate an additional pathway for the outflow of intraocular fluid through the drainage system of the eye - the uveoscleral, which in healthy eyes accounts for up to a third of the drained fluid (by the way, pilocarpine, which was recently popular among Ukrainian ophthalmologists, on the contrary, blocks the uveoscleral outflow ). This pathway was discovered and studied relatively recently, because only humans and primates have it, and rabbits are not suitable for this. It is also believed that prostaglandin analogues, in addition to normalizing IOP, also provide neuroprotection of MN due to vasodilation and correction of NO metabolism.
Side effects of these drugs include changes in eye color (less commonly, darkening of the eyelid skin), as well as thickening, darkening, and an increase in the number of eyelashes. Therefore, the speakers joked, cosmetologists became seriously interested in Travatan...
In addition to Alcon, products from other manufacturers were exhibited at the small exhibition: Farmak presented its “ophthalmological portfolio”, the company Konark β-blocker yotim; Materials on the vasodilator picamilon (manufactured by the Russian Akrikhin) were presented. And the participants of the conference, who were pretty chilled in the cold hall of the former Military Academy, were helped to dilate their blood vessels by a friendly buffet after the completion of the scientific program.
Artem Batrak
Treatment of glaucoma is a rather complex task in the daily practice of an ophthalmologist. Due to the wide list of antihypertensive drugs in pharmacies, treatment should begin with the first choice drugs, which include Travatan.
Appearance packaging of the drug Travatan and the bottle itself
Travatan is a drug that is a synthetic analogue of prostaglandin F2a - the substance travaprost. The drug effectively reduces elevated intraocular pressure by 30-35% of the initial value; it is used only once a day before bedtime, which makes its use very convenient for patients.
The drug is produced in small dropper bottles with a volume of 2.5 ml.
Theoretically, this bottle should be enough for 1 month of daily use, but since glaucoma affects mainly elderly people, who instead of 1 drop drop 2-3, the bottle is sometimes not enough for 2 weeks.
The drug is included in the list of preferential drugs under the territorial program, and is given free of charge to patients who are registered with glaucoma at the dispensary.
Indications for use
The only indication for the use of travaprost is primary open-angle glaucoma. In cases of secondary or its use is advisable only in combination with drugs from other groups (beta-blockers, carbonic anhydrase inhibitors, alpha-adrenergic agonists, miotics).
Composition of the drug
Travatan contains both the main active ingredient - travaprost, and preservatives used for long-term storage of the drug - benzalkonium chloride, sodium chloride, as well as a solvent - water for injection.
Mechanism of action of Travatan
Travatan, like its analogues, belongs to the group of prostaglandins, which, when instilled into the eye, penetrate through the cornea into the eye, where under the influence of enzymes they transform into an active form.
When Travaprost enters the eye, it binds to FP receptors, resulting in increased uveoscleral outflow of aqueous humor and a slight increase in fluid output through the trabecular system of the eye.
Common analogues and their features
Eye drops have effective substitutes, but remember that only a doctor can change the drug Travatan has the only analogue, which is produced by the Romanian pharmaceutical company Romfarm, and it is called Travapress. There are no differences between these drugs, since the active ingredient in them is travaprost.
Another representative of the prostaglandin group, latanoprost, has a very similar effect. Latanoprost is produced by many pharmaceutical companies under different names:
- Xalatan - manufactured by Pfizer in Belgium, and is one of the most popular drugs in the treatment of glaucoma;
- Glauprost is a drug popular in many regions of Russia, not inferior in effectiveness to xalatan, produced in Romania;
- Prolatan is a drug that is gaining popularity, produced in India, because, like any generic, it has a fairly low cost.
- Xalatamax is inexpensive, effective drug, produced in Croatia;
- Lanotan is a drug that is not yet widely used in Russia and is produced in Ukraine.
All of the above drugs have approximately the same effectiveness (±5%) and are used for primary open-angle glaucoma. Unlike Travoprost, the effect after instillation develops somewhat later - after 3-4 hours, which is not significant with regular long-term use.
