Ganfort, 30 pcs., 0.4 ml, 0.3 mg+5 mg/ml, eye drops, without preservatives

Material and methods

In the Department of Diabetic Retinopathy and Ophthalmic Surgery of the Federal State Budgetary Institution Scientific Research Center of the Ministry of Health of Russia (Moscow), for the period from June 2012 to January 2014 inclusive, 50 patients (51 eyes, 21 men and 29 women) with symptoms of secondary uncompensated NG in combination with diabetes were observed . The average age of the patients was 63.4±3.7 years. The average duration of diabetes was 14.0±3.6 years, the average level of glycated hemoglobin was 8.9±1.8 mmol/l. All patients underwent routine endocrinological (monitoring of blood sugar, glycated hemoglobin, triglyceride levels, cholesterol) and ophthalmological (visometry, ophthalmoscopy, gonioscopy, non-contact tonometry, tonography, perimetry) examination. If necessary, studies were carried out aimed at identifying and clarifying complications of diabetes and concomitant somatic pathology.

When visiting a doctor, every 5th patient was without any antihypertensive regimen; for the rest, it was ineffective, as evidenced by the average IOP level, which, according to non-contact tonometry, was 46.8 ± 2.8 mm Hg. and when measured using Maklakov’s method - 48.7±2.6 mmHg. All patients had their antihypertensive regimen changed during the period of preparation for surgery, and if there was no effect, drainage surgery was performed. For this purpose, the previous treatment was canceled and the combined drug Ganfort was prescribed, one drop into the conjunctival sac once in the morning. The patients were conditionally divided into 2 groups: the 1st group included patients who “responded” to Ganfort therapy (37 eyes, 72.5%), who did not require surgical intervention, and the 2nd group included patients (14 eyes, 27. 5%) whose IOP decreased but did not reach the target value. They underwent drainage antiglaucoma surgery.

Ganfort eye drops: instructions for use

The effectiveness of Ganfort is explained by its unique composition, which includes two active components at once. The first of them - bimatoprost - is an analogue of prostaglandins, the essence of its effect is to activate the outflow of intraocular fluid. The second compound is timolol, a beta-blocker that reduces the formation of the same moisture.

Anatomy of an eye with glaucoma

Due to its double effect, the drug actively reduces blood pressure. Indications for use are:

• open-angle glaucoma;
• intraocular hypertension.

Bimatoprost has a side effect that is often noted by patients - increased eyelash growth. The effect is achieved by increasing life expectancy and the appearance of new hairs. Today this compound has become widespread in cosmetology.

Such diagnoses require constant monitoring by an ophthalmologist, and it is the doctor who must decide on the use of drops. Ganfort is often prescribed when a beta-blocker or prostaglandin analog alone does not give the desired result.

The drug should not be taken for cosmetic purposes

It is important to prevent the development of complications due to keratitis - treatment of inflammation of the cornea of ​​the eye.

Results and discussion

All patients (51 eyes, 100%) experienced a decrease in IOP after starting to use the drug. The IOP level according to non-contact tonometry in patients of group 1 who did not require surgical treatment decreased within 2 weeks by 2.5 times compared to the baseline and amounted to 18.7 ± 1.7 mm Hg. (Table 1)

.

In patients with pain when visiting a doctor (40 patients, 40 eyes), it was relieved within 2 weeks of taking the drug, including in patients who later required surgical intervention.

Analysis of the number of “adverse” events when using Ganfort showed that the data we obtained did not differ significantly from those in the study by A. Hommer [8] (Table 2)

.

It should be taken into account that A. Hommer studied these phenomena in patients without diabetes with “usual” primary open-angle glaucoma, and not with secondary NG and diabetes.
In this regard, hyperemia of the conjunctiva, detected during biomicroscopy in some patients (Fig. 1)

Figure 1. Fig. 1. Local hyperemia of the conjunctiva during instillation of Ganfort. , in our opinion, cannot be attributed to complications of drug therapy. The effect of compensating the level of IOP in such severe patients clearly exceeds the slight hyperemia of the conjunctiva, which is often detected only during biomicroscopy.

