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DESCRIPTIONTravoprost is a synthetic prostaglandin F2α analogue.Its chemical name is

[1R -[1α(Z ),2β(1E ,3R *),3α,5α]]-7-[3,5-Dihydroxy-2-[3-hydroxy-4-[3-(trifluoromethyl)phenoxy]-1-butenyl]cyclopentyl]-5-heptenoic acid,1-methylethylester. It has a molecular formula ofC26H35F3O6 and a molecular weight of 500.55. Thechemical structure of travoprost is:

Travoprost is a clear, colorless to slightly yellow oilthat is very soluble in acetonitrile,methanol, octanol,and chloroform. It is practically insoluble in water.

TRAVATAN Z® ophthalmic solution is supplied assterile, buffered aqueous solution of travoprost witha pH of approximately 5.7 and an osmolality ofapproximately 290 mOsmol/kg. Each mL ofTRAVATAN Z® contains: Active: travoprost 0.004%.Inactives: polyoxyl 40 hydrogenated castor oil,(boric acid, propylene glycol, sorbitol, zinc chloride),sodium hydroxide and/or hydrochloric acid to adjustpH, and purified water, USP. Preserved in the bottlewith an ionic buffered system, .

CLINICAL PHARMACOLOGYMechanism of ActionTravoprost free acid is a selective FP prostanoidreceptor agonist which is believed to reduceintraocular pressure by increasing trabecularmeshwork and uveoscleral outflow. The exactmechanism of action is unknown at this time.

Pharmacokinetics/Pharmacodynamics Absorption:Travoprost is absorbed through the cornea and is

hydrolyzed to the active free acid. Data from fourmultiple dose pharmacokinetic studies (totaling 107subjects) have shown that plasma concentrations ofthe free acid are below 0.01 ng/mL (the quantitationlimit of the assay) in two-thirds of the subjects.In those individuals with quantifiable plasmaconcentrations (N=38), the mean plasma Cmax was0.018 ± 007 ng/mL (ranged 0.01 to 0.052 ng/mL)and was reached within 30 minutes. From thesestudies, travoprost is estimated to have a plasmahalf-life of 45 minutes. There was no difference inplasma concentrations between Days 1 and 7,indicating that there was no significant accumulation.

Metabolism:Travoprost, an isopropyl ester prodrug, is hydrolyzedby esterases in the cornea to its biologically activefree acid. Systemically, travoprost free acid ismetabolized to inactive metabolites viabeta-oxidation of the α(carboxylic acid) chain to givethe 1,2-dinor and 1,2,3,4-tetranor analogs, viaoxidation of the 15-hydroxyl moiety, as well as via

reduction of the 13,14 double bond.Elimination:The elimination of travoprost free acid from plasmawas rapid and levels were generally below the limitof quantification within one hour after dosing. Theterminal elimination half-life of travoprost free acidwas estimated from fourteen subjects and rangedfrom 17 minutes to 86 minutes with the meanhalf-life of 45 minutes. Less than 2% of the topicalocular dose of travoprost was excreted in the urinewithin 4 hours as the travoprost free acid.

Clinical StudiesIn clinical studies, patients with open-angle glaucomaor ocular hypertension and baseline pressure of25–27 mm Hg, who were treated with TRAVATAN®(travoprost ophthalmic solution) or TRAVATAN Z®(travoprost ophthalmic solution) dosed once-dailyin the evening demonstrated 7-8 mm Hg reductionin intraocular pressure. In subgroup analysis of this

study, mean IOP reduction in black patients was upto 1.8 mm Hg greater than in non-black patients.It is not known at this time whether this differenceis attributed to race or to heavily pigmented irides.

In a multi-center, randomized, controlled trial,patients with mean baseline intraocular pressure of24-26 mm Hg on TIMOPTIC* 0.5% BID who weretreated with travoprost 0.004% dosed QDadjunctively to TIMOPTIC* 0.5% BID demonstrated6-7 mm Hg reductions in intraocular pressure.

Travoprost ophthalmic solution, 0.004% has beenstudied in patients with hepatic impairment and alsoin patients with renal impairment. No clinically

relevant changes in hematology, blood chemistry,or urinalysis laboratory data were observed in thesepatients.

INDICATIONS AND USAGETRAVATAN Z® ophthalmic solution is indicated forthe reduction of elevated intraocular pressure inpatients with open-angle glaucoma or ocularhypertension who are intolerant of other intraocularpressure lowering medications or insufficientlyresponsive (failed to achieve target IOP determinedafter multiple measurements over time) to anotherintraocular pressure lowering medication.

CONTRAINDICATIONSTRAVATAN Z® is contraindicated in patients withhypersensitivity to travoprost or any other ingredientsin this product.

WARNINGSProstaglandin analogues, including travoprostophthalmic solution, 0.004% have been reportedto cause changes to pigmented tissues. The mostfrequently reported changes have been increasedpigmentation of the iris and periorbital tissue(eyelid) and increased pigmentation and growthof eyelashes. These changes may be permanent.

