LUMIGAN (Bimatoprost)

What Is LUMIGAN and What Is It Used For?

LUMIGAN (bimatoprost) is a prostaglandin analogue eye drop prescribed to reduce elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. It works by increasing the natural outflow of aqueous humour from the eye, thereby lowering the pressure inside the eye and helping to prevent optic nerve damage and vision loss.

LUMIGAN belongs to a class of medications called prostamides, which are structurally related to prostaglandins. Bimatoprost, the active ingredient, is a synthetic analogue that mimics the effects of naturally occurring prostamides in the eye. It exerts its pressure-lowering action primarily by enhancing aqueous humour outflow through both the uveoscleral pathway and the trabecular meshwork – the two main drainage routes within the eye.

The eye constantly produces a clear fluid called aqueous humour, which nourishes the front part of the eye and maintains its shape. This fluid is continuously produced and drained in a carefully balanced cycle. In conditions such as open-angle glaucoma and ocular hypertension, the drainage of this fluid becomes impaired, leading to a build-up of pressure inside the eye. Over time, elevated intraocular pressure can damage the optic nerve – the nerve responsible for transmitting visual information from the eye to the brain. This damage is typically gradual and painless, and without treatment it can lead to irreversible peripheral vision loss and eventually blindness.

LUMIGAN can be used as monotherapy (the sole eye drop treatment) or in combination with beta-blocker eye drops such as timolol. In fact, a fixed-dose combination product called GANFORT (bimatoprost 0.3 mg/ml + timolol 5 mg/ml) is available for patients who require both medications. Combination therapy is typically considered when a single agent does not achieve adequate IOP reduction.

Clinical trials have demonstrated that bimatoprost reduces IOP by approximately 25–33% from baseline, with onset of action within 4 hours of the first dose and peak effect at approximately 8–12 hours. This places bimatoprost among the most effective topical IOP-lowering agents, comparable to latanoprost, travoprost, and tafluprost. The European Glaucoma Society (EGS) and the American Academy of Ophthalmology (AAO) both recommend prostaglandin analogues, including bimatoprost, as first-line therapy for open-angle glaucoma.

What Should You Know Before Using LUMIGAN?

Before using LUMIGAN, inform your ophthalmologist about all your medical conditions, any planned eye surgery, and whether you wear contact lenses. LUMIGAN is not recommended during pregnancy or breastfeeding, and it has not been studied in children under 18 years of age.

Contraindications

You should not use LUMIGAN if any of the following apply to you:

• Allergy to bimatoprost or any other ingredient in the formulation (including the preservative benzalkonium chloride) – symptoms of an allergic reaction may include severe eye redness, itching, swelling, or skin rash
• Previous intolerance to benzalkonium chloride – if you have previously had to stop using eye drops due to a side effect caused by this preservative, you should not use LUMIGAN

Warnings and Precautions

Talk to your ophthalmologist or pharmacist before using LUMIGAN if you have or have had any of the following conditions:

• Breathing problems – particularly asthma or chronic obstructive pulmonary disease (COPD), as bimatoprost may occasionally worsen respiratory symptoms
• Liver or kidney disease – LUMIGAN has not been extensively studied in patients with significant hepatic or renal impairment
• Previous cataract surgery – prostaglandin analogues may increase the risk of macular oedema (swelling of the central retina) in patients who are aphakic (lacking a natural lens) or pseudophakic with a torn posterior lens capsule
• Dry eyes – the preservative benzalkonium chloride may exacerbate dry eye symptoms
• Corneal problems – conditions affecting the cornea (the clear front surface of the eye) may be worsened by benzalkonium chloride or the phosphate buffers in the formulation
• Active eye inflammation or viral eye infection – including herpes simplex keratitis, uveitis, or iritis
• Low blood pressure or slow heart rate – although systemic absorption of bimatoprost is minimal, caution is advised

Use in Children and Adolescents

LUMIGAN has not been studied in patients under 18 years of age and should therefore not be used in children or adolescents. If intraocular pressure management is needed in paediatric patients, your ophthalmologist will recommend an alternative treatment with an established safety profile in younger age groups.