Latanoprost, like Travoprost, reduces intraocular pressure by 30-35% and is administered once in the evening.
Another analogue of Travatan, similar in its action, is a new representative of prostaglandins - the drug Taflotan. This medicine is produced in neighboring Finland, and currently has no generic versions.
The drops contain tafluprost. According to studies, this drug is slightly more effective in reducing intraocular pressure, unlike its predecessors, and is much less likely to cause side effects.
Taflotan is also used - one drop in the evening into the affected eye. Its only drawback is its high cost - 30-40% more expensive than its predecessors.
Use in children, nursing and pregnant women
Before use, pregnant women or children should consult a specialist. Preparations of the prostaglandin group, and in particular Travatan, are not used in the treatment of children with congenital glaucoma.
The use of these drugs in pregnant women is possible only in cases where the risk of deterioration in the mother's vision is higher than the potential risk to the fetus.
There have been no clinical studies on the use of latanoprost in pregnant women, so it is difficult to assume its possible effect on the fetus.
During lactation, the use of Travatan and its analogues is not recommended, since the drug passes into breast milk through the systemic bloodstream.
Contraindications
There are no absolute contraindications to the use of Travatan and other prostaglandins. Relative contraindications for use include:
- Age under 18 years, due to lack of studies on use in children;
- Pregnancy and lactation period;
- Afakia - in given time an uncommon condition in which the lens is missing;
- Diabetic retinopathy - long-term use of prostaglandin drugs has been proven to increase the risk of developing diabetic macular edema;
- Condition after surgical treatment various diseases corneas (donor cornea transplants, all types of keratoplasty). IN in this case the use of the drug may cause graft rejection and corneal edema;
- In the first three months after cataract surgery, the use of Travatan may cause cystoid macular edema. For this period of time, it is better to use drugs from other groups, for example a combination of dorzolamide or timolol.
Adverse reactions of Travatan
If you follow the dosage regimen and the correct frequency of instillations, the risk of adverse reactions is minimized When using prostaglandin analogues adverse reactions develop quite rarely. This mainly occurs with very long-term use, more than 1 year. The side effect is manifested by the following symptoms:
- Redness of the eyes, accompanied by a feeling of burning, itching, foreign body;
- Transient deterioration of vision;
- Inflammation of the anterior segment of the eyeball - punctate keratitis, blepharitis, extremely rarely iridocyclitis;
- Redness with further hyperpigmentation of the skin of the eyelids;
- Changes in the growth of eyelashes - they become longer and sometimes curl towards the cornea, which can cause traumatic keratitis or conjunctivitis;
- Sometimes when used, headaches and dizziness, exacerbation and increased frequency of attacks may occur. bronchial asthma, development of shortness of breath;
- Extremely rarely, with long-term use of drops containing prostaglandin receptor agonists, pain in the muscles and joints may appear, which is associated with systemic exposure.
When wearing contact lenses, before using prostaglandin drugs, you should remove them, since the drops contain benzalkonium chloride, which destroys the SCL, reduces the permeability of the drug deep into the eye, and also causes a strong burning sensation.
When driving a car, you must wait 15-20 minutes after instilling the drops, as the drug causes a short-term feeling of a “veil” before the eyes.
When using several drugs for the treatment of glaucoma, a 5-7 minute interval should be maintained between instillations so that one drug does not wash out with the other.
It is rational to prescribe in case combination therapy daily medications (timolol, azopt, dorsopt, etc.) at 8-00 and 20-00, and prostaglandins at 21-00.
Prices in pharmacies
Prostaglandin drugs are quite expensive, which is why they are included in the list of preferential drugs.
List of drugs with approximate prices for Travatan and its analogues:
- Travatan – 610-650 rub.
- Travapress – 380-400 rub.
- Xalatan – 590-630 rub.
- Glauprost – 460-480 rub.