Prostaglandin analogues, including travoprostophthalmic solution, 0.004% may gradually changeeye color, increasing the amount of brownpigmentation in the iris by increasing the number ofmelanosomes (pigment granules) in melanocytes. Thelong term effects on the melanocytes and theconsequences of potential injury to the melanocytesand/or deposition of pigment granules to other areasof the eye are currently unknown. The change in iriscolor occurs slowly and may not be noticeable formonths to years. Patients should be informed of thepossibility of iris color change.

Eyelid skin darkening has been reported inassociation with the use of prostaglandin analogues,including travoprost ophthalmic solution, 0.004%.

Prostaglandin analogues, including travoprostophthalmic solution, 0.004% may gradually change

eyelashes in the treated eye; these changes includeincreased length, thickness, pigmentation, and/ornumber of lashes.

Patients who are expected to receive treatment inonly one eye should be informed about the potentialfor increased brown pigmentation of the iris,periorbital and/or eyelid tissue, and eyelashes in thetreated eye and thus heterochromia between theeyes. They should also be advised of the potential fora disparity between the eyes in length, thickness,and/or number of eyelashes.

PRECAUTIONSGeneralThere have been reports of bacterial keratitisassociated with the use of multiple-dose containersof topical ophthalmic products. These containers hadbeen inadvertently contaminated by patients who, inmost cases, had a concurrent corneal disease or adisruption of the epithelial surface (see Informationfor Patients).

Patients may slowly develop increased brown

pigmentation of the iris. This change may not benoticeable for months to years (see WARNINGS).Iris pigmentation changes may be more noticeablein patients with mixed colored irides, i.e., blue-brown,grey-brown, yellow-brown, and green-brown;however, it has also been observed in patients withbrown eyes. The color change is believed to be due toincreased melanin content in the stromal melanocytesof the iris. The exact mechanism of action is unknownat this time. Typically the brown pigmentation aroundthe pupil spreads concentrically towards the peripheryin affected eyes, but the entire iris or parts of it maybecome more brownish. Until more i nformation aboutincreased brown pigmentation is available, patientsshould be examined regularly and, depending on thesituation, treatment may be stopped if increasedpigmentation ensues.

TRAVATAN Z® ophthalmic solution should be usedwith caution in patients with a history of intraocular

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inflammation (iritis/uveitis) and shouldgenerally not be used in patients with activeintraocular inflammation.

Macular edema, including cystoid macular edema,has been reported during treatment withprostaglandin F2α analogues. These reports havemainly occurred in aphakic patients, pseudophakicpatients with a torn posterior lens capsule, or inpatients with known risk factors for macular edema.TRAVATAN Z® should be used with caution inthese patients.

TRAVATAN Z® has not been evaluated for thetreatment of angle closure, inflammatory orneovascular glaucoma.

Information for PatientsPatients should be advised concerning all theinformation contained in the Warnings andPrecautions sections. Patients should also beinstructed to avoid allowing the tip of the dispensingcontainer to contact the eye or surrounding structuresbecause this could cause the tip to becomecontaminated by common bacteria known to causeocular infections. Serious damage to the eye andsubsequent loss of vision may result from usingcontaminated solutions.

Patients also should be advised that if they developan intercurrent ocular condition (e.g., trauma, orinfection) or have ocular surgery, they shouldimmediately seek their physician’s advice concerningthe continued use of the multi-dose container.

Patients should be advised that if they develop anyocular reactions, particularly conjunctivitis and lidreactions, they should immediately seek theirphysician’s advice.

If more than one topical ophthalmic drug is beingused, the drugs should be administered at least five(5) minutes apart.

Carcinogenesis, Mutagenesis, Impairment of FertilityTwo-year carcinogenicity studies in mice and rats atsubcutaneous doses of 10, 30, or 100 μg/kg/day didnot show any evidence of carcinogenic potential.However, at 100 μg/kg/day, male rats were onlytreated for 82 weeks, and the maximum tolerateddose (MTD) was not reached in the mouse study. Thehigh dose (100 μg/kg) corresponds to exposure levelsover 400 times the human exposure at the maximumrecommended human ocular dose (MRHOD) of 0.04μg/kg, based on plasma active drug levels.

Travoprost was not mutagenic in the Ames test,mouse micronucleus test and rat chromosomeaberration assay. A slight increase in the mutantfrequency was observed in one of two mouselymphoma assays in the presence of rat S-9activation enzymes.

Travoprost did not affect mating or fertility indices in

male or female rats at subcutaneous doses up to 10μg/kg/day [250 times the maximum recommendedhuman ocular dose of 0.04 μg/kg/day on a μg/kgbasis (MRHOD)]. At 10 μg/kg/day, the mean numberof corpora lutea was reduced, and the post-implantation losses were increased. These effects were notobserved at 3 μg/kg/day (75 times the MRHOD).