Pregnancy and Breastfeeding

If you are pregnant, think you might be pregnant, or are planning to become pregnant, you must inform your doctor before using LUMIGAN. The safety of bimatoprost during pregnancy has not been established in humans. Animal studies have shown reproductive toxicity at high systemic doses. LUMIGAN should not be used during pregnancy unless your ophthalmologist considers the benefit to you to outweigh the potential risk to the unborn child.

Bimatoprost may pass into breast milk. If you are breastfeeding, your doctor will advise whether to discontinue breastfeeding or discontinue LUMIGAN, taking into account the importance of the medication for your eye health. A decision should be made whether to stop breastfeeding or to stop LUMIGAN treatment.

Other Medications

Tell your ophthalmologist or pharmacist about all medications you are currently using, have recently used, or might use. Although bimatoprost has minimal systemic absorption when applied topically to the eye, drug interactions should still be considered. Of particular note, using LUMIGAN together with other prostaglandin analogues (such as latanoprost or travoprost) is generally not recommended, as the combined effect on IOP may be paradoxically reduced rather than enhanced.

If you are using other eye drops in addition to LUMIGAN, wait at least 5 minutes between each medication to prevent the first drop from being washed out by the second. If you also use an eye ointment, the ointment should be applied last.

Driving and Operating Machinery

Your vision may become temporarily blurred immediately after instilling LUMIGAN eye drops. Do not drive a car or operate machinery until your vision has cleared. If blurred vision persists for more than a few minutes after instillation, consult your ophthalmologist.

LUMIGAN Contains Benzalkonium Chloride

LUMIGAN contains benzalkonium chloride (0.2 mg/ml) as a preservative. This substance can be absorbed by soft contact lenses and may permanently discolour them. You must remove your contact lenses before instilling LUMIGAN and wait at least 15 minutes before reinserting them. Benzalkonium chloride may also cause eye irritation, especially in patients with dry eyes or compromised corneal surfaces. If you experience an abnormal sensation, stinging, or pain in the eye after using LUMIGAN, inform your doctor.

How Does LUMIGAN Interact with Other Drugs?

LUMIGAN has minimal systemic absorption and therefore has a low risk of systemic drug interactions. However, combining it with other prostaglandin analogue eye drops is not recommended, as this may paradoxically reduce the IOP-lowering effect. Spacing between different eye drops should be at least 5 minutes.

Because bimatoprost is applied topically to the eye and undergoes minimal systemic absorption, clinically significant systemic drug interactions are uncommon. However, the following interactions are relevant in ophthalmic practice:

Major Interactions

The most clinically significant interaction is the concurrent use of LUMIGAN with other prostaglandin analogues. Multiple studies have shown that combining two prostaglandin analogues – for example, bimatoprost with latanoprost – does not produce an additive effect on IOP reduction. Instead, the combination may result in less IOP lowering than either agent used alone. This is thought to be because both drugs compete for the same receptor-mediated outflow pathways. For this reason, switching between prostaglandin analogues rather than combining them is the recommended approach when a single agent is insufficiently effective.

Minor Interactions and Practical Considerations

When using multiple eye drops, the order and timing of administration matters. Each drop needs time to be absorbed by the eye before the next is applied. If a second drop is instilled too soon after the first, it can dilute or wash away the previous medication, reducing its efficacy. The standard recommendation is to wait at least 5 minutes between different eye drop medications. Eye ointments should always be applied after all eye drops have been instilled, as the ointment base can act as a barrier preventing subsequent drops from reaching the ocular surface.

Although systemic drug interactions are rare with topical bimatoprost, patients using systemic medications that affect blood pressure or heart rate should inform their ophthalmologist. The combination of topical beta-blockers (such as timolol) with systemic beta-blockers, calcium channel blockers, or cardiac glycosides may have additive cardiovascular effects – though this is a consideration for the beta-blocker component rather than bimatoprost itself.

