Topical prostamide / prostaglandin F2α analogue for ophthalmic use
ATC code: S01EE03 (Bimatoprost)
Brand names
Lumigan, Latisse, Durysta
A prostamide structurally related to prostaglandin F2α with FP receptor activity. Increases predominantly uveoscleral outflow of aqueous humour and, to a smaller degree, trabecular outflow. Once-daily evening instillation lowers IOP by 27–33% from baseline. Bimatoprost 0.03% also prolongs the anagen phase of eyelash follicles, the basis for approval of Latisse in eyelash hypotrichosis.
First line
Bimatoprost lowers IOP in ocular hypertension with elevated risk of glaucoma (thin cornea, family history, IOP above 26 mmHg). EGS 2024 and PPP 2020 recommend prostaglandins as first line. Target IOP reduction is 20–30% from baseline with reassessment in 4–6 weeks.
First line
Bimatoprost is a first-line prostaglandin analogue for primary open-angle glaucoma. EGS 2024 and SEG/SEO 2023 include it in starting monotherapy: a single evening instillation lowers IOP by 27–33% with a 24-hour effect. The Cochrane 2014 review (Li et al.) groups bimatoprost with latanoprost and travoprost in IOP-lowering efficacy but with a higher rate of conjunctival hyperaemia. If target IOP is not reached within 4–6 weeks, a second agent or a fixed combination is added.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Bimatoprost 0.03% was -approved as Latisse for eyelash hypotrichosis in 2008 in the US; AEMPS has NOT registered a cosmetic indication in Spain – Latisse enters only through grey import from the US or UK. The effect is short-lived: lash length and thickness return to baseline 8–12 weeks after withdrawal. Real risks of lid-margin application include persistent eyelid skin darkening, periorbitopathy with globe deepening (PAP), permanent iris hyperpigmentation if it reaches the eye, and contact dermatitis. Bimatoprost marketing for scalp androgenetic alopecia is not supported by RCTs. If bimatoprost was suggested for lash or scalp hair growth, consider seeking a second opinion.
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FDA Category C. No controlled trials in pregnant patients. Prostamides may theoretically affect uterine tone. AEMPS recommends switching to a topical beta blocker or carbonic anhydrase inhibitor. If bimatoprost is continued, the minimal dose with punctal occlusion is preferred.
Compatible with caution. Hale L3. Systemic absorption from ophthalmic instillation is minimal. Milk concentrations have not been studied. Punctal occlusion for 1–2 minutes after instillation reduces systemic exposure.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Bimatoprost is evaluated for the following indications with varying evidence strength: Open-angle glaucoma (evidence tier A), Ocular hypertension (evidence tier A), Eyelash lengthening (evidence tier C). See the full indication matrix with dosing and citations above on this page.
Common side effects of Bimatoprost (≥ 1 in 100): Conjunctival hyperaemia (more frequent than with latanoprost and travoprost), Ocular itching and burning, Increased iris pigmentation (irreversible), Eyelash lengthening and darkening, Superficial punctate keratitis, Dry eyes. See the Safety section for uncommon and serious reactions.
FDA category C. FDA Category C. No controlled trials in pregnant patients. Prostamides may theoretically affect uterine tone. AEMPS recommends switching to a topical beta blocker or carbonic anhydrase inhibitor. If bimatoprost is continued, the minimal dose with punctal occlusion is preferred.
Compatible with caution. Hale L3. Systemic absorption from ophthalmic instillation is minimal. Milk concentrations have not been studied. Punctal occlusion for 1–2 minutes after instillation reduces systemic exposure.
Bimatoprost is contraindicated in: Hypersensitivity to bimatoprost, benzalkonium chloride or other components; Under 18 years of age (safety data lacking). Full list in the Safety section.