In group 2 (14 patients, 14 eyes), the IOP level also decreased significantly (Table 3)

, but did not reach the target value. Due to a further decrease in visual functions and unfavorable development of the process, a decision was made on the need for surgical intervention. They underwent glaucoma drainage surgery using Ahmed valves (10 cases) and Molteno valves (4 cases). After using drainage surgery, stable compensation of IOP was achieved in all cases, which was also observed in the long-term postoperative period.

The lack of the desired effect in achieving the target pressure in the 2nd group of patients cannot be considered as a failure in the use of the drug Ganfort in patients with uncompensated neovascular glaucoma. A decrease in IOP by almost 30% compared to the baseline (from 46.8 to 32.8 mm Hg, respectively) led to a decrease in the number of hemorrhagic complications (hyphema, hemophthalmos) both during surgery and in the early postoperative period ( Fig. 2)

.

Figure 2. Fig.
2. Hyphema in the early postoperative period after drainage surgery. It was shown that the synthetic prostamide bimatoprost did not increase the incidence of hemorrhagic complications in the early postoperative period in operated patients. Only in three (21.4%) cases out of 14 were hemorrhagic complications recorded, whereas with conventional drainage surgery, hemorrhagic complications occur on average in 24.5% of cases [5].

Ganfort eye drops fl-cap 3ml

Compound

Active ingredients: bimatoprost - 0.3 mg/ml, timolol maleate - 6.8 mg/ml (in terms of timolol - 5.0 mg/ml). Excipients: benzalkonium chloride, citric acid monohydrate, sodium hydrogen phosphate heptahydrate, sodium chloride, hydrochloric acid, sodium hydroxide, water.

Pharmacokinetics

Ganfort
Systemic absorption of the drug is minimal and does not differ either with combined treatment or with instillation of each of the components of the drug separately.

In two studies lasting 12 months, no systemic accumulation of any of the active substances was observed.

Bimatoprost

In vitro studies have shown that bimatoprost penetrates the iris and sclera. When instilling a 0.03% solution of bimatoprost, 1 drop into both eyes once a day for 2 weeks, the Cmax of bimatoprost in the blood plasma is achieved within 10 minutes after application, and within 1.5 hours its concentration in the blood plasma decreases to the lower limit of detection (0.025 ng/ml). The mean values ​​of Cmax and area under the concentration-time curve (AUC0-24 h) of bimatoprost were similar on days 7 and 14 of use, and were 0.08 ng/ml and 0.09 ng×h/ml, respectively, indicating that the equilibrium concentration bimatoprost is achieved within the first week of use.

Bimatoprost is moderately distributed in tissues, and the systemic volume of distribution when the drug reaches equilibrium concentration is 0.67 l/kg. Bimatoprost is found predominantly in blood plasma. The binding of bimatoprost to plasma proteins is approximately 88%. Bimatoprost undergoes oxidation, N-deethylation and glucuronidation to form various metabolites.

Bimatoprost is excreted primarily by the kidneys. About 67% of the drug administered intravenously to healthy volunteers was excreted in the urine, and 25% was excreted through the gastrointestinal tract (GIT). T1/2 of bimatoprost, determined after its intravenous administration, was approximately 45 minutes; and the total clearance is 1.5 l/h/kg.

In elderly patients:

When using bimatoprost 2 times a day, the average value of AUC0-24 hours in elderly patients is 0.0634 ng×h/ml, which significantly exceeds the value of this indicator in healthy young individuals - 0.0218 ng×h/ml.

However, this difference is not clinically significant, since the systemic exposure of bimatoprost when applied topically in elderly patients and healthy young individuals remains very low. Cumulation of bimatoprost in the systemic circulation is not observed, the safety profile does not differ in elderly patients and young people.

