Rocklatan alternatives: What can I take instead of Rocklatan?

Compare Rocklatan alternatives | Combigan | Rhopressa | Latanoprost | Cosopt | Simbrinza | Natural alternatives | How to switch meds

Rocklatan (netarsudil ophthalmic and latanoprost) is the brand name of an eye drop that contains two medications used to lower eye pressure in people with glaucoma or ocular hypertension. Approved by the Food and Drug Administration (FDA) in 2019, Rocklatan is a combination ophthalmic solution that contains a Rho kinase inhibitor (netarsudil 0.02%) and a prostaglandin analog (latanoprost 0.005%). Rocklatan works to reduce elevated intraocular pressure (IOP), which is the fluid pressure inside the eye. Increased fluid pressure in conditions like glaucoma and ocular hypertension can cause damage to the eye and lead to reduced vision. Rocklatan is used in each affected eye once daily. With two medications in one eye drop, Rocklatan is a more convenient eye drop option than using two individual eye drops. Rocklatan is the only combination eye drop that contains the first-in-class medication netarsudil.

While an effective treatment for some people, Rocklatan may not be the best and safest option for all people with either glaucoma or ocular hypertension. Not all people with elevated eye pressure will require two medications and may only require a single medication eye drop. The individual medications found in Rocklatan are available as separate eye drops called Rhopressa (netarsudil) solution and Xalatan or Xelpros (latanoprost) solution for people who may only need one medication to lower their eye pressure. Additionally, Rocklatan is currently only available as a brand name medication. One of the biggest advantages of some alternatives is that they are available as generic eye drops that can be more affordable for people. Furthermore, Rocklatan has some unique side effects that people may want to avoid including changes in eye color (pigmentation of the iris) and eyelash changes (increased length, thickness, pigmentation, the number of lashes and/or misdirected growth of eyelashes). Other adverse effects of Rocklatan include conjunctival hyperemia, instillation site pain/eye pain, corneal verticillata (deposits in cornea), and conjunctival hemorrhage (broken blood vessel in eye).

RELATED: What it’s like living with glaucoma

What can I take in place of Rocklatan?

There are several brand name fixed combination eye drops containing two prescription drugs aside from Rocklatan including Combigan, Cosopt, and Simbrinza. Currently, both Combigan and Cosopt are available as generic eye drops. There are a variety of single medication eye drops and oral medications available as alternatives. While many glaucoma medications have common side effects, some alternatives have distinct adverse effects that should be considered before switching from Rocklatan.

Other alternatives to Rocklatan

For people seeking other alternative eye pressure lowering eye drops, there are a variety of brand name eye drops, generic eye drops, and oral medications.

Ophthalmic Alpha Adrenergic Receptor Agonists

• Apraclonidine
• Iopidine (apraclonidine)

Ophthalmic Beta-blockers

• Betagan (levobunolol hydrochloride)
• Betaxolol hydrochloride
• Betimol (timolol)
• Betoptic (betaxolol hydrochloride)
• Carteolol hydrochloride
• Istalol (timolol maleate)
• Levobunolol hydrochloride

Ophthalmic Carbonic Anhydrase Inhibitors

• Azopt (brinzolamide)

Oral Carbonic Anhydrase Inhibitors

• Acetazolamide capsules/tablets
• Methazolamide tablets

Ophthalmic Prostaglandins

• Durysta (bimatoprost implant)
• Travatan Z (travoprost)
• Travoprost
• Vyzulta (latanoprostene bunod)
• Zioptan (tafluprost)

Ophthalmic Cholinergic Agonists/Miotic Agents

• Isopto carpine
• Miostat (carbachol)
• Phospholine iodide (echothiophate iodide)
• Vuity (pilocarpine hydrochloride)

Top 5 Rocklatan alternatives

1. Combigan and generic

Combigan is a combination eye drop that can be used to manage open-angle glaucoma and ocular hypertension. Unlike Rocklatan, Combigan has a generic option available called brimonidine tartrate and timolol maleate. The generic combination medication may be a less expensive option for people and using a SingleCare discount card can generate additional savings. Combigan contains an alpha-adrenergic receptor agonist (brimonidine) and a beta-adrenergic receptor inhibitor (timolol). Combigan is dosed twice daily into the affected eyes. Combigan should not be used in people who have asthma, chronic obstructive pulmonary disease (COPD), sinus bradycardia, second or third degree atrioventricular block, overt cardiac failure, or cardiogenic shock. Combigan may be best suited for individuals who require more than one medication to manage their intraocular pressure (IOP) and want the convenience of a combination eye drop.

2. Rhopressa

Rhopressa is a single medication eye drop that can be used to manage open-angle glaucoma and ocular hypertension. It is currently only available as a brand name eye drop and does not have a generic option. Rhopressa (netarsudil) is one of the two medications in Rocklatan. Rhopressa is a newer first-in-class medication called a Rho kinase inhibitor. Like Rocklatan, Rhopressa is dosed once daily in the evening. Switching to Rhopressa may be best suited for individuals who no longer require combination therapy with Rocklatan or are unable to tolerate latanoprost (the other medication in Rocklatan).

