Consumer medicine information

Xalacom

Latanoprost + Timolol

BRAND INFORMATION

Brand name

Xalacom

Active ingredient

Latanoprost + Timolol

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using Xalacom.

What is in this leaflet

This leaflet answers some common questions about Xalacom. It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of you using Xalacom against the benefits it is expected to have for you.

If you have any concerns about using this medicine, ask your doctor or pharmacist.

Keep this leaflet with the medicine. You may need to read it again.

What Xalacom is used for

Xalacom is used to lower raised pressure in the eye and to treat glaucoma. Glaucoma is a condition in which the pressure of fluid in the eye may be high. However, some people with glaucoma may have normal eye pressure.

Glaucoma is usually caused by a build up of the fluid which flows through the eye. This build up occurs because the fluid drains out of your eye more slowly than it is being pumped in. Since new fluid continues to enter the eye, joining the fluid already there, the pressure continues to rise. This raised pressure may damage the back of the eye resulting in gradual loss of sight. Damage can progress so slowly that the person is not aware of this gradual loss of sight. Sometimes even normal eye pressure is associated with damage to the back of the eye.

There are usually no symptoms of glaucoma. If glaucoma is not treated it can lead to serious problems, including total blindness. In fact, untreated glaucoma is one of the most common causes of blindness.

Xalacom is made up of 2 active ingredients, latanoprost and timolol maleate. Latanoprost works by allowing more fluid to flow out from within your eye(s). Timolol maleate lowers the pressure in the eye by reducing the production of fluid.

Latanoprost belongs to a family of medicines called prostaglandin agonists. Timolol maleate belongs to a family of medicines called beta-blockers.

Although Xalacom helps control your glaucoma it does not cure it. So you must keep using it until your doctor tells you to stop.

Ask your doctor if you have any questions about why Xalacom has been prescribed for you. Your doctor may have prescribed it for another reason.

Xalacom is not recommended for use in children. The safety and effectiveness of Xalacom in children have not been established.

Before you use Xalacom

When you must not use it

Do not use Xalacom if:

  • you have an allergy to Xalacom or any of the ingredients listed at the end of this leaflet
    Symptoms of an allergic reaction may include:
    - asthma, wheezing or shortness of breath
    - swelling of the face, lips or tongue which may cause difficulty in swallowing or breathing
    - hives, itching or skin rash
    - fainting.
  • you have asthma, or a history of asthma, chronic obstructive lung disease (emphysema) or other breathing problems
  • you have certain heart conditions, such as a very slow heart rate, an irregular heartbeat, or heart failure
  • the bottle/packaging shows signs of tampering
  • the expiry date on the pack has passed.
    If you use this medicine after the expiry date has passed, it may not work.

If you are not sure whether you should start using Xalacom, talk to your doctor.

Before you start to use it

Tell your doctor if:

  1. you have had an allergy to any other medicines or any other substances, such as foods, preservatives or dyes
  2. you are pregnant or intend to become pregnant
There is no adequate experience with Xalacom in pregnant women, therefore, it should not be used during pregnancy.
  1. you are breast-feeding or intend to breast-feed
One of the active ingredients in Xalacom has been detected in breast milk. Because of the potential harm to the infant, nursing women should either stop using Xalacom or stop breast-feeding while using it.
  1. you have or have had any medical conditions, especially the following:
  • heart disease
  • lung disease
  • circulation problems
  • any other types of glaucoma or eye conditions
  • diabetes
  • myasthenia gravis
  • hyperthyroidism.

Tell your doctor if you plan to have surgery.

If you have not told your doctor about any of the above, tell him or her before you use Xalacom.

Taking other medicines

Tell your doctor or pharmacist if you are taking any other medicines, including any that you buy without a prescription from your pharmacy, supermarket or health food shop.