Timolol

In patients who underwent surgical treatment of cataracts, after instillation of eye drops in the form of a 0.5% solution, the Cmax of timolol in the intraocular fluid after 1 hour was 898 ng/ml. A certain amount of the drug enters the systemic circulation and is metabolized in the liver. T1/2 of timolol is about 4-6 hours. Part of timolol, metabolized in the liver, is excreted through the gastrointestinal tract, and the other part and metabolites are excreted by the kidneys. Timolol is slightly bound to plasma proteins.

Indications for use

Reduction of intraocular pressure (IOP) in patients with open-angle glaucoma and intraocular hypertension with insufficient effectiveness of local use of beta-blockers and prostaglandin analogues.

Contraindications

• hypersensitivity to the components of the drug;
• syndrome of increased reactivity of the respiratory tract, including bronchial asthma in the acute stage and past episodes in history, severe chronic obstructive pulmonary disease (COPD);
• sinus bradycardia, atrioventricular block II and III degrees, clinically significant heart failure, cardiogenic shock;
• age under 18 years;
• pregnancy, breastfeeding period.

With caution: impaired liver and kidney function (the drug has not been sufficiently studied in this category of patients). In patients with risk factors for macular edema (for example, aphakia, pseudophakia, lens rupture).

In patients with diabetes mellitus (unstable course) and impaired glucose tolerance, since the beta-blocker timolol included in the drug Ganfort can mask the signs of hypoglycemia. In patients with inflammatory changes in the eyes, neovascular, inflammatory, closed-angle glaucoma, congenital glaucoma or narrow-angle glaucoma (no data on efficacy and safety studies).

Directions for use and doses

Recommended doses for adults (including elderly patients):
One drop is instilled into the conjunctival sac of the affected eye once a day in the morning or evening. The drug should be used daily at the same time.

Available literature data for Ganfort® suggest that the evening dose may be more effective in lowering IOP than the morning dose. However, the possibility of following the chosen regime should be taken into account.

If the drug is missed once, the drug is administered the next day. It is not recommended to exceed the dose - 1 administration once a day. If more than 2 drugs are used, it is necessary to take a 5-minute break between each instillation.

Applying pressure to the nasolacrimal duct area or closing the eyelids for 2 minutes reduces systemic absorption, which may result in fewer side effects and increased local exposure.

The single-dose container is for one-time use only. One container is sufficient for instillation into both eyes. The container with the remaining solution must be thrown away immediately after instillation.

Storage conditions

Store out of the reach of children at a temperature not exceeding 25°C.

Best before date

2 years. Do not use after the expiration date stated on the packaging.

special instructions

Just like other ophthalmic drugs, Ganfort® can penetrate into the systemic circulation.
Due to the presence of timolol, a beta-adrenergic component, various types of adverse reactions (from the cardiovascular, respiratory and other systems) may be observed, as with the use of systemic beta-blockers.

The incidence of adverse reactions with local administration of the drug is lower than with systemic use.

The cardiovascular system

Patients with cardiovascular disease (such as coronary artery disease, Prinzmetal's angina and heart failure) and on antihypertensive therapy with beta-blockers should be critically assessed and the use of other drugs should be considered. Monitoring of patients with cardiovascular disease is necessary to monitor for signs of worsening of these diseases and adverse reactions.

Patients with severe peripheral circulatory disorders (for example, severe forms of Raynaud's disease or Raynaud's syndrome) should use the drug with caution.

Respiratory system

Respiratory reactions, including death due to bronchospasm, have been reported in patients with asthma following use of certain ophthalmic beta-blockers.

Endocrine system

Beta-blockers can mask the symptoms of hypoglycemia and hyperthyroidism.

Other beta blockers

Timolol may affect intraocular pressure or enhance the effect of systemic beta-blockers in patients already receiving a systemic beta-blocker. Close monitoring of such patients is recommended. Also, the use of two local beta-blockers is not recommended.

Anaphylactic reactions

In patients with a history of atopic manifestations and severe anaphylactic reactions to various allergens, doses of epinephrine (adrenaline), which are usually used to relieve anaphylactic reactions, may be ineffective against the use of beta-blockers.

