Why Use Latanoprost At Night? Eye Doctor Explains.
Latanoprost is a widely used medication in the management of glaucoma. Many patients ask, “Why do I have to use latanoprost at night?”
You don’t have to use latanoprost at night, but you really should.
Let’s take a look at why these glaucoma eye drops are recommended for use right before bed.
Why Use Latanoprost At Night? 4 reasons…
Ophthalmologists and optometrists will usually ask their patients to use the latanoprost at night. There are a few main reasons your eye doctor wants you to use latanoprost eye drops at night.
1. Eye Pressure Spikes At Night
When patients sleep and they are lying down, the blood in the body is no longer rushing to their feet and then being pumped back up. By lying down, there is more pressure on the episcleral veins in the eye. This increase in episcleral venous pressure means more resistance to outflow of the aqueous fluid inside ones eye.
This increased resistance to outflow means that the eye pressure is higher at night when we sleep. This intraocular pressure spike is natural and this is why doctors recommend to use your latanoprost at night. The latanoprost and other medications like latanoprost (like travoprost, Lumigan, bimatoprost, Travatan Z) are all intended to blunt the natural pressure spike that happens at night. This high pressure can be mitigated by taking the drop at night and can help with slowing the progression of glaucoma.
2. Limit Side Effects Of Latanoprost
One of the side effects that people notice when taking latanoprost is that their eye may become red and slightly irritated. This, unfortunately, is not uncommon. Many patients may complain of redness of the eye after taking their eye drop. Some of this may be due to the preservative benzalkonium chloride that is found in many eye drops.
Latanoprost is in a group of medications called prostaglandin analogues. When a patient uses prostaglandin analogues at night, it makes the adverse effects of the drop (like redness) less noticeable.
3. Possible Increased Absorption Of Medication
Using latanoprost at night can lead to increased absorption of the medication. This is because the eye’s natural tear production and blinking being reduced during sleep. As a result, the medication has more time to be absorbed by the eye, leading to better efficacy in reducing intraocular pressure.
4. Compliance With Medication
Another positive reason to use latanoprost at night is that in the clinical experience of many doctors, keeping a consistent routine can help to increase compliance. This means that if you take the drug every night at the same time, you are less likely to forget it.
Compliance is important for controlling intraocular pressure. Good compliance with eye drops reduces the chance that your glaucoma will get worse. The effect of this class of medication lasts about 24 hours, so it is important that it gets re-dosed at the same time to ensure the most benefit to the patient.
What Happens If You Don’t Take Latanoprost At Night
For some patients, taking their eye drops at night can be difficult. Some patients may have a job where they come home very late or a job where they are working overnight. In these patients, they should take the drop before their sleep-whenever that is.
The most important thing to remember is that you should use the medication. If you absolutely can not remember to take it at night, then be sure to take it at the same time each day.
You should also make sure to have regular eye exams. Your ophthalmologist can tell you if the given drug is working or not. If it is not working, then the doctor can switch you to a different medication if needed or even add a second eye drop.
Can You Place Latanoprost In Direct Sunlight?
Patients should not place Latanoprost in direct sunlight as exposure to direct sunlight and heat could change how well Latanoprost works. It is recommended to store the medication in a cool and dry place and out of direct sunlight.
Does Latanoprost Have To Be Refrigerated?
Ideally, yes, it is recommended to refrigerate Latanoprost, but it should not be frozen. For many patients, however, keeping latanoprost by their bedside is the best way for them to remember to take it. So, for some patients when the issue of compliance arises, keep the latanoprost in a convenient place may be better for IOP lowering. Remember that this is for educational purposes only and its always best to talk to your eye doctor.
Your ophthalmologist can provide recommendations on how to properly store the drug and they can also let you know about keeping it by your bedside.
How Does Latanoprost Work
Prostaglandin analogs, such as latanoprost, have been shown to effectively flatten the circadian IOP curve. This means that these medications can consistently control pressure levels in the eyes throughout a 24-hour period. Latanoprost helps maintain stable IOP even during nocturnal hours. For exact drug information, you should also read the insert that comes with the eye drop.
What Is The Circadian IOP Curve?
The circadian IOP curve refers to the daily variation of intraocular pressure (IOP) over a 24-hour period. Studies have shown that IOP is highest during sleeping hours and lower during waking hours for both normal controls and untreated glaucoma patients. The curve is important in the pathogenesis and management of glaucoma (source: AAO).
If patients glaucoma is progressing despite good pressure control that is documented in the doctor’s office, this could mean that the pressure is spiking at home. It is most likely that the pressure would spike at night since this is when the natural nocturnal IOP does spike. While a diurnal IOP curve may suffice in most cases, a complete 24-hour or 48-hour curve may be needed in selected cases to unmask periods of exposure to higher levels of IOP during the night.
How Does Circadian Rhythm Affect Your Eye Pressure?
he circadian rhythm affects intraocular pressure (IOP) by causing a daily variation of IOP over a 24-hour period. IOP is highest during sleeping hours and lower during waking hours for both normal controls and untreated glaucoma patients. The peak IOP typically occurs in the early morning hours, around 4-6 am, and the lowest IOP occurs in the mid-afternoon, around 4-6 pm.
The exact mechanism of how the circadian rhythm affects IOP is not fully understood, but it is believed that the autonomic nervous system, which controls the body’s internal clock, regulates the production and drainage of aqueous humor, the fluid in the eye that maintains IOP. Disruptions in the circadian rhythm, such as those caused by shift work or jet lag, can lead to changes in IOP and may increase the risk of developing glaucoma
Should You Check Your Eye Pressure At Night?