- Prolatan – 390-430 rub.
- Xalatamax – 400-430 rub.
- Lanotan – 480-500 rub.
- Taflotan – 820-840 rub.
Travatan is a well-known antiglaucoma drug, a representative of the class of prostaglandin receptor agonists. He has effective analogues containing latanoprost and tafluprost. Eye drops are sold in pharmacies at an affordable price, as for a drug in its series.
You can find interesting information about glaucoma in the video:
V.N. Alexeev, M.A. Levko, A.M. Al-Gifari Musa
St.-Petersburg State Medical Academy named after Mechnikov I.I.
Purpose: Comparative evaluation of hypotensive effects of Xalatan, Travatan and Tafluprost and compliance factor.
Materials and methods: 90 patients were included in the study. All of them were divided into 3 groups. Period of observation lasted 6 months. Each month patients underwent examination. It consisted of IOP measurement, biomicroscopy and ophthalmoscopy, evaluation of main ophthalmologic and somatic indicators. Compliance with treatment regimen was also controlled.
Results and conclusion: IOP level was reduced by necessary level in all groups. Xalatan and Tafluprost resulted in almost equal hypotensive effect. In Travatan group IOP level was lower because of more evident side effects. Life quality in Travatan group was lower but it was compensated by more evident hypotensive effect.
Primary glaucoma is considered one of the main factors leading to vision loss. According to WHO, total The number of patients with glaucoma in the world has exceeded 100 million; about 600 thousand new cases of blindness as a result of glaucoma are registered annually.
Despite the constant improvement of the diagnostic and treatment capabilities of modern ophthalmology, the frequency of blindness from glaucoma in the world has remained virtually unchanged over the past decades and amounts to 14-15% of the total number of all blind people [Nesterov A.P., 1995[.
Prevalence of this dangerous disease increases with age. Thus, at 40-45 years old, primary open-angle glaucoma (POAG) affects 1% of the population, at 50-60 years old - 1.5-2.0%, at 75 years old and older - more than 18% [Nesterov A.P., 1999; Malevannaya O.A., 2005].
Availability high level intraocular pressure leads to accelerated development of glaucomatous optic neuropathy and decreased visual functions. The use of adequate antihypertensive treatment reduces the risk of developing POAG. Therefore, in the traditional algorithm for the complex treatment of primary glaucoma, local antihypertensive drugs are given paramount importance. Typically, these drugs are prescribed for a long period and their use is effective if the patient carefully follows the doctor’s recommendations and dosage regimen (“compliance”). That's why antihypertensive drugs should have not only long-term and persistent effectiveness, but also good tolerability, a minimum of side effects, and ease of use.
Currently, these requirements are best met by prostaglandin analogues, used both as monotherapy and in combination with previously proposed classes of antihypertensive drugs.
The purpose of the work is a comparative assessment of the antihypertensive effectiveness of three drugs from the group of prostaglandin analogues (Xalatan, Travatan and Tafluprost), as well as a comparative study of adherence to treatment (the “compliance” factor) in groups of patients using these drugs.
Materials and methods
The study involved 90 patients, divided into three equal groups, depending on the drug used.
The inclusion criteria were:
- age over 18 years;
- presence of POAG at an initial or advanced stage (worst eye);
- initial tonometric IOP in the worse eye is 22-30 mm Hg;
- visual acuity worst eye not lower than 0.2;
- ability to go through everything necessary research throughout the entire observation period.
Exclusion criteria: at the preliminary selection stage, patients with advanced or terminal stage glaucoma who had previously used prostaglandins were excluded from the study; having a history of filtering antiglaucoma surgery, any inflammatory disease eyes (except for conjunctivitis - it was taken into account only for the last 3 months); have had an eye injury within the last 6 months.
Patients who had standard contraindications to the use of prostaglandin analogs were also excluded; severe somatic pathology; pregnant women, planning pregnancy, lactating women; as well as patients who do not meet the inclusion criteria.