Choroidal detachment

Cases of choroidal detachment have been reported with the use of therapy that reduces the flow of intraocular fluid (eg, timolol, acetazolamide) after filtration surgery.

Surgical anesthesia

Ophthalmic drugs with beta-blocking activity may inhibit the systemic effects of beta-agonists such as epinephrine. It is necessary to warn the anesthesiologist about the patient's use of timolol.

Liver

In patients with mild liver disease or initially elevated liver enzymes alanine aminotransferase (ALT), aspartate aminotransferase (AST) and/or total bilirubin, bimatoprost had no effect on liver function over a study period of more than 24 months.

There are no data on adverse reactions due to the effect of timolol on liver function.

Organ of vision

Before starting treatment, patients should be informed about the possible growth of eyelashes, increased pigmentation of the skin of the eyelids and pigmentation of the iris, since these side effects were established during studies of bimatoprost and Ganfort®. Some changes may be permanent, and may be accompanied by differences between eyes if the drug is instilled in only one eye.

After discontinuation of the drug Ganfor®, pigmentation of the iris may remain permanent.

After 12 months of treatment with Ganfort®, pigmentation of the iris was noted in 0.2% of patients. And after 12 months of treatment with only bimatoprost in the form of eye drops - in 1.5%, a further increase in the frequency of this effect was not observed during therapy lasting 3 years.

Increased pigmentation of the iris is due to increased production of melanin by melanocytes, and not simply an increase in the number of melanocytes. The duration of development of the effect of increased pigmentation of the iris is unknown. The change in color of the iris observed with the use of bimatoprost may not be pronounced over a period of several months to several years. The use of the drug does not affect nevi or pigment deposits on the iris of the eye. It has been reported that pigmentation of the periorbital region is reversible in some patients. A change in refraction is possible (due to discontinuation of therapy with miotic agents in some cases).

Leather

Hair growth is possible on those areas of the skin where the drug was accidentally applied. It is important to use the drug Ganfort® strictly in accordance with the instructions for medical use and not to allow the drug Ganfort® to come into contact with the skin.

Excipients

The excipient benzalkonium chloride, which is part of the drug Ganfort®, can cause irritation of the mucous membrane of the eyes and discoloration of soft contact lenses. Contact lenses must be removed before administering the drug; they can be put on 15 minutes after instillation. Benzalkonium chloride may cause acute keratitis and/or toxic corneal ulcer. In this regard, it is necessary to monitor the patient’s condition during frequent or prolonged treatment with Ganfort® in persons with dry eye syndrome and with changes in the cornea.

After opening the bottle, the possibility of microbial contamination of its contents cannot be ruled out, which can lead to inflammatory eye lesions. The shelf life of the drug after first opening the bottle is 28 days. After the specified time has expired, the bottle should be discarded, even if the solution is not completely used.

It is recommended to write down the date the bottle was opened on the cardboard package of the medicinal product.

Once opened, the aluminum foil pouch containing 5 single-dose strip containers must be used within 7 days.

The opened single-dose container should be thrown away immediately after use.

Description

Antiglaucoma drug.

Dosage form

Transparent, colorless or light yellow solution.

Use in children

Contraindication: age under 18 years.

Pharmacodynamics

Ganfort is a combination drug, its constituents bimatoprost and timolol reduce intraocular pressure (IOP) due to combined interaction, leading to a significantly more pronounced hypotensive effect compared to the effect of each component separately.
Bimatoprost is a synthetic prostamid, similar in chemical structure to prostaglandin F2a (PGF2a). Bimatoprost does not affect any of the known types of prostaglandin receptors. The hypotensive effect of bimatoprost is due to increased outflow of intraocular fluid through the trabecula and along the uveoscleral pathway of the eye.

Timolol is a non-selective beta-blocker and does not have intrinsic sympathomimetic or membrane-stabilizing activity.

Timolol reduces IOP by reducing the formation of intraocular fluid. The exact mechanism of action has not been established; it may be associated with inhibition of the synthesis of cyclic adenosine monophosphate (c-AMP) and is caused by endogenous stimulation of beta-adrenergic receptors.