Pregnancy: Teratogenic EffectsPregnancy Category: C Travoprost was teratogenic in rats, at an intravenous(IV) dose up to 10 μg/kg/day (250 times the MRHOD),evidenced by an increase in the incidence of skeletalmalformations as well as external and visceralmalformations, such as fused sternebrae, domedhead and hydrocephaly.

Travoprost was not teratogenic in rats at IV doses upto 3 μg/kg/day (75 times the MRHOD), or in mice atsubcutaneous doses up to 1.0 μg/kg/day (25 timesthe MRHOD). Travoprost produced an increase inpost-implantation losses and a decrease in fetalviability in rats at IV doses > 3 μg/kg/day (75 times

the MRHOD) and in mice at subcutaneous doses > 0.3μg/kg/day (7.5 times the MRHOD). In the offspring offemale rats that received travoprost subcutaneouslyfrom Day 7 of pregnancy to lactation Day 21 at thedoses of ≥ 0.12 μg/kg/day (3 times the MRHOD), theincidence of postnatal mortality was increased, andneonatal body weight gain was decreased. Neonataldevelopment was also affected, evidenced by delayedeye opening, pinna detachment and preputialseparation, and by decreased motor activity.

There are no adequate and well-controlled studies inpregnant women. TRAVATAN Z® should be usedduring pregnancy only if the potential benefit justifiesthe potential risk to the fetus.

Nursing Mothers A study in lactating rats demonstrated thatradiolabeled travoprost and/or its metabolites wereexcreted in milk. It is not known whether this drug orits metabolites are excreted in human milk. Becausemany drugs are excreted in human milk, cautionshould be exercised when TRAVATAN Z® ophthalmicsolution is administered to a nursing woman.

Pediatric UseSafety and effectiveness in pediatric patients havenot been established.

Geriatric UseNo overall differences in safety or effectivenesshave been observed between elderly and otheradult patients.

ADVERSE REACTIONSThe most common adverse event observed incontrolled clinical studies with TRAVATAN®(travoprost ophthalmic solution) 0.004% andTRAVATAN Z® (travoprost ophthalmic solution)0.004% was ocular hyperemia which wasreported in 30 to 50% of patients. Up to 3%of patients discontinued therapy due tosubconjunctival hyperemia.

Ocular adverse events reported at an incidence of5 to 10% in these clinical studies included decreasedvisual acuity, eye discomfort, foreign body sensation,pain and pruritus.

Ocular adverse events reported at an incidence of1 to 4% in clinical studies with TRAVATAN® orTRAVATAN Z® included abnormal vision, blepharitis,blurred vision, cataract, cells, conjunctivitis, cornealstaining, dry eye, eye disorder, flare, iris discoloration,keratitis, lid margin crusting, photophobia,subconjunctival hemorrhage, and tearing.

Nonocular adverse events reported at an incidenceof 1 to 5% in these clinical studies were accidentalinjury, allergy, angina pectoris, anxiety, arthritis, backpain, bradycardia, bronchitis, chest pain, cold/flusyndrome, depression, dyspepsia, gastrointestinaldisorder, headache, hypercholesterolemia,hypertension, hypotension, infection, pain, prostatedisorder, sinusitis, urinary incontinence, and urinarytract infection.

DOSAGE AND ADMINISTRATIONThe recommended dosage is one drop in the affectedeye(s) once-daily in the evening. The dosage ofTRAVATAN Z® ophthalmic solution should not exceedonce-daily since it has been shown that morefrequent administration of travoprost may decreasethe intraocular pressure lowering effect.

Reduction of intraocular pressure starts approximately2 hours after administration of travoprost. The maximum effect is observed 12 hours after administration and ismaintained throughout the day.

TRAVATAN Z® may be used concomitantly with othertopical ophthalmic drug products to lower intraocularpressure. If more than one topical ophthalmic drug isbeing used, the drugs should be administered at leastfive (5) minutes apart.

HOW SUPPLIEDTRAVATAN Z® (travoprost ophthalmic solution)0.004% is a sterile, isotonic, buffered, preserved,aqueous solution of travoprost (0.04 mg/mL) suppliedin Alcon’s oval DROP-TAINER® package system.

TRAVATAN Z® is supplied as a 2.5 mL solutionin a 4 mL and a 5 mL solution in a 7.5 mL naturalpolypropylene dispenser bottle with a naturalpolypropylene dropper tip and a turquoisepolypropylene overcap. Tamper evidence is providedwith a shrink band around the closure and neck areaof the package.2.5 mL fill in 4 mL bottle NDC 0065-0260-255 mL fill in 7.5 mL bottle NDC 0065-0260-05

Storage: Store at 2º - 25ºC (36º - 77ºF).

Rx OnlyU.S. Patent Nos. 5,889,052 and 6,235,781

* TIMOPTIC is the registered trademark of Merck & Co., Inc.

A ALCON LABORATORIES, INC.Fort Worth, Texas 76134 USA 

© 2005-2007 Alcon, Inc.