Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Bimatoprost 0.03% discontinued

The manufacturer of bimatoprost (Lumigan®) has discontinued the 0.3mg/ml or 0.03% strength of this product in dropped bottles, the 0.01% product and the unit dose version are not affected and remain available.

According to an Assessment Report at the European Medicines agency the lower strength product is a direct equivalent. The report states, "Compared with the current authorised strength which contains 0.3 mg/ml bimatoprost and 50 ppm benzalkonium chloride, the new strength contains a third of the concentration of bimatoprost (0.1 mg/ml) and 200 ppm benzalkonium chloride. The higher concentration of benzalkonium chloride increases the ocular absorption of bimatoprost thus allowing for a lower concentration of bimatoprost to be administered (0.1 mg/ml). This new formulation, with a reduced concentration of bimatoprost, achieves comparable IOP-lowering efficacy to the current authorised strength and an improved overall safety profile.

There is a cost difference between the two strengths with the 0.03% strength currently priced at £10.30 for 3ml and the 0.01% strength currently more expensive at £11.71 for 3ml.

Action: Clinicians should be aware of this product being discontinued. It may be prudent to run clinical system searches to identify any patients who are currently prescribed this product to allow a review and an alternative to be arranged.

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20 Comments to “Bimatoprost 0.03% discontinued”

  1. BCBS stopped covering Lumigan 0.01% and I would like to know if Bimatoprost 0.03% will work as well.

    Comment by Lorraine Allen — February 27, 2017 #
    Reply

    1. @Lorraine

      The two different strengths are equally effective to each other as stated above.

      Comment by Matthew Robinson — February 27, 2017 #
      Reply

  2. Anyone taking Lumigan on a long-term basis should be aware of the increase of the preservative Benzalkonium Chloride in the new dosage. I would suggest a visit to the US National Library of Medicine (www.ncbi.nlm.nih.gov) and their article on this preservative.
    We are all aware that drugs can contain elements which can cause side-effects, including eye drops, but decreasing the active ingredient and increasing a potentially dangerous preservative beggars belief. The unit dose of Lumigan 0.03 contains no preservative. In my case I have had a bad reaction to the new dosage and have changed to the unit dose.
    Please think about reading the article - after all, our eyes are precious and we definitely should have a say in what we put in them.

    Take care,
    Regards,
    Genny Bobroff

    Comment by Genny Bobroff — February 6, 2016 #
    Reply

    1. @Genny

      I have searched the US National Library of Medicine for the term "Benzalkonium chloride" and there are in excess of 30,000 articles, to which particluar one are you referring? Please can you provide a direct link to the article.

      While I accept that you have had a reaction to the increased content of the preservative this does not mean everyone will be affected in the same way.

      Comment by Matthew Robinson — February 6, 2016 #
      Reply

      1. Matthew, apologies for not getting back to you sooner re my comments of February 6th. If you go to the site I mentioned and in the search box key in Preservatives in eye drops - the good, the bad and the ugly, you will find one of many articles all over the Glaucoma sites regarding Benzalkonium Chloride. Another couple of sites you might like to view are glaucoma.org and search "preservative-free medications", then click on the site indicated below the first result. Also glaucomatoday.com contains an article by Dr Robert D Fichtner on the same subject.
        Whilst I take your point that different reactions to medications can occur from patient to patient, there is more and more evidence for removing BAK from all eye drops that contain it. Among other things, there is concern that it causes OSD in an increasing number of patients. I am now taking the preservative-free Lumigan and I find it very difficult to understand the use of a preservative that when used for other things, such as an antiseptic, the advice is never to let it get into the eyes - admittedly, in antiseptic form it would be stronger. Our eyes are so precious, so I feel very strongly that they should be treated with the utmost respect and care by us and in the case of issues requiring medical intervention, by the practitioners and the drug companies who may have to become involved.
        Kind regards,
        Genny

        Comment by Genny Bobroff — March 16, 2016 #
        Reply

        1. @Genny,

          Thanks for the follow up. It's quite reasonable to be concerned about your eye health and by extension about the impact that BKA, or any preservative for that matter, might be having on your eye when using drops.

          There are 2 issues that arise from this for me. Firstly there is a difference between 'association' and 'cause and effect'. Although this might seem flippant as a statement, just because an eye drop is applied to the eye and some problem then develops does not immediately mean that the eye drop caused the problem, or more specifically that a single ingredient cause the problem. It may be allergy to another ingredient, allergy to something else or simple coincidence.

          The second, and perhaps less contentious issue, is that in the process of instilling something into the eye one needs to be assured that the drop is sterile. This means using preservatives or manufacturing the product to be sterile but preservative free. The latter approach, while certainly the more ideal approach unfortunately comes with added costs. That factor becomes a consideration for individuals funding their own healthcare and also for centrally funded, free (or cheap) at the point of access healthcare services like the NHS.

          Bottom line is that while preservatives are not ideal, they are necessary. And for those patients who find they cannot tolerate the preservatives due to confirmed and persistent irritation, the preservative-free alternatives are there as an alternative but at a cost premium.

          Comment by Matthew Robinson — March 17, 2016 #
          Reply

  3. I am very concerned that damage has been done to my eyes as in August I received a new prescription from my surgery. I was told the 0.03% had been discontinued but no reason was given.It stated 3 drops a day which my pharmist told me was equivalent to the old 0.03% dose. It hasn't been easy taking that amount at one time. Now I have found out I have been overdosing.

