Related guidance:
Glaucoma: diagnosis and management NICE guideline (NG81 November 2017, updated January 2022)
As advised by secondary care
- Where a prostaglandin analogue is indicated for reducing intraocular pressure (IOP), Latanoprost is first line. Patients currently using other forms of prostaglandin analogues may be reviewed when seen routinely by secondary care.
- Offer another pharmacological treatment to people with an IOP of 24 mmHg or more who cannot tolerate their current treatment. The first choice should be an alternative generic prostaglandin analogue (PGA), and if this is not tolerated, offer a beta-blocker. If neither of these options is tolerated, offer a non-generic PGA, carbonic anhydrase inhibitor, sympathomimetic, miotic or a combination of treatments.
| Therapeutic Area | Formulary Choices | Cost for 28 (unless otherwise stated) | Rationale for decision / comments |
|---|---|---|---|
| Prostaglandin analogues | Advise patients to tell their health professional if they experience severe eye irritation. See MHRA (July 2015) for Latanoprost (Xalatan): increased reporting of eye irritation since reformulation. | ||
| Latanoprost | 50mcg/ml eye drop: £1.62 (2.5ml) | First line | |
| Latanoprost Preservative-free as Lotacryn® | 50mcg/ml eye drop: £7.99 (2.5ml) | ||
| Latanoprost Preservative-free single use as Monopost® | 50mcg/ml eye drop: £8.49 (30 x 0.2ml) | ||
| Bimatoprost | 300mcg/ml eye drop: £14.54 (3ml) | ||
| Bimatoprost Preservative-free as Eyreida® | 300mcg/ml eye drop: £9.79 (3ml) | ||
| Bimatoprost Preservative-free as Zimed® | 300mcg/ml eye drop: £7.99 (3ml) | ||
| Bimatoprost Preservative-free as Bimi® | 300mcg/ml eye drop: £8.33 (3ml), £21.97 (9ml) | Cost effective alternative during Monoprost® shortage, seek advice from specialist before switching. | |
| Beta-adrenoceptor blockers | Timolol | 2.5mg/ml eye drop: £2.80 (5ml) | |
| 5 mg/ml eye drop: £2.72 (5ml) | |||
| Timolol Preservative-free as Eysano® | 2.5mg/ml eye drop: £8.45 (5ml) | ||
| 5mg/ml eye drop: £9.65 (5ml) | |||
| Timolol Preservative-free single use as Tiopex® | 1mg/g eye gel: £7.49 (30) | ||
| Carbonic anhydrase inhibitors | Acetazolamide | 250mg tablet: £5.39 (112) | NHS Somerset classify as an Amber drug for the reduction in intra-ocular pressure in glaucoma and epilepsy. |
| 250mg modified-release capsule: £16.66 (30) | |||
| Dorzolomide | 20mg/ml eye drop: £3.25 (5ml) | ||
| Dorzolomide Preservative-free as Dimaz® | 20mg/ml eye drop: £6.98 (5ml) | ||
| as Eydelto® | 20mg/ml eye drop: £7.08 (5ml) | ||
| Carbonic anhydrase inhibitor with beta-adrenoceptor blocker | Dorzolomide and timolol Preservative-free as Codimaz® | 20mg and 5mg/ml eye drop: £8.03 (5ml) | |
| Dorzolomide and timolol Preservative-free as Eylamdo® | 20mg and 5mg/ml eye drop: £8.13 (5ml) | ||
| Dorzolomide and timolol Preservative-free as Cosopt iMulti® | 20mg and 5mg/ml eye drop: £28.00 (10ml) | Provides two months treatment. | |
| Prostaglandin analogue with beta-adrenoceptor blocker | Latanoprost and timolol | 50mcg and 5mg/ml eye drop: £3.33 (2.5ml) | |
| Latanoprost and timolol Preservative-free as Fixapost® | 50mcg and 5mg/ml eye drop: £13.49 (30 x 0.2ml) | ||
| Bimatoprost and Timolol | 300mcg and 5mg/ml eye drop: £4.08 (3ml) | ||
| Prostaglandin analogue with rho kinase inhibitor | Latanoprost and netarsudil as Roclanda® | 50micrograms/ml + 200micrograms/ml eye drop: £10.00 (2.5ml) | NHS Somerset classify as amber 1 for reducing intraocular pressure (IOP) in adults with primary open-angle glaucoma or ocular hypertension when a prostaglandin analogue alone has not reduced IOP enough, only if: they have then tried a fixed-dose combination treatment and it has not reduced IOP enough, or a fixed-dose combination treatment containing beta-blockers is unsuitable as per NICE TA. |