Checking your nocturnal IOP is challenging. There are at home IOP measuring devices but they are not inexpensive. However, in certain cases your doctor may recommend that you try it. Additionally, you may need some help to check the pressure at night to actually get a proper reading. For most patients, especially those who have mild glaucoma, checking pressure at night will not provide much additional value.
​How Can You Maximize The Effect Of Latanoprost?
To maximize the effectiveness of latanoprost, there are few things you can do.
Punctal Occlusion
After applying the eye drops, keep the eyes shut. Then, using your index finger, apply gentle pressure to the inside corner of the eye for about one to two minutes. This technique is called punctal occlusion.
Punctal occlusion (also called nasolacrimal duct occlusion) is a technique used after instilling eye drops to prevent the medication from draining out of the eye too quickly. This allows the medication to stay in the eye longer and increases its effectiveness. It also decreases the absorption of the medication in the patient’s bloodstream. This is not as important for latanoprost but for other types of medications like beta blockers, it could be helpful. It can prevent systemic absorption of medication that can have effects on the body outside the eye.
Proper Instillation Of The Eye Drop
It is important to make sure that you actually get the eye drop in your eye. It is a good idea to use a mirror when applying the eye drop. Simply pull your lower eyelid down and place the eye drop into the lower part of the eye and then close the eyes. Either being in the sitting position or standing in front of a mirror seems to be the easiest for most patients. Healthcare professionals can show you how to put an eye drop in the eye easily if you are having trouble.
If your IOP measurements are not getting lower after you have started medication, you may want to show your doctor during office hours how you put the drop in. It is important to have good IOP control in Open Angle Glaucoma to prevent the progression of the disease. Significant IOP fluctuation can be bad for optic nerve health. Properly putting the drop in can make signifcant differences in the effectivity of the medication.
Understanding How Latanoprost Works
Latanoprost’s role in remodeling the extracellular matrix to facilitate an easier outflow of aqueous humor through the ciliary muscle bundles is confirmed by various research findings. A meta-analysis of randomized clinical trials evaluated the IOP reduction achieved by frequently prescribed glaucoma medications, including latanoprost. The primary way it works is by increasing uveoscleral outflow.
The uveoscleral pathway is a non-traditional drainage pathway for aqueous humor, the fluid in the eye that maintains intraocular pressure (IOP). By increasing the outflow of aqueous humor, Latanoprost lowers IOP, which is important in the treatment of open-angle glaucoma and ocular hypertension. Latanoprost is a prostaglandin analogue that mimics the action of prostaglandin F2-alpha, a natural substance in the body that regulates the outflow of aqueous humor. Latanoprost is believed to work by binding to specific receptors in the eye, which increases the permeability of the ciliary muscle and increases the outflow of aqueous humor
Side Effects Of Latanoprost
The most common side effects of Latanoprost (ophthalmic solution) may include itching, joint or muscle pain, redness of the eyes, tearing, watery eyes, itchy eyes, puffy eyelids, stinging, burning, or redness of the eyes, blurred vision, feeling like something is in your eye, your eyes may be more sensitive to light, darkened eye color, or eyelash thickening.
Overall, however, latanoprost and other prostaglandin analogues are very well tolerated. For the most part they do not cause burning like carbonic anhydrase inhibitors and they are well tolerated. Dry eyes can happen from the use of latanoprost but this is really more likely when a patient is on multiple glaucoma medications.
Contraindications To Latanoprost
Although latanoprost is widely recommended for use at night, there may be some situations in which night-time use is not ideal. For example, if a patient has a history of allergies or hypersensitivity to the active ingredients in latanoprost, they should consult their healthcare professional about the risks associated with using it at night.
Additionally, some individuals might find it difficult to consistently apply the medication at night, which could affect the efficacy of the treatment. In such cases, patients should discuss alternative dosing times or treatments with their healthcare provider to ensure that their glaucoma is effectively managed.
Practical Tips For Latanoprost Usage
When using Latanoprost, it is essential to follow consistent routines and proper techniques to ensure optimum results. Here are a few practical tips for latanoprost night usage:
- Dosing: The usual dose for adults and children is one drop into the affected eye or eyes, once a day. Make sure to follow your doctor’s instructions or the directions on the label, and do not alter the dosage without consulting your healthcare professional.
- Application: After applying the drop, it can be helpful to keep the eyes closed for at least two minutes. This helps prevent the medication from draining out and increases its effectiveness. Avoid touching the eye or eyelid with the dropper to minimize the risk of contamination or infection.
- Storage: Store Latanoprost in a cool, dry place to maintain its potency and efficacy. Always ensure the container is tightly sealed when not in use.
- Consistency: It is vital to use latanoprost every day for it to work effectively. This will require establishing a routine to ensure you don’t miss any doses. Consider setting an alarm or reminder to help maintain consistency in your medication schedule.
- Monitoring: Continuously monitor your eye pressure and keep regular appointments with your eye doctor. This will enable them to make adjustments to your treatment plan as necessary and address any potential issues in a timely manner.
It is worth noting that while these tips can maximize the benefits of latanoprost, always follow your healthcare provider’s specific recommendations and advice regarding the proper use, handling, and storage of this medication.
Why Use Latanoprost At Night: Conclusion
Latanoprost, a prostaglandin analogue, is commonly prescribed as an eye drop medication to manage open-angle glaucoma and ocular hypertension. The medication helps with intraocular pressure reduction, which is crucial in preventing vision loss. Clinical studies provide evidence of the efficacy and optimal timing of latanoprost administration for patients to achieve the best outcomes. The reasons to take latanoprost at night include blunting of the body’s noctural IOP spike, reduced appearance of eye redness, possibly increased absorption, as well as increased chance of compliance. Maintaining a regular schedule for your eye medication will help to effectively control IOP levels throughout the day and night.