Side effects

The frequency of side effects identified during the studies was assessed as follows: very often (>1/10), often (>1/100, <1/10);
uncommon (>1/1000, <1/100). Clinical studies of the drug Ganfort revealed the following side effects:

From the central nervous system: infrequently - headache;

From the organ of vision: very often - conjunctival hyperemia, eyelash growth; often - superficial keratitis, corneal erosion, burning sensation, itching, burning pain in the eyes, foreign body sensation, dry mucous membrane of the eyes, redness of the eyelids, pain in the eyes, photophobia, discharge from the eyes, blurred vision, itching of the skin of the eyelids; uncommon - iridocyclitis, irritation of the mucous membrane of the eyes, conjunctival edema, blepharitis, epiphora, swelling of the eyelids, soreness of the eyelids, decreased visual acuity, asthenopia, trichiasis; frequency unknown: cystoid macular edema.

From the respiratory system: infrequently - rhinitis;

From the skin and subcutaneous fat: often - pigmentation of the skin of the eyelids; infrequently - hirsutism.

Other side effects that were observed when using one of the components of the drug and are potentially possible during treatment with Ganfort:

• Bimatoprost

From the cardiovascular system: increased blood pressure.
General disorders and changes at the injection site: asthenia, peripheral edema.

From the organ of vision: allergic conjunctivitis, cataracts, darkening of eyelashes, increased pigmentation of the iris, blepharospasm, eyelid retraction, retinal hemorrhage, uveitis.

Laboratory indicators: changes in the activity of liver enzymes.

• Timolol

Mental disorders: insomnia, nightmares, decreased libido.
From the central nervous system: myasthenia gravis, paresthesia, cerebral ischemia.

On the part of the organ of vision: decreased sensitivity of the cornea, diplopia, ptosis, retinal detachment (after surgical treatment), changes in refraction (due to discontinuation of miotic therapy in some cases), keratitis.

From the organ of hearing and vestibular apparatus: tinnitus.

From the cardiovascular system: heart block, cardiac arrest, cardiac arrhythmias, loss of consciousness, bradycardia, heart failure, congestive heart failure; decreased blood pressure, chest pain, cerebrovascular accident, intermittent claudication, Raynaud's syndrome, cold extremities, palpitations.

From the respiratory system: bronchospasm (mainly in persons with a history of episodes of bronchospasm), shortness of breath, cough.

From the gastrointestinal tract: nausea, diarrhea, dyspepsia, dry oral mucosa.

From the skin and subcutaneous fat: alopecia, psoriasis-like rashes, exacerbation of psoriasis.

From the musculoskeletal system and connective tissue: systemic lupus erythematosus.

From the urinary system: Peyronie's disease.

Other: swelling, chest pain, fatigue.

Use during pregnancy and breastfeeding

There are no adequate data on the use of the fixed combination bimatoprost/timolol in pregnant women.
Ganfort® during pregnancy should be used only in cases where the expected benefit to the mother outweighs the potential risk to the fetus. Adequate and strictly controlled studies of the drug Ganfort® have not been conducted in pregnant women. Animal studies have provided data on reproductive toxicity at high doses of bimatoprost.

Epidemiological studies have not revealed congenital malformations of the fetus, but have established the risk of intrauterine growth retardation when taking beta-blocker drugs orally. In cases where patients took a beta-blocker before delivery, the neonates experienced clinical symptoms characteristic of this group of drugs (for example, bradycardia, hypotension, respiratory distress syndrome and hypoglycemia).

In the case of using the drug Ganfort® until birth, it is necessary to monitor the condition of the newborn during the first days of life.

Animal studies have shown reproductive toxicity of timolol at doses significantly higher than those prescribed in clinical practice.

Thus, Ganfort® is not recommended for use during pregnancy, except in cases of special need.

Beta blockers pass into breast milk. However, when timolol is used in the form of eye drops in therapeutic doses, the development of clinical symptoms in children is unlikely due to the lack of sufficient amounts of the drug in breast milk.