Some medicines and Xalacom may interfere with each other. These include:

  • certain medicines used to treat high blood pressure or heart conditions such as beta-blockers, calcium channel blockers or digoxin
  • certain medicines used to treat irregular heartbeats such as amiodarone and quinidine
  • some medicines used to treat depression, such as phenelzine, fluoxetine or paroxetine
  • some medicines used to treat Parkinson's disease, such as selegiline
  • adrenaline, a hormone used in the treatment of asthma, slow or irregular heartbeat, acute allergic disorders and glaucoma
  • some medicines that may have been prescribed to help you pass urine or restore normal bowel movements
  • narcotics such as morphine used to treat moderate to severe pain
  • eye drops which contain an ingredient called thiomersal. If using such eye drops as well as Xalacom, you should wait at least 5 minutes between using these eye drops and Xalacom
  • medicines used to treat diabetes or high blood sugar
  • some other eye drops that contain a beta-blocker or a prostaglandin. The use of two or more beta-blocker eye drops and/or two or more prostaglandin eye drops at the same time is not recommended.

Your doctor or pharmacist has more information on medicines to be careful with or avoid while using Xalacom.

How to use Xalacom

Use Xalacom only when prescribed by your doctor.

Follow all directions given to you by your doctor carefully. They may differ from the information contained in this leaflet.

If you are being changed from one eye drop to another, follow your doctor's instructions carefully as to when to stop the old drops and when to start the new drops.

How much to use

The usual dose of Xalacom is one drop into the affected eye, or eyes, once daily.

Use Xalacom every day, at about the same time each day, unless your doctor tells you otherwise. Using your eye drops at the same time each day will have the best effect on your eye pressure. It will also help you remember when to use the eye drops.

How to use it

If you are wearing soft contact lenses, remove them before putting the drops in your eye. The preservative in Xalacom (benzalkonium chloride) may be deposited in soft contact lenses. You can put your soft contact lenses back into your eyes 15 minutes after you have used Xalacom.

If using other eye drops in addition to Xalacom, wait at least 5 minutes before putting any other drops in your eye(s).

Be careful not to touch the dropper tip against your eye, eyelid or anything else. Touching the dropper tip against something may contaminate the eye drops and give you an eye infection.

You may find it easier to put drops in your eye while you are sitting or lying down.

  1. Wash your hands well with soap and water.
  2. Twist off the protective overcap from the bottle.
  3. Unscrew the inner cap.
  4. Use your finger to gently pull down the lower eyelid of your affected eye.
  5. Tilt your head back and look up.
  6. Place the tip of the bottle close to but not touching your eye. Squeeze the bottle gently so that only one drop goes into your eye, then release the lower eyelid. Close your eye. Do not blink or rub your eye.
  7. While your eye is closed, place your index finger against the inside corner of your eye and press against your nose for about two minutes. This will help to stop the medicine from draining through the tear duct to the nose and throat, from where it can be absorbed into other parts of your body. Ask your doctor for more specific instructions on this technique.
  8. Screw the inner cap back on the bottle.
  9. Wash your hands again with soap and water to remove any residue.

You may feel a slight burning sensation in the eye shortly after using the eye drops.

If this persists, or is very uncomfortable, contact your doctor or pharmacist.

How long to use it

Continue using Xalacom every day for as long as your doctor prescribes. Xalacom helps control your condition but does not cure it.

If you forget to use it

If you miss a dose, skip the dose you missed and use your next dose when you are meant to. If you are not sure whether to skip the dose, talk to your doctor or pharmacist.

Do not use double the amount to make up for the dose that you missed.

If you use too much (overdose)

If you accidentally put several drops in your eye(s), immediately rinse your eye(s) with warm water.

If you think that you or anyone else may have swallowed Xalacom, immediately telephone your doctor or the Australian Poisons Information Centre (telephone 131 126) for advice, or go to Accident and Emergency at your nearest hospital. Do this even if there are no signs of discomfort or poisoning.

If Xalacom is accidentally swallowed, or if you use too many drops, you may feel light-headed or dizzy, you may faint, have a very slow pulse rate, or have wheezing or difficulty breathing. Other effects include headache, nausea, abdominal pain, fatigue, hot flushes and sweating.

While you are using Xalacom

Things you must do

To make sure Xalacom is working properly, have your eye pressure checked regularly. Have your eyes checked regularly for any other changes, including a change in eye colour. A slow change in eye colour, which may be permanent, has been reported to occur in some patients who use Xalacom. Your doctor will decide whether you should continue using Xalacom.

If you develop an eye infection, receive an eye injury, or have eye surgery tell your doctor. Your doctor may tell you to use a new container of Xalacom because of possible contamination of the old one, or may advise you to stop your treatment with Xalacom.

