Bimatoprost

Bimatoprost (marketed in the U.S., Canada and Europe by Allergan, under the trade name Lumigan) is a prostaglandin analog/prodrug used topically (as eye drops) to control the progression of glaucoma and in the management of ocular hypertension. It reduces intraocular pressure (IOP) by increasing the outflow of aqueous fluid from the eyes.^[1] It has also been used and prescribed off-label to lengthen eyelashes.^[2] In December 2008, this use was approved by the U.S. Food and Drug Administration (FDA); the cosmetic formulation of bimatoprost is sold as Latisse ( /ləˈtiːs/).^[3] Recently, at least three case series have suggested that bimatoprost has the ability to reduce adipose (fat) tissue.

Cosmetic use

In patients using ophthalmic prostaglandins such as travoprost and latanoprost, as well as prostamides like bimatoprost, it has been anecdotally noted that they have grown long and lush eyelashes. Allergan has initiated clinical trials investigating the usage of Lumigan as a cosmetic drug.^[2] On December 5, 2008, the FDA Dermatologic and Ophthalmic Drugs Advisory Committee voted to approve bimatoprost for the cosmetic use of darkening and lengthening eyelashes. The medical term for this is treatment of hypotrichosis, however, the FDA approval is for purely cosmetic purposes.^[4]

According to Allergan's package labeling, users of its Latisse cosmetic product didn't develop darker irises in clinical studies; however, "patients should be advised about the potential for increased brown iris pigmentation which is likely to be permanent."^[5]

Several cosmetics companies have released products based on prostaglandin analogs, as non-drug cosmetics.

• Age Intervention Eyelash by Jan Marini Skin Research
• RevitaLash by Athena Cosmetics Corp.
• MD Lash Factor by PhotoMedex Inc.

These companies have been sued by Allergan for patent infringement.^[2] The FDA has seized Age Intervention Eyelash as an "unapproved and misbranded drug" because Jan Marini Skin Research promoted it as something that increases eyelash growth^[6] and because it is "adulterated" with bimatoprost.^[7]

Fat-reducing properties

Reductions in orbital fat (i.e., fat around the eye) have been observed in patients using bimatoprost as glaucoma therapy.^[8] Of particular interest, the loss of orbital fat was unilateral in patients who used bimatoprost on only one eye.^[9] The effect appears reversible upon cessation of bimatoprost use. The effect is likely to explain deepening of the lid sulcus described in a series of three patients on bimatoprost.^[10] The mechanism for the apparent fat reduction remains unclear. However, bimatoprost is chemically analogous to prostaglandin F2 alpha (PGF2alpha), a compound which is known to reduce fat by inhibition of adipocyte differentiation and survival.^[11]

Formulations

Lumigan is a 0.03% solution of bimatoprost, and contains benzalkonium chloride as a preservative. Contact lenses should therefore be removed before use, and replaced no less than 15 minutes later;^[1] other eye drops or ointments should be given no less than five minutes before or after bimatoprost.^[1] It is administered once daily.

Efficacy

Studies have shown once-daily bimatoprost 0.03% ophthalmic solution to be more effective than timolol twice daily in reduction of intraocular pressure (IOP) and as effective as or more effective than the prostaglandin analogues latanoprost and travoprost in reducing IOP.^[12]

Side effects

Possible side effects of this medication are:

• May cause blurred vision.
• May cause eyelid redness.
• May permanently darken eyelashes.
• May cause eye discomfort.
• May eventually cause permanent darkening of the iris to brown.
• May cause a temporary burning sensation during use.
• May cause thickening of the eyelashes.
• It may cause unexpected growth of hair if applied inappropriately, on the cheek, for example.
• It may cause infection if the one-time applicators which come with the genuine product are reused.
• Lashes may grow so long that they become ingrown and scratch the cornea.
• May cause darkening of the eyelid or of the area beneath the eye.^[13]

On November 19, 2007, the FDA issued a warning during the seizure of a bimatoprost-containing cosmetic.^[14] The warning stated that "the extra dose of bimatoprost may decrease the prescription drug's effectiveness. Damage to the optic nerve may lead to decreased vision and possibly blindness."

References

Citations

• Chen M, Cheng C, Chen Y, Chou C, Hsu W (2006). "Effects of bimatoprost 0.03% on ocular hemodynamics in normal tension glaucoma.". J Ocul Pharmacol Ther 22 (3): 188–93. doi:10.1089/jop.2006.22.188. PMID 16808680. 
• Kruse P, Rieck P, Sherif Z, Liekfeld A (2006). "Cystoid macular edema in a pseudophakic patient after several glaucoma procedures. Is local therapy with bimatoprost the reason?". Klin Monatsbl Augenheilkd 223 (6): 534–7. doi:10.1055/s-2005-858992. PMID 16804825. 
• Steinhäuser S (2006). "Decreased high-density lipoprotein serum levels associated with topical bimatoprost therapy.". Optometry 77 (4): 177–9. doi:10.1016/j.optm.2006.02.001. PMID 16567279. 

External links

• Medical News Today: FDA Seizes $2 Million Of Cosmetic Eye Product Which Contains Drug Ingredient And Makes Unapproved Drug Claims. Christian Nordqvist. 18 November 2007
• Wired Science: FDA Seizes Cosmetic That Can Blind. Brandon Keim. November 19, 2007