What is a good substitute for latanoprost? A guide to alternatives

October 9, 2025 •

4 min read

Globally, glaucoma is a leading cause of irreversible blindness, with medication like latanoprost being a common treatment. For those seeking effective alternative therapies, understanding what is a good substitute for latanoprost is crucial for managing intraocular pressure and protecting vision.

Quick Summary

This guide explores alternative treatments for glaucoma and ocular hypertension when latanoprost is unsuitable. It covers other prostaglandin analogues, beta-blockers, and more to lower eye pressure effectively.

Key Points

Alternative Prostaglandin Analogues: Other PGAs like bimatoprost, travoprost, and tafluprost are available, offering similar or sometimes greater IOP-lowering efficacy compared to latanoprost.
Other Drug Classes: Alternatives outside the PGA class include beta-blockers (e.g., timolol), alpha-adrenergic agonists (e.g., brimonidine), and carbonic anhydrase inhibitors (e.g., dorzolamide).
Novel Medications: Newer options such as the rho kinase inhibitor netarsudil and the dual-action prostaglandin latanoprostene bunod provide alternative mechanisms for lowering intraocular pressure.
Combination Drops: Fixed combination products, which combine two different medications in one bottle, can offer enhanced IOP reduction for those needing more control.
Preservative-Free Options: For patients with sensitivities or ocular surface disease, preservative-free formulations like Zioptan and Iyuzeh (preservative-free latanoprost) are excellent alternatives.
Consult a Professional: Selecting the right substitute requires an ophthalmologist's guidance to weigh factors like efficacy, side effects, and patient health history.

Latanoprost, available under the brand name Xalatan and as a generic, is a first-line therapy for treating elevated intraocular pressure (IOP) associated with open-angle glaucoma and ocular hypertension. As a prostaglandin analogue, it works by increasing the outflow of aqueous humor, the fluid inside the eye, which lowers IOP. However, latanoprost is not suitable for everyone. Reasons for seeking an alternative can include insufficient IOP reduction, problematic side effects like iris discoloration or eyelid changes, or sensitivity to preservatives found in the standard formulation. Fortunately, several other pharmacological options exist, both within the same class and in different drug classes, to help manage eye pressure effectively.

Alternative Prostaglandin Analogues (PGAs)

PGAs are typically considered the most effective drug class for lowering IOP, and if one PGA proves ineffective or poorly tolerated, another from the same class may be a suitable replacement.

Bimatoprost (Lumigan): Studies suggest bimatoprost may provide a slightly greater IOP reduction than latanoprost. It operates by increasing fluid drainage through multiple pathways. A notable side effect is a higher incidence of conjunctival hyperemia (eye redness).
Travoprost (Travatan Z): Travoprost has shown similar IOP-reducing efficacy to latanoprost but is often preserved with SofZia, a less toxic preservative than the benzalkonium chloride (BAK) found in many standard formulations, making it a good choice for sensitive eyes.
Tafluprost (Zioptan): This is a prostaglandin analogue available as a preservative-free formulation in single-use vials, making it an excellent option for patients with ocular surface disease or allergies to preservatives. Its efficacy is comparable to latanoprost and travoprost.
Latanoprostene Bunod (Vyzulta): A newer PGA, Vyzulta releases nitric oxide to improve outflow through the trabecular meshwork, in addition to the uveoscleral outflow, providing a dual mechanism of action. It has demonstrated greater IOP-lowering efficacy than latanoprost in some trials.

Alternative Classes of Eye Drops

When a PGA is not the right fit, different drug classes offer alternative mechanisms for lowering IOP.

Beta-Blockers: Medications like timolol (Timoptic) work by reducing the production of aqueous humor. They are dosed once or twice daily. Key differences from PGAs include the absence of iris or lash changes, but potential systemic side effects like slowed heart rate or lower blood pressure should be considered.
Alpha-Adrenergic Agonists: Brimonidine (Alphagan-P) and apraclonidine (Iopidine) are examples that both reduce aqueous humor production and increase its outflow. They are typically used multiple times per day and can cause side effects such as fatigue, dry mouth, or eye irritation.
Carbonic Anhydrase Inhibitors (CAIs): Dorzolamide (Trusopt) and brinzolamide (Azopt) are topical CAIs that decrease fluid production. They can cause local side effects like stinging, burning, and a bitter taste. Oral CAIs, like acetazolamide, are also an option for more severe cases.
Rho Kinase (ROCK) Inhibitors: Netarsudil (Rhopressa) is a novel drug class that increases outflow through the trabecular meshwork. It is often prescribed once daily and can cause side effects like conjunctival hyperemia and subconjunctival hemorrhages.