If you become pregnant while using Xalacom tell your doctor immediately.

If you are about to be started on any new medicine tell your doctor and pharmacist that you are using Xalacom.

Tell all doctors and pharmacists who are treating you that you are using Xalacom.

Things you must not do

Do not give Xalacom to anyone else, even if they have the same condition as you.

Do not use this medicine to treat any other complaints unless your doctor tells you to.

Do not stop using Xalacom without first talking to your doctor. If you stop using your eye drops, your eye pressures may rise again and damage to your eye may occur.

Things to be careful of

Be careful driving or operating machinery until you know how Xalacom affects you. Xalacom generally does not cause any problems with your ability to drive a car or operate machinery. However, it may cause blurred vision in some people. Make sure you know how you react to Xalacom or that your vision is clear before driving a car or operating machinery.

Side effects

Check with your doctor as soon as possible if you have any problems while using Xalacom, even if you do not think the problems are connected with the medicine or are not listed in this leaflet. Like other medicines, Xalacom can cause some side effects. If they occur, most are likely to be minor and temporary. However, some may be serious and need medical attention.

Ask your doctor or pharmacist to answer any questions you may have.

Tell your doctor if you notice any of the following and they worry you:

  • a slow change in eye colour over a period of time. The iris may become browner in colour and appear darker. This change may be permanent and more noticeable if you are only being treated in one eye
  • blurred vision, double vision or other visual problems
  • allergic reactions including redness, swelling and/or itching of the eye
  • burning, grittiness or stinging of the eyes
  • eye pain
  • redness or watering of the eye/s
  • irritation or feeling of having something in the eye, dry eyes
  • discharge, itching of the eye/s, crusty eyelashes
  • drooping of eyelid/s
  • darkening, thickening, lengthening or an increase in the number of eye lashes and fine hair on the eyelids
  • misdirected eye lashes sometimes causing eye irritation
  • darkening of the skin of the eyelids
  • crusting, redness, thickening, itching or burning of the eyelids
  • sensitivity to light
  • headache
  • tiredness, weakness
  • sleepiness
  • ringing or buzzing in the ears
  • difficulty sleeping, nightmares
  • change in mood such as depression, anxiety or nervousness
  • confusion, disorientation or memory loss
  • hallucinations
  • feeling sick (nausea) or vomiting, upset or painful stomach
  • diarrhoea
  • anorexia
  • dry mouth
  • change to your sense of taste
  • cold hands or feet
  • numbness, tingling and colour change (white, blue then red) in fingers when exposed to the cold (Raynaud's Phenomenon)
  • numbness or tingling in the fingers or toes
  • cough
  • nasal congestion
  • hair loss or thinning
  • less desire for sex
  • impotence or sexual dysfunction
  • muscle/joint pain
  • skin rash.

Tell your doctor immediately if you notice any of the following:

  • fast or irregular heartbeat, also called palpitations
  • dizziness and light-headedness, which may be due to low blood pressure
  • skin rash, itching
  • swelling of hands, feet, ankles or legs.

These may be serious side effects. You may need urgent medical attention. Serious side effects are rare.

If any of the following happen, stop using Xalacom and tell your doctor immediately or go to Accident and Emergency at your nearest hospital:

  • wheezing, difficulty in breathing (asthma or worsening of asthma)
  • shortness of breath
  • very slow pulse, chest pain
  • fainting
  • swelling of the face, lips, mouth, tongue or throat which may cause difficulty in swallowing or breathing
  • severe and sudden onset of pinkish, itchy swellings on the skin, also called hives or nettle rash
  • white deposits or plaque in the cornea causing the transparent front part of your eye to look white or cloudy.

These are very serious side effects. You may need urgent medical attention. These side effects are rare.

Tell your doctor if you notice any other effects. Other side effects not listed above may also occur in some patients.

Do not be alarmed by this list of possible side effects. You may not experience any of them.

After using Xalacom

Storage

Keep your eye drops in a safe place away from the sight and reach of children. A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

Before opening Xalacom, keep the bottle in its box in a refrigerator (2°C - 8°C) protected from light.

After opening Xalacom, keep the bottle in its box in a cool place where the temperature stays below 25°C. You do not need to keep it refrigerated. Keep the box properly closed and protected from light.