3. Latanoprost

Latanoprost is a generic, single medication eye drop that can be used to manage open-angle glaucoma and ocular hypertension. Brand name medications for latanoprost include Xalatan and Xelpros. Latanoprost is one of the two medications in Rocklatan. As a generic eye drop, latanoprost may be a less expensive option for people. Latanoprost is a prostaglandin analogue. Like Rocklatan, latanoprost is dosed once daily in the evening. Additionally, generic latanoprost is available in a preservative-free formulation (latanoprost PF) that can cause less inflammation of the eyes and be beneficial for those who experience dry eyes. Switching to latanoprost may be best suited for individuals who no longer require combination therapy with Rocklatan and have improved intraocular pressure (IOP).

4. Cosopt and generic

Cosopt is a combination eye drop that can be used to manage open-angle glaucoma and ocular hypertension. Unlike Rocklatan, Cosopt has a generic option available called dorzolamide hydrochloride and timolol maleate. The generic combination medication may be a less expensive option for people. Cosopt contains a carbonic anhydrase inhibitor (dorzolamide) and a beta-adrenergic receptor (timolol). Cosopt is dosed twice daily into the affected eyes. Additionally, Cosopt is available in a preservative-free formulation (Cosopt PF) that can cause less inflammation of the eyes and be beneficial for those who experience dry eyes. Cosopt should not be used in people who have asthma, chronic obstructive pulmonary disease (COPD), sinus bradycardia, second or third degree atrioventricular block, overt cardiac failure, or cardiogenic shock. Cosopt may be best suited for individuals who require more than one medication to manage their intraocular pressure (IOP) and want the convenience of a combination eye drop.

5. Simbrinza

Simbrinza is a combination eye drop that can be used to manage open-angle glaucoma and ocular hypertension. This is currently only available as a brand name eye drop and does not have a generic option. Simbrinza contains a carbonic anhydrase inhibitor (brinzolamide) and an alpha 2 adrenergic receptor agonist (brimonidine tartrate). Unlike Rocklatan, Simbrinza is dosed three times daily. Simbrinza has reports of side effects that Rocklatan does not have including a bad taste in the mouth and dry mouth. Simbrinza may be best suited for individuals who require more than one medication to manage their intraocular pressure (IOP) and want the convenience of a combination eye drop.

Natural alternatives to Rocklatan

Alternative remedies for Rocklatan include certain supplements, lifestyle changes, and diet modifications to keep the eyes healthy. According to the American Optometric Association, proper nutrition for eye health includes a diet that has zinc, copper, essential fatty acids, lutein, vitamin C, vitamin E, and vitamin A. The oral supplement, PreserVision, includes many of these nutrients and is available as an over-the-counter medication.

Additionally, omega-3 supplementation has shown evidence of lowering intraocular pressure (IOP). A 2018 study determined omega-3 supplementation for 3 months significantly reduced IOP in normotensive (normal pressure) adults with an average reduction of 8%. Omega-3 supplementation is available over-the-counter in a few formulations including capsules and softgels.

Lifestyle modifications include incorporating physical exercise into a routine that can have a positive impact on reducing some glaucoma risk factors such as high blood pressure and diabetes. Diet modifications include reducing caffeine intake as caffeine may have an impact on raising intraocular eye pressure.

RELATED: Eye health 101: How to protect vision and keep your eyes healthy

How to switch to a Rocklatan alternative

1. Discuss all health conditions with a healthcare provider

Before switching from Rocklatan to an alternative, it’s important the prescribing doctor has reviewed all health conditions. Some alternatives such as Combigan, Cosopt, Betagan (levobunolol), carteolol, and Betimol (timolol) must not be used in people who have asthma, chronic obstructive pulmonary disease (COPD), sinus bradycardia, second or third degree atrioventricular block, overt cardiac failure, and cardiogenic shock. It’s best to seek medical advice prior to changing medication therapy.

2. Do not suddenly stop taking Rocklatan

Before stopping Rocklatan, make an eye care plan with the prescribing doctor to make sure to avoid increases in intraocular pressure. Once a plan has been established, Rocklatan can be safely discontinued and replaced with the new glaucoma treatment.

3. Continue proper eye drop administration

Using eye drops correctly ensures proper drug administration and absorption into the eye. It’s important to make sure contact lenses are taken out of the eye prior to using eye drops, unless the eye doctor has instructed the patient to keep them in. Make sure hands are washed, tilt head backward while sitting, standing, or lying down, place the index finger below the lower lid to gently pull down and form a pocket, look up, and squeeze drop into the pocket. It’s important to keep the eye closed after the drop has been administered. Try to keep the eye closed for one to three minutes without blinking. If using more than one drop or more than one type of eye drop, wait five minutes before putting the next drop in. This will keep the first drop from being washed out by the second before it has had time to work.

4. Keep and maintain eye doctor appointments

People with glaucoma and ocular hypertension should be regularly checked by their eye doctor. At these appointments, the intraocular eye pressure (IOP) can be measured to determine the effectiveness of the medication regimen. It’s important for people managing their IOP to be aware of the normal eye pressure range (12-22 mm Hg) and the high pressure range (greater than 22 mm Hg). Vision tests may also be performed for glaucoma patients to check for any loss of sight or optic nerve damage.