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Generic vs brand name glaucoma drops

Hello Dr Hagen
Is there any difference between generic latanoprost and Xalatan? Are the inactive ingredients the same? Are there any differences in quality or effectiveness? I've read of people reacting to the generic (red, stinging eyes, darkening around the eyes), but being fine with the brand name. Also, is it worth requesting the preservative-free version, Zioptan? I want to minimise side effects. Thanks :)
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233488 tn?1310693103
MEDICAL PROFESSIONAL
No difference. Ingredients the same. Generic much less expensive.  If you tolerate generic use it as it will save a lot of time/money.  Latonprost is generally very well tolerated. That cannot be said of "Lumigan" a brand name prescription drop in the same family.  Zioptan will be ultra expensive.
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Thank you, Doctor! I have a feeling there's a bit of cognitive bias going on re generics and side effects
Many generics are not nearly as good as the brand names. For instance  brominidine is not nearly as good as the glaucoma drop Alphagan-P but there are many that work as good as brand names. latanoprost is one of them. There are over 20 companies that make latanoprost. Studys have shown that some are underfilled and some produce drops that are so large that the bottle will not last the expected 6 weeks.
Thank you for your perspective. It's very helpful. I have deferred beginning the drops until my follow-up appointment in 10 days (three weeks in total fro my first consult with the GS), as I want to get my IOP tested again after having increased my cardio exercise and made some dietary changes (more leafy greens, berries, oily fish etc), as well as seeing a PCP to control my low BP. If nothing has changed or it has worsened, then I will fully commit to the drops
Remember that the IOP in the eye changes from hour to hour, like your blood pressure or your blood sugar.  The daily variation is called the "diurnal curve"  so if your IOP was 22 last time and next time it's 18 it doesn't mean its getting better or that better diet/exercise has helped. Conversely if its 24 it doesn't mean getting worse.  So need to treat with drops is made on basis of not only IOP over many visits but Visual Fields, cornea thickness, OCT of nerve fiber layer,  Optic nerve cup/disk ratio, family history and risk factors including age and reliability.
Yes, I realise this. I'm not sure why I'm so resistant. The GS said it was up to me whether to start or not. OCT and visual fields were OK. Nerves were suspicious, so she will watch over time. She said my IOP was not that high, but it was the fact it was in concert with very low BP that was concerning. I will start drops next visit, after I discuss things further with her after she dilates my eyes :) Thanks again
She said my C/D was .2 and .4, though in the past I was told it was .4 and .45, and the OCT machine said .7 (she said she disregards that). Most perplexing
Dr. Hagan, your comment on how much IOP can change day to day and inter-day is very interesting.  
I remember I was first put on Travantan Z when my right eye was first diagnosed with glaucoma, and that kept my IOP down around 18.  6 months later I went to a glaucoma specialist and she switched me to Lumigan and the measured IOP after a month was only one point lower than the month previously.  She indicated that was evidence Lumigan was better.  I doubted that since I figured the IOP could probably vary more than 1 point day to day.

The new comprehensive ophthalmologist I have switched to since the beginning of the year believes the  generic latanoprost is fine, so I hope to be able to try switching to that instead of Lumigan in a few months.
More Important that minor IOP changes are changes in fields, OCT and optic nerve C/D ration
I had my latest routine eye checkup (mostly for IOP checks) yesterday with the new comprehensive ophthalmologist I switched to at the start of this year.  I needed an updated Rx for my glaucoma eyedrops and he switched me from the brand name Lumigan to the generic latanoprost as I had hoped! He mentioned it might help reduce the eye redness that Lumigan can cause.  Hopefully it will maintain a similar IOP in my right eye - it was measured as 16 yesterday.
You will save some money but have to get used to the much smaller bottle.
Happy new year!

Had my routine eye checkup at my comprehensive ophthalmologist a couple weeks ago. Now over a year since right eye cataract surgery with Tecnis toric monofocal IOL and several months on latanoprost, my IOP in both eyes was down to 14 and accuity was 20/15 for each eye with glasses!
Hi Night Hawk Guy,   I just read your post.  That is certainly great news.  Congratulations!!
=
Great news all around @NightHawkGuy
Great way to start (and end) 2019
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