Fixed Combination Eye Drops

For patients needing more significant IOP reduction or who prefer a simpler regimen, fixed combination drops combine two different drug classes into a single bottle.

Dorzolamide/timolol (Cosopt): Combines a CAI and a beta-blocker. Available in a preservative-free version (Cosopt PF).
Brimonidine/timolol (Combigan): Combines an alpha-agonist and a beta-blocker.
Latanoprost/netarsudil (Rocklatan): Combines a PGA and a ROCK inhibitor, offering a powerful IOP-lowering effect through two different mechanisms.

Comparative Overview of Latanoprost Alternatives

This table provides a quick overview of key alternatives to latanoprost based on their mechanism and general characteristics.


Feature	Prostaglandin Analogues	Beta-Blockers	Alpha-Adrenergic Agonists	CAIs
Mechanism	Increase aqueous humor outflow	Decrease aqueous humor production	Decrease production; Increase outflow	Decrease aqueous humor production
Examples	Bimatoprost, Travoprost, Tafluprost	Timolol, Betaxolol	Brimonidine	Dorzolamide, Brinzolamide
Dosing	Once daily (usually evening)	Once or twice daily	Twice or three times daily	Two or three times daily
Key Side Effects	Iris/lash changes, hyperemia	Slowed heart rate, low blood pressure, fatigue	Dry mouth, fatigue, red eyes, ocular allergies	Stinging, burning, bitter taste
Preservative-Free Options	Yes (e.g., Zioptan, Iyuzeh)	Yes (e.g., Timoptic Ocudose, Cosopt PF)	No	Yes (e.g., Cosopt PF)

How to Choose the Right Substitute

Choosing the best substitute is a collaborative process between a patient and their ophthalmologist. The decision depends on several factors, including the required level of IOP reduction, the patient's sensitivity to preservatives, any underlying systemic health conditions (especially with beta-blockers), and previous response to medications. For instance, a patient with a history of asthma or heart problems would likely avoid beta-blockers, while someone experiencing significant ocular surface irritation from preserved latanoprost might benefit from a preservative-free alternative.

Regular follow-up appointments with an eye care professional are essential to monitor IOP and assess the effectiveness and tolerance of any new medication. Never discontinue or switch glaucoma medication without medical guidance, as this can lead to vision loss.

Conclusion

While latanoprost is a cornerstone of glaucoma treatment, a wide array of effective alternatives exists for patients who require a change in therapy. From other PGAs like bimatoprost or the preservative-free Zioptan to different classes like beta-blockers, alpha-agonists, CAIs, or ROCK inhibitors, a tailored approach can ensure optimal IOP control. Fixed combination drops also provide a powerful option for enhanced efficacy. Ultimately, the decision on what is a good substitute for latanoprost should be made in consultation with an ophthalmologist, who can guide the selection based on individual needs and health considerations. For further information and resources on glaucoma treatment, consider consulting reliable sources like the Glaucoma Research Foundation.

Frequently Asked Questions

The primary difference lies in the mechanism of action, dosing schedule, and side effect profile. While latanoprost increases fluid outflow, alternatives like beta-blockers reduce fluid production. Other PGAs have similar mechanisms but may differ slightly in potency and side effects like hyperemia.

No, you should never switch or stop using glaucoma medication without consulting your eye care professional. Changing medication without supervision can result in uncontrolled eye pressure, potentially leading to irreversible vision damage.

Compared to PGAs, beta-blockers generally don't cause eye color or eyelash changes. However, they can have systemic side effects such as a slowed heart rate, lower blood pressure, fatigue, and breathing difficulties, and should be avoided by patients with certain heart or lung conditions.

Yes. If irritation from preservatives is a concern, preservative-free alternatives include tafluprost (Zioptan), the preservative-free latanoprost formulation Iyuzeh, and dorzolamide/timolol preservative-free (Cosopt PF).

Not necessarily. While all PGAs share some similar side effects, the severity and tolerance can vary between individuals and specific formulations. For example, some studies indicate bimatoprost may cause more hyperemia, while latanoprost may be better tolerated in that respect.

Fixed combination eye drops combine two medications into one bottle. This simplifies the treatment regimen for patients who require more than one medication, potentially improving adherence and providing a more powerful IOP-lowering effect.

While lifestyle changes alone are not a substitute for prescribed medication, they can support overall eye health. Regular moderate exercise, a healthy diet including omega-3 fatty acids, and managing stress can contribute to better eye health.