    Comment by Sandra Dando — January 21, 2016 #
    Reply

    1. @Sandra

      I doubt you will have caused any damage to you eyes using this dose. I presume you have not experienced any side effects like blurring of vision for example.

      I still think you should let your doctor and pharmacist know that the two products are dose equivalent so they are aware for other patients.

      Comment by Matthew Robinson — January 23, 2016 #
      Reply

  4. I also recently discovered my drops had been altered. I only noticed that the cap colour was different, so checking with both the doctor and the chemist, I was told the 0.03% strength was discontinued. It would have bee nice if the medical teams could have informed all users, so saving everyone worry and stress. Glaucoma and other eye diseases, may not seem very important to people not affected, but to us it is a matter of great concern, sight is very precious. Barrie

    Comment by Barrie Grant — January 10, 2016 #
    Reply

    1. @Barrie

      It is unfortunate that neither your surgery nor the pharmacy advised you of the change in the drops - especially as it seems your prescription was changed by the surgery if you were supplied the new strength. A sudden change for a treatment for your eyes can be worrying but at least having read the above you can be reassured that it will be doing the same job.

      The manufacturer will have tried to communicate this issue to their customers in the NHS (so surgeries and pharmacies) unfortunately with the amount of post they each will get it could quite easily have been missed or forgotten about.

      Comment by Matthew Robinson — January 10, 2016 #
      Reply

  5. I went for my prescription of lumigan this morning, but the chemist told me that these have now been discontinued. No alternative eye drop was offered.

    Comment by Michael Thompson — January 8, 2016 #
    Reply

    1. @Michael

      I think that's pretty poor service from your pharmacy to leave you without any alternative or even advice to return to your GP for an alternative. As above though, the alternative is the same drug in a 0.01% strength, so ask you GP for that.

      Comment by Matthew Robinson — January 10, 2016 #
      Reply

  6. I am not surprised that there is a perceived problem with the change in strength of this product. When I picked up my prescription today I queried the change with the pharmacist. The dosage instruction stuck on the packaging at the pharmacy said use according to the consultants instructions, which was of course for the original strength.
    The pharmacist suggested I contacted my consultant - Has anybody ever tried? I am assured that somebody in the GP's surgery will have his telephone number! This being Wales it takes 6 months to see anybody so I have little faith in this suggestion. However, I am reassured by the comments on your site, but this is a bit like DIY medicine. GP's do not seem to know anything about the change.

    Comment by Edmund Jones — December 11, 2015 #
    Reply

    1. @Edmund

      It's a shame that the packaging for the new product does not clearly indicate that the new version is the same as the old one despite the apparent difference in strength. If that were the case, patients and pharmacists could be instantly aware and assured that the new and old do exactly the same job and save everyone a lot of time and worry.

      Comment by Matthew Robinson — December 11, 2015 #
      Reply

  7. I was informed back in August this year that I was being moved on to the lower strength lumigan 0.1mg/ml from the 0.03%. Since then I have had a terrible dry mouth everytime I try to sleep, even if I try and grab an hour or so in the daytime within minutes my mouth dries up.
    I have just this minute started looking up dry mouth and what causes it but this new strength of lumigan is very new and I am struggling to find any information. Has anyone else on here experienced the same problems? Any help would be very much appreciated as this is now disrupting my sleep that much I am finding it unbearable. All my G.P has given me is synthetic saliva to use in the night which does bring relief at the time but only until I wake up 30 mins later with the same problem. I am just hoping it is these drops to be honest so I can get this sorted...Please Help!

    Comment by Wayne — November 29, 2015 #
    Reply

    1. @Wayne

      Dry mouth is not a listed side effect for either strength of these drops. It has been reported as a side effect once to the UK regulatory authorities when in a combination drop (probably with timolol). So, it seems unlikely it is due to these drops, but before you despair ask to be switched to an alternative and see if the side effect resolves; even though it is unlikely to be the drops there is still a possibility.

      Comment by Matthew Robinson — November 29, 2015 #
      Reply

      1. Thanks for the reply Mathew, Something has been added to the strength 0.01% that is not in the 0.03%, not sure what but I think this is the problem. Just ordered the 0.03% again I will go back on these and see if there is any difference

        Regards

        Wayne

        Comment by Wayne — November 29, 2015 #
        Reply

        1. @Wayne

          The list of ingredients for the two strengths is the same in the references I can check. The difference is that the 0.01% product contains more benzalkonium chloride. One other thing you can try is manual punctal occlusion. Sounds clever but basically it reduces tear drainage from the eye into the nose and throat. It is simple to do, just apply firm but gentle pressure to the corder of the eye nearest to the nose when you put the drops in.

          Comment by Matthew Robinson — November 30, 2015 #
          Reply

  8. I have just found out from the chemist that since July 2015 I have been prescribed a lower dose of lumigan from 0.3 to 0.1 & was very upset, because no one had let me know. My carer found this out for me, I hope this lower dose won't make my eyes worse as I have macula degeneration also.

    Not very happy
    Yours
    Stanley barker

    Comment by Mr S. Barker — November 12, 2015 #
    Reply

    1. @Stanley

      I agree that is is not very good that neither your doctor or pharmacy old you or you carer about the change but please rest assured that while the strength is lower the newer drop has exactly the same effect on your eyes. Another ingredient in the drops is in the newer one in a greater quantity and that makes the drug more effective, so even though it seem to be a lower dose it actually has the same effect.

      Comment by Matthew Robinson — November 12, 2015 #
      Reply

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