What Is the Correct Dosage of LUMIGAN?

The recommended dose of LUMIGAN is one drop in each affected eye, once daily in the evening. Do not use more than once daily, as more frequent administration may actually decrease its IOP-lowering effectiveness. Always follow your ophthalmologist's instructions exactly.

Adults

LUMIGAN is available in two concentrations. The 0.1 mg/ml formulation was developed to provide equivalent IOP reduction to the 0.3 mg/ml formulation but with a potentially improved tolerability profile and fewer cosmetic side effects such as conjunctival hyperaemia (eye redness). Your ophthalmologist will select the concentration most appropriate for your clinical situation.

When using LUMIGAN together with other eye drop medications, allow at least 5 minutes between each medication. If you also use an eye ointment or gel, apply LUMIGAN first and the ointment or gel last.

How to Apply LUMIGAN Eye Drops

Proper instillation technique is important for ensuring the medication reaches the eye and minimising systemic absorption:

1. Check the seal: Do not use the bottle if the tamper-evident seal around the bottle neck is broken before first use
2. Wash your hands thoroughly before handling the eye drops
3. Tilt your head back and look up at the ceiling
4. Gently pull down your lower eyelid to create a small pocket between the eyelid and the eye
5. Turn the bottle upside down and gently squeeze to release one single drop into the pocket
6. Release the lower eyelid and close your eye for 30 seconds. Optionally, apply gentle pressure with your finger over the inner corner of the eye (punctal occlusion) to reduce drainage into the nasal passages and minimise systemic absorption
7. Wipe away any excess fluid that runs down the cheek
8. Do not touch the dropper tip to the eye, eyelid, or any other surface to prevent contamination
9. Replace the cap tightly immediately after use

If the drop misses the eye, try again with a single drop. Do not instil more than one drop per eye per dose.

Children and Adolescents

Elderly Patients

No dose adjustment is required in elderly patients. Clinical studies of LUMIGAN included patients aged 65 years and older, and no overall differences in safety or efficacy were observed compared to younger adults. However, elderly patients may be more susceptible to systemic side effects and should report any unusual symptoms to their ophthalmologist.

Missed Dose

If you forget to use LUMIGAN, instil a single drop as soon as you remember, then return to your regular evening dosing schedule. Do not use a double dose to make up for a missed one. If it is almost time for your next scheduled dose, skip the missed dose and continue with your regular routine.

Overdose

If you accidentally use more drops than prescribed, it is unlikely to cause serious harm. The eye can only hold approximately one drop of fluid, so any excess will simply overflow. If excessive drops are applied, there may be a temporary increase in eye irritation or redness. Administer your next dose at the usual time. If you have concerns or experience unusual symptoms after accidental overuse, contact your ophthalmologist or pharmacist.

In the event of accidental oral ingestion, symptoms are unlikely given the small volume of the bottle (3 ml). However, if a significant amount is swallowed, seek medical advice. Systemic effects might include mild respiratory effects, hypotension, or nausea.

What Are the Side Effects of LUMIGAN?

Like all medications, LUMIGAN can cause side effects, although not everyone experiences them. The most common side effect is mild eye redness, occurring in up to 29% of patients. LUMIGAN also frequently causes changes in eyelash appearance and periorbital fat loss. Some cosmetic changes, including iris darkening, may be permanent.

Side effects of LUMIGAN are primarily local (affecting the eye and surrounding tissue) rather than systemic. Many of the ocular side effects are mild and tend to diminish with continued use. However, certain changes – particularly iris colour darkening and eyelash changes – may be irreversible. The side effects listed below are grouped by how frequently they occur.

