Side Effects

The side effect profiles of the various PG analogs are compared in table 2.1. Eye irritation, conjunctival hyperemia, and eyelash changes are the most frequently reported side effects. Eye irritation, burning, and pain are reported with variable frequency in the various studies, and the rates of these symptoms with the various PG analogs are not substantially different from each other or from timolol. A wide range of other signs or symptoms such as superficial punctate keratitis, blurred vision, cataract, and headache have been reported at low rates in various clinical studies. The side effects of iris color changes, eyelash changes, and periocular skin color changes are specifically associated with the PG analogs.

Bimatoprost and travoprost have been reported to give a higher incidence of hyperemia and eyelash changes compared to latanoprost,2,3,45,46 and package insert labeling reflects this difference. There is no clear evidence that the incidence or severity of other side effects vary substantially among these medications. At the time this chapter was prepared, peer-reviewed reports were not available regarding benzalkonium chloride-free travoprost ophthalmic solution 0.004% (Travatan Z). More experience is required with the newer PG analogs to determine whether the incidence of rare side effects is different among the PGs.

2.5.1 Conjunctival Hyperemia. Conjunctival hyperemia is reported significantly more frequently with bimatoprost and travoprost than with latanoprost (table 2.1).2,3,45,46 In general, the level of hyperemia is very mild for most patients and usually is not noticed by the patient and not severe enough to require discontinuation of the medication.2,3,29,45-49 Based on the phase III clinical trials and as stated in the package inserts, 3% of patients required discontinuation of therapy with tra-voprost or bimatoprost because of intolerance to conjunctival hyperemia, whereas

Table 2.1 Percentage of Patients in Comparative Trials Exhibiting Specific Ocular Signs and Symptoms
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