After the selection, the patients were distributed as follows: there were 37 men, 53 women. The age of the patients was from 40 to 66 years. The number of eyes corresponded to the number of patients, since the study took into account hydrodynamic and functional indicators obtained only in the worst (according to the stage of glaucoma) eye, and in the case of symmetry of the process - only in the right eyes. The distribution depending on the stage of glaucoma and IOP level is shown in Table 1.
Patients were randomly assigned to the following groups:
1 group using Xalatan - 30 people. They used Xalatan (latanoprost 0.005%) once in the evening at 20:00.
Group 2, who used Travatan - 30 people. Travatan (travoprost 0.004%) was also instilled once at 20:00.
Group 3, using Tafluprost - 30 people. Tafluprost (0.0015% solution) was also used once a day, at 20:00.
The observation period was 6 months. During this period, patients were examined once a month. The following indicators were studied:
1. At each visit it was measured arterial pressure(BP) and heart rate (HR).
2. The visual field was examined at the beginning and at the end of the study. Kinetic perimetry and suprathreshold static perimetry were performed on the Peri-com perimeter.
3. Best-corrected visual acuity was examined at all visits using the traditional method.
4. Biomicroscopy was performed at each visit.
5. Tonometric IOP was studied with a Maklakov tonometer at all visits at approximately the same time of day (at 8-9 am).
6. Ophthalmoscopy was performed at each visit.
7. Patients' adherence to treatment was monitored continuously during each visit. Availability was confirmed side effects, patient compliance with the instillation regimen, changes in the patient’s self-assessment of his condition.
Ophthalmological examination and group-appropriate antihypertensive therapy were administered to both eyes (if required), but outcome assessment was performed only on eyes meeting study criteria.
Research results
Final study results were tracked in 88 cases. One patient (Travatan group) was excluded from the study 2 weeks after its start due to severe conjunctival hyperemia and one patient (Tafluprost group) was unable to complete the study for reasons unrelated to health.
The dynamics of tonometric indicators in the groups are presented in Table 2.
As can be seen from the table, by the end of the first month, IOP decreased to the required values in all three groups. The level of generally accepted goal pressure was practically maintained throughout the entire study period also in all groups. A slightly more pronounced hypotensive effect was observed with the use of Travatan. Xalatan and Tafluprost showed almost the same hypotensive effect.
Side effects of antihypertensive drugs can significantly worsen the functional results of treatment by reducing patient adherence to prescribed therapy. The frequency of treatment side effects in the study groups is presented in Table 3.
In one patient from the Travatan group, conjunctival hyperemia was so severe that he refused further participation in the study. In other cases, hyperemia was assessed as moderate and tolerated without additional treatment. In our study, complaints of some discomfort were most often reported during treatment with Travatan, and were least pronounced during treatment with Tafluprost.
Visometry indicators, perimetric indicators and the condition of the fundus did not change statistically during the study. significant changes. This may be due to the relatively short follow-up period. Blood pressure and heart rate data fluctuated slightly and also did not change significantly.
All patients showed approximately the same adherence to treatment. Slightly more complaints about the quality of life were made in the group using Travatan, but this was psychologically compensated by a more pronounced hypotensive effect of the drug (patients were informed about IOP values during each visit).
conclusions
The use of drugs from the group of prostaglandin analogues is characterized by pronounced clinical effectiveness. Travatan has the most significant hypotensive effect, Xalatan and Tafluprost show slightly less and approximately the same hypotensive activity.
Side effects from the use of prostaglandin analogue drugs do not have a significant impact on the quality of life of patients and their attitude towards treatment. Xalatan and Tafluprost have the least severity of side effects.
Literature
1. Malevannaya O.A. Evaluation of the effectiveness of the dispensary observation system in patients with primary open-angle glaucoma. // Problems of health promotion and disease prevention. Scientific and practical conference: Materials. - St. Petersburg. - 2004. - p. 175.
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