Vyzulta (Latanoprostene Bunod)

Vyzulta (latanoprostene bunod ophthalmic solution) is a prescription eye drop for lowering intraocular pressure (IOP) in patients with glaucoma or ocular hypertension. It's unique because it works through two pathways—prostaglandin and nitric oxide—providing enhanced pressure-lowering effect.

How It Works

Vyzulta provides dual-action pressure lowering:

Prostaglandin pathway (latanoprost acid):

• Increases fluid drainage through the uveoscleral pathway
• Same mechanism as latanoprost

Nitric oxide pathway (butanediol mononitrate):

• Relaxes trabecular meshwork
• Increases fluid drainage through conventional outflow
• Adds to prostaglandin effect

This dual mechanism may provide better pressure control than prostaglandins alone.

Common Uses

• Open-angle glaucoma
• Ocular hypertension
• When maximum IOP lowering is needed
• Alternative to standard prostaglandins

How to Use

• Dosing: One drop in affected eye(s) once daily in the evening
• Timing: Evening dosing is important
• Contact lenses: Remove before use; wait 15 minutes before reinserting
• Technique: Standard drop instillation
• Multiple drops: Wait at least 5 minutes between different medications
• Storage: Refrigerate before opening; room temperature once opened

What to Expect

Pressure Reduction

• Typically lowers IOP by 7-9 mmHg
• May provide 1-2 mmHg additional lowering vs. latanoprost alone
• Effect maintained with continued use

Side Effects

Similar to other prostaglandin drops—see below

Side Effects

Common

• Eye redness (conjunctival hyperemia)
• Eye irritation
• Eye pain
• Increased eyelash growth
• Darkening of eyelashes
• Iris color change (permanent)
• Eyelid skin darkening

Less Common

• Blurred vision
• Dry eye
• Itching
• Foreign body sensation

Long-Term Changes

From the prostaglandin component:

• Iris may darken (especially in mixed-color eyes)
• Eyelashes become longer, thicker, darker
• Eyelid skin may darken
• Changes may be permanent

Precautions

• Eye inflammation: Use with caution in active intraocular inflammation
• Macular edema risk: Use with caution in aphakia, pseudophakia with torn posterior lens capsule
• Contact lenses: Remove before use
• Pregnancy: Discuss with doctor
• Storage: Refrigerate unopened; room temperature after opening (use within 8 weeks)

Cost and Insurance

• Brand-name medication
• May require prior authorization
• Check manufacturer savings programs
• Generic latanoprost is much less expensive if adequate

Vyzulta vs. Other Prostaglandins

Medication	Mechanism	Typical IOP Reduction
Vyzulta	Prostaglandin + Nitric oxide	~7-9 mmHg
Latanoprost	Prostaglandin	~6-8 mmHg
Travoprost	Prostaglandin	~6-8 mmHg
Bimatoprost	Prostaglandin	~6-8 mmHg

Frequently Asked Questions

Is Vyzulta better than regular latanoprost?

Vyzulta may provide 1-2 mmHg additional IOP lowering compared to latanoprost. Whether this matters depends on your target pressure and how well you respond to standard prostaglandins. Your doctor can help determine if Vyzulta is appropriate for you.

Why is evening dosing recommended?

Prostaglandin-type medications work best when used in the evening. Studies show this timing provides optimal 24-hour pressure control.

Will Vyzulta change my eye color?

Like other prostaglandins, Vyzulta can cause iris darkening, especially in eyes with mixed colors (hazel, green-brown). This change is gradual and usually permanent.

Can I switch from latanoprost to Vyzulta?

Yes, your doctor may switch you if additional pressure lowering is needed. The transition is typically straightforward.

What if I was on refrigerated Vyzulta and it got warm?

Once opened, Vyzulta can be stored at room temperature for up to 8 weeks. If unopened product was unrefrigerated briefly, it's likely fine, but check with your pharmacist if concerned.

Is generic Vyzulta available?

No generic is currently available. If cost is a concern and adequate control isn't achieved with generic latanoprost, discuss options with your doctor.