It is unknown whether bimatoprost passes into breast milk in humans, but it has been found to be present in the milk of lactating rats.

Ganfort® should not be used in women during breastfeeding.

Interaction

No special studies have been conducted to study drug interactions with the fixed combination of bimatoprost/timolol.

It is possible to potentiate the effects of combined use of ophthalmic solutions of beta-blockers and ingested blockers of “slow” calcium channels, guanethidine, beta-blockers, parasympathomimetics, antiarrhythmic drugs (including amiodarone) and cardiac glycosides, which was manifested by a decrease in blood pressure and/or severe bradycardia.

Potentiation of the systemic effects of beta-blockers (eg, decreased heart rate, depression) has been reported when timolol is co-administered with CYP2D6 inhibitors (quinidine, fluoxetine, paroxetine).

Cases of mydriasis have been occasionally reported with the concomitant use of ophthalmic beta blockers and adrenaline (epinephrine).

Patients using Ganfort® with other prostaglandin analogues should be monitored for changes in intraocular pressure.

Very rare cases of corneal calcification have been reported when used concomitantly with phosphate-containing eye drops in some patients with significant corneal damage.

Overdose

When administering the drug Ganfort®, an overdose is unlikely or may be associated with toxic effects.

• Bimatoprost

In case of unintentional intake of the drug Ganfort® with a preservative orally, the following information may be useful: no symptoms of toxic effects of bimatoprost were noted in doses up to 100 mg/kg/day during 2 weeks of oral administration in an experiment on rats and mice.
The dose used in the study, expressed in mg/m2, is 70 times higher than the possible dose of bimatoprost if the contents of a bottle of Ganfort® with a preservative were accidentally ingested by a child weighing 10 kg. If you unintentionally take Ganfort® without a preservative orally, the following information may be useful: there were no symptoms of toxic effects of bimatoprost in doses up to 100 mg/kg/day during 2 weeks of oral administration in an experiment on rats and mice; this is equivalent to human doses of 8.1 and 16.2 mg/kg, respectively. These doses are at least 7.5 times higher than the possible dose of bimatoprost in case of accidental ingestion of the contents of a cardboard pack of Ganfort® without a preservative (90 single-dose containers x 0.4 ml; 36 ml) by a child weighing 10 kg [(36 ml*0.3 mg/ml bimatoprost)/10 kg; 1.08 mg/kg].

• Timolol

In case of an overdose of timolol, the following symptoms may be observed: bradycardia, decreased blood pressure, bronchospasm, headache, dizziness, shortness of breath, cardiac arrest. Studies have shown that timolol is not completely eliminated by hemodialysis. If an overdose occurs, symptomatic and supportive therapy is necessary.

Impact on the ability to drive vehicles and operate machinery

There may be a transient deterioration in vision after administration of the drug, so the patient should wait until vision is completely restored before driving a car or operating machinery.

Prices and reviews

In addition to the potential risk of extraneous reactions, the disadvantages of the product include its high cost. Economical consumption and high efficiency help reduce the unpleasant impression of visiting a pharmacy.

There are cases when girls use drops not for their intended purpose, but to improve the quality of eyelashes. Such “self-medication” is unacceptable and dangerous to health. The composition should be used on the recommendation of a doctor.

Headaches cannot be tolerated - treatment of ocular migraines.

These and other features of taking the medicine can be identified in patient reviews:

• Tamara Albanova: “I’ve been using the drug Ganfort for 2 years now, my vision has improved, but I have tinnitus... Of course, it’s unpleasant, but I tried to change the medicine with my doctor, but it didn’t suit me.”
• Sudoku: “Grandma is dripping, she has glaucoma in 1 eye. Now one eye is blue, the other is brown.”

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Contraindications

The substances included in the composition determine not only its effectiveness, but also its prohibitions. Ganfort is a medicine whose uncontrolled use is unacceptable.