Additional Side Effects with Higher Concentration (0.3 mg/ml)

The following side effects have been additionally observed with the 0.3 mg/ml formulation of bimatoprost (higher than the standard 0.1 mg/ml concentration):

• Burning sensation in the eye
• Allergic reaction in the eye
• Inflamed eyelids (blepharitis)
• Difficulty seeing clearly
• Worsening vision
• Swelling of the clear layer covering the eye (conjunctival oedema)
• Retinal bleeding
• Inflammation inside the eye (uveitis)
• Cystoid macular oedema – retinal swelling leading to impaired vision
• Eyelid twitching or retraction
• Skin redness around the eye
• Weakness
• Elevated liver function tests

Eye Drops Containing Phosphate

In very rare cases, patients with severe corneal damage have developed cloudy deposits (calcification) on the cornea during treatment with phosphate-containing eye drops. If you have significant corneal disease and are using LUMIGAN, your ophthalmologist will monitor you closely for this potential complication.

How Should You Store LUMIGAN?

Store LUMIGAN at room temperature below 25°C (77°F). Once opened, discard the bottle after 4 weeks, even if drops remain. Do not use the eye drops after the expiry date on the label. Keep out of sight and reach of children.

Proper storage of LUMIGAN is essential to maintain the sterility and effectiveness of the medication. Contaminated eye drops can cause serious eye infections.

• Before opening: Store below 25°C (77°F). Do not freeze. Keep the bottle in the outer carton to protect from light
• After opening: You must discard the bottle 4 weeks after first opening, even if drops remain in the bottle. This precaution is necessary to prevent microbial contamination, which can cause eye infections. Write the date you opened the bottle on the outer carton to help you remember
• Expiry date: Do not use LUMIGAN after the expiry date printed on the bottle label and carton (marked “EXP”). The expiry date refers to the last day of the stated month
• Keep out of reach of children: Store LUMIGAN where children cannot see or reach it
• Disposal: Do not dispose of medicines via wastewater or household waste. Return unused or expired eye drops to your pharmacy for safe disposal. This helps protect the environment

Each LUMIGAN bottle contains 3 ml of solution, which is sufficient for approximately 4 weeks of daily treatment in both eyes. The bottles are intentionally only half-filled to allow room for the dropper mechanism to function properly.

What Does LUMIGAN Contain?

The active substance in LUMIGAN is bimatoprost. Each millilitre of solution contains 0.1 mg of bimatoprost (LUMIGAN 0.1 mg/ml). LUMIGAN also contains benzalkonium chloride as a preservative, along with inactive ingredients to maintain stability and physiological pH.

Active Ingredient

The active pharmaceutical ingredient is bimatoprost. One millilitre of LUMIGAN 0.1 mg/ml solution contains 0.1 mg of bimatoprost. For the higher-concentration formulation, one millilitre contains 0.3 mg of bimatoprost.

Inactive Ingredients (Excipients)

The inactive ingredients serve essential functions in maintaining the stability, sterility, and comfort of the eye drop formulation:

• Benzalkonium chloride – preservative (0.2 mg/ml) that prevents microbial growth in the multi-dose bottle
• Sodium chloride – maintains isotonicity (matching the saltiness of natural tears) for comfortable instillation
• Sodium phosphate dibasic heptahydrate – buffer to maintain stable pH
• Citric acid monohydrate – buffer to maintain stable pH
• Purified water – solvent base
• Hydrochloric acid or sodium hydroxide – small amounts added as needed to adjust the pH to a normal, physiological level

Appearance and Packaging

LUMIGAN is a clear, colourless eye drop solution. It is supplied in white plastic bottles with screw caps. Each bottle contains 3 ml of solution and is approximately half-filled. Packs contain either 1 or 3 bottles. Not all pack sizes may be available in your country.

Marketing authorisation holder and manufacturer: LUMIGAN is manufactured by Allergan Pharmaceuticals Ireland (Castlebar Road, Westport, Co. Mayo, Ireland) and marketed by AbbVie Deutschland GmbH & Co. KG (Knollstrasse, 67061 Ludwigshafen, Germany).

Frequently Asked Questions About LUMIGAN

References

Editorial Team