Do not store Xalacom or any other medicine in the bathroom or near a sink. Do not leave it in the car or on window sills. Do not carry the eye drops in pockets of your clothes. Heat and dampness can destroy some medicines.

Put the top back on the bottle right away after use to avoid contaminating the eye drops.

Disposal

Write the date on the bottle when you open the eye drops and throw out any remaining solution after four weeks.

Open a new bottle every 4 weeks. Eye drops contain a preservative which helps prevent germs growing in the solution for the first four weeks after opening the bottle. After this time there is a greater risk that the drops may become contaminated and cause an eye infection.

If your doctor tells you to stop using the eye drops or they have passed their expiry date, ask your pharmacist what to do with any remaining solution.

Product description

What it looks like

Xalacom eye drops come in a plastic bottle with a dropper and screw cap inside a protective overcap. Remove this overcap before use.

When you first receive your Xalacom bottle, it will appear half full. This corresponds to 2.5 mL of eye drop solution, giving a minimum of 80 drops. This volume is enough to last 4 weeks if used in both eyes.

Ingredients

The active ingredients in Xalacom eye drops are latanoprost and timolol maleate. Each 1 mL of Xalacom contains 50 micrograms of latanoprost and 5 mg of timolol (equivalent to 6.83 mg timolol maleate). Each drop contains about 1.5 micrograms of latanoprost and 150 micrograms of timolol.

Xalacom eye drops also contain:

  • sodium chloride
  • monobasic sodium phosphate monohydrate
  • dibasic sodium phosphate
  • water for injections
  • hydrochloric acid
  • sodium hydroxide
  • benzalkonium chloride (as a preservative).

Identification

Xalacom can be identified by the Australian Register Number AUST R 80311, which is found on the box.

Supplier

Xalacom is supplied in Australia by:

Aspen Pharmacare Australia Pty Ltd
34-36 Chandos Street
St Leonards NSW 2065
Australia
http://www.aspenpharma.com.au

For more information about glaucoma, contact Glaucoma Australia Inc. (telephone 1800 500 880).

This leaflet was revised in March 2021.

Trademarks are owned by or licensed to the Aspen group of companies.

© 2021 Aspen Group of companies or its licensor. All rights reserved.

Published by MIMS April 2021

BRAND INFORMATION

Brand name

Xalacom

Active ingredient

Latanoprost + Timolol

Schedule

S4

 

1 Name of Medicine

Latanoprost and timolol maleate.

2 Qualitative and Quantitative Composition

Xalacom is a combination eye drop containing latanoprost and timolol maleate.
Latanoprost is a prostaglandin F analogue.
Xalacom is a sterile, isotonic solution containing 50 microgram/mL of latanoprost and 5 mg/mL of timolol (6.83 mg timolol maleate) in an aqueous buffer solution of pH 6.0.
Each 5 mL bottle contains 2.5 mL eye drop solution corresponding to a minimum of 80 drops of solution. One drop contains approximately 1.5 microgram latanoprost and 150 microgram timolol.
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

Eye drops, solution.
The solution is a clear and colourless liquid, filled in a polyethylene container.

4 Clinical Particulars

4.9 Overdose

Symptoms. There is no human data available on overdosage with Xalacom.
There have been reports of inadvertent overdosage with timolol maleate ophthalmic solution resulting in systemic effects similar to those seen with systemic beta-adrenergic blocking agents such as dizziness, headache, shortness of breath, bradycardia, hypotension, bronchospasm, and cardiac arrest. Apart from ocular irritation and conjunctival or episcleral hyperaemia, the ocular effects of latanoprost administered at high doses are not known.
Treatment. If overdosage with Xalacom occurs, treatment should be symptomatic and supportive. Studies have shown that timolol is not readily dialyzable. If Xalacom is accidentally ingested the following information may be useful. One bottle contains 125 microgram latanoprost and 12.5 mg timolol. Both timolol and latanoprost are extensively metabolised in the liver. More than 90% of latanoprost is metabolised during the first pass through the liver. Intravenous infusion of up to 3 microgram/kg in healthy volunteers induced no symptoms but a dose of 5.5-10 microgram/kg caused nausea, abdominal pain, dizziness, fatigue, hot flushes and sweating. These events were mild to moderate in severity and resolved without treatment within 4 hours after terminating the infusion. In patients with bronchial asthma, bronchoconstriction was not induced by latanoprost when applied topically on the eyes in a dose of seven times the clinical dose of latanoprost.
For information on the management of overdose, contact the Poisons Information Centre on 13 11 26 (Australia).