So, it is prohibited to use the product in the following cases:

• under 18 years of age, pregnant and lactating women;
• in the presence of intolerance to any component;
• the presence of diseases of the respiratory system (bronchial asthma, chronic obstructive pulmonary disease) and heart (failure, cardiogenic shock, bradycardia, blockade of 2 and 3 degrees).

Long-term use in the presence of corneal damage (dry eye syndrome and others) requires careful monitoring. This is due to the compound benzalkonium chloride, which can cause keratitis or ulcers of the membrane.

Since the effect of the drug in people suffering from kidney and liver diseases has not been carried out to the proper extent, the prescription is allowed, but requires the attention and constant supervision of a doctor. The situation is similar in patients at risk of macular edema (yellow spot on the retina), which is possible with aphakia and lens rupture.

For diabetes and impaired glucose tolerance, the medicine can hide the symptoms of hypoglycemia, and therefore also requires extreme caution.

The first sign of glaucoma development

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Analogs

In case of an allergy to any component, the presence of contraindications, the development of a negative reaction, or simply the product not being on sale, the doctor has the right to recommend a replacement. Fortunately, today many formulations are produced for the treatment of glaucoma, including those based on the same substances.

When instilled, cases of overdose are unlikely. But an excess amount of timolol in the body can cause bradycardia, bronchospasm, dizziness, and shortness of breath. If any such symptoms occur, you should consult a doctor.

Competition for Ganfort comes from Azopt, Betoptik, Azarga and cheap analogues of eye drops Azopt, Kosopt, Okumed, Timolol and others. But before choosing a replacement, you should consult your ophthalmologist.

If symptoms of intolerance appear, it is advisable to turn to analogues of the drug

A doctor’s mistake or the body’s reaction is a secondary cataract after lens replacement.

Negative companions of treatment

The drug can enter the circulatory system and contribute to the development of adverse reactions, both from the visual side and general to the whole body.

According to studies, the following manifestations often occur (from 1 to 10% of cases):

• burning sensation, foreign body;
• pain, itching, redness;
• keratitis, corneal erosion;
• itching and pigmentation of the skin of the eyelashes.

After a course of use, the color of the iris may change, in some cases it lasts for life. When the drug is instilled into only one organ, visible differences sometimes appear.

Rhinitis, headache, hirsutism (excessive hair growth) are less likely to occur, as well as eye irritation, blepharitis, swelling, and deterioration of visual acuity.

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Features of composition and release

Ganfort includes active elements in the following concentration per 1 ml of the finished composition:

• bimatoprost – 300 mcg;
• timolol – 5 mg.

In addition, the medicine contains excipients, including sodium hydroxide, sodium citrate, water and other elements.

The composition is packaged in the form of 3 ml bottles with a dropper, which not only makes instillation convenient, but also reduces the risk of infection. In pharmacies, the product is sold in a cardboard box with one or three bottles and instructions. You must present a doctor's prescription before purchasing.

The shelf life is 2 years at temperatures up to 25 °C; once opened, the drops should only be used within 28 days and then thrown away. The date can be written on the packaging.

Correctly instill the medicine into the conjunctival sac

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Method of use

The ophthalmic drug has a pronounced and long-lasting effect, and therefore it is prescribed one drop into the eye once a day (usually instillation is carried out in the morning so that the effect lasts all day). This scheme is optimal for adults and even elderly patients. The drug is contraindicated for children, especially newborns.

Place the mixture in the space between the lower eyelid and the apple, then blink several times. It is necessary to follow the rules of hygiene, do not allow the bottle to come into contact with the eye, and do not touch the dispenser with your hands.

Benzalkonium chloride, which is included in the drops as an adjuvant, can damage contact lenses. Therefore, before instillation, they must be removed and put on only after half an hour.

If a dose is missed, do not replenish the dosage the next day and exceed the daily amount of medication. Treatment is continued according to the regimen recommended by the doctor and in the instructions for use. After instillation, vision sometimes deteriorates, so you can start driving a car or other important activities after a while.

The use of other medications is allowed 5 minutes after Ganfort. The drug is known to reduce the effectiveness of adrenaline.

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