Fixed combination netarsudil-latanoprost for the treatment of glaucoma and ocular hypertension

Introduction: Reduction of intraocular pressure (IOP) is the only known modifiable risk factor for prevention and treatment of glaucoma. Rho-kinase (ROCK) inhibitors are a new class of glaucoma medications introduced recently with novel mechanisms of action and favorable safety profiles. Latanoprost, a common first line drug used for treatment of glaucoma, does not adequately control pressures in all cases. Addition of more than one anti-glaucoma medication affects patient compliance and adherence. Fixed-combination eye drops are combinations of two or more active drugs in a single dosage form, thus simplify dosing. New to this group is the fixed combination netarsudil- latanoprost (FCNL).Area covered: This review focuses on FCNL, its pharmacodynamics and pharmacokinetics. It also details the efficacy and safety of individual drugs compared to FCNL.Expert opinion: The combination of latanoprost and netarsudil is a potent medication and modulates all known targets for IOP reduction in a single drop and has been shown to be more effective than either drug alone. FCNL is an alternative for those with inadequately controlled IOP on a prostaglandin analog alone, as well as those for whom a simplified regimen is desirable, or those who are not good candidates for other classes of glaucoma medications.