5 Pharmacological Properties

5.3 Preclinical Safety Data

Genotoxicity. Mutagenicity studies with Xalacom have not been conducted.
Latanoprost was not mutagenic in gene mutation assays in bacteria and mouse lymphoma L5178Y cells and was negative in studies of unscheduled DNA synthesis. Chromosome aberrations were observed with human lymphocytes in vitro but latanoprost did not induce micronucleus formation in vivo.
In vitro and in vivo studies with timolol maleate did not reveal a mutagenic potential.
Carcinogenicity. Carcinogenicity studies with Xalacom have not been conducted.
Latanoprost was not carcinogenic in either rats or mice when administered by oral gavage at doses up to 170 microgram/kg/day for 24 and 20 months respectively.
No evidence of carcinogenicity was observed with timolol maleate at oral doses up to 100 mg/kg/day in rats and 50 mg/kg/day in mice. However, there was a statistically significant increase in the incidence of adrenal phaeochromocytomas in male rats administered 300 mg/kg/day. In female mice, statistically significant increases in the incidence of benign and malignant pulmonary tumours, benign uterine polyps and mammary carcinomas were found at 500 mg/kg/day. The increased incidence of mammary tumours was considered to be attributed to a species specific elevation in serum prolactin.
Animal toxicity. No adverse ocular or systemic effects were seen in rabbits treated topically with fixed combinations of latanoprost and timolol maleate for up to 52 weeks or with concomitantly administered latanoprost and timolol ophthalmic solutions for 4 weeks.
In long-term ocular toxicity studies in monkeys, latanoprost has been shown to induce increased iris pigmentation. The pigmentation did not progress upon discontinuation of treatment. The results from pre-clinical studies have demonstrated that the primary mechanism of increased pigmentation is stimulation of melanin production in melanocytes of the iris stroma. There is no evidence of melanocyte proliferation.
Long-term ocular administration of latanoprost at a dose of 6 microgram/eye/day (4 times the daily human dose) to cynomolgus monkeys has also been shown to induce an increase or widening in the palpebral fissure. This effect was reversible upon discontinuation of the drug.
Timolol maleate did not produce any adverse ocular effects in rabbits and dogs, when administered as multiple daily topical doses for up to 52 and 104 weeks, respectively.

6 Pharmaceutical Particulars

6.7 Physicochemical Properties

Latanoprost. It has a molecular weight of 432.58. It is a colourless to slightly yellow oil which is practically insoluble in water, freely soluble in ethanol, ethyl acetate, isopropanol, methanol, acetone and octanol, and very soluble in acetonitrile.
Sixty four isomers of latanoprost are possible however, for Xalacom it is purified as a single isomer.
Chemical structure. The chemical name of latanoprost is isopropyl-(Z)-7[(1R,2R,3R,5S) 3,5-dihydroxy-2-[(3R)-3- hydroxy-5-phenyl-1-pentyl]cyclopentyl]-5-heptenoate, according to IUPAC. Its molecular formula is C26H40O5.
The chemical structure is as follows:
https://stagingapi.mims.com/au/public/v2/images/fullchemgif/CSLATANO.gif CAS number. 130209-82-4.
Timolol maleate. Timolol maleate is a beta-adrenergic receptor blocking agent. It has a molecular weight of 432.50. It is a white to off-white crystalline powder which is soluble in water, alcohol and practically insoluble in ether.
Chemical structure. The chemical name of timolol maleate is (S)-1-(tert-butylamino)-3-[(4-morpholino-1,2,5- thiadiazol-3-yl)oxy]-2-propanol maleate (1:1) (salt). Its molecular formula is C13H24N4O3S.C4H4O4.
The chemical structure is as follows:
https://stagingapi.mims.com/au/public/v2/images/fullchemgif/CSTIMOMA.gif CAS number. 26921-17-5.

7 Medicine Schedule (Poisons Standard)

S4, Prescription Only Medicine.

Summary Table of Changes

https://stagingapi.mims.com/au/public/v2/images/fulltablegif/XALACOST.gif