Ongentys
Ongentys
Generic Name
Ongentys
Mechanism
- Selective EP₂ receptor agonist:
- Binds to prostaglandin E₂ receptor subtype EP₂ on ciliary body cells.
- Stimulates cyclic‑AMP formation → enhances aqueous humor outflow via the uveoscleral pathway.
- Minimal effect on beta‑ and alpha‑adrenergic receptors, reducing systemic cardiovascular side effects common to some other prostaglandin analogs.
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Pharmacokinetics
| Parameter | Detail |
| Systemic absorption | Minimal; <1 % of applied dose reaches systemic circulation. |
| Peak serum concentration (C_max) | ~3 µg/L (approx. 48 h after application). |
| Half‑life (t½) | ~12 h ocular; ~19 h systemic. |
| Metabolism | Converted to active metabolite (omidenepag isodifumarate) by intestinal esterases; hepatic conjugation mainly via UGT1A1 and UGT1A9. |
| Elimination | Renal excretion (~60 % unchanged); biliary excretion (~30 % conjugated). |
| Drug interactions | Weak CYP3A4 inducer; avoid concomitant strong inhibitors/inducers that may alter local ocular drug exposure. |
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Indications
- Primary open‑angle glaucoma (POAG).
- Ocular hypertension (OHT).
- Secondary open‑angle glaucoma (e.g., pseudoexfoliative).
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Contraindications
| Category | Detail |
| Contraindications |
• Known hypersensitivity to omidenepag, its excipients, or any prostaglandin analog. |
| Warnings |
• Cataract Formation: Use with caution in patients with existing cortical or nuclear cataracts; may accelerate cataract progression.
• Ocular Surface Disease: Avoid in severe dry eye or active inflammation where prostaglandins could exacerbate symptoms.
• Pregnancy/Breastfeeding: Category C; limited data. Use only if benefits > risks. |
| Precautions |
• Monitor intra‑ocular inflammation in patients with history of uveitis. |
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Dosing
- Standard Dose: 0.002 % (1 mg/mL) ophthalmic solution.
- Frequency: Once nightly, preferably in the evening.
- Administration: Instill 1–2 drops into affected eye(s), wait 5 min after prior topical medication.
- Duration: Long‑term; evaluate efficacy every 4–6 weeks.
- Medication‑Management Tips
- Do not mix with other topical ophthalmic agents without proper washout intervals.
- Avoid exposure to high temperatures; store below 25 °C.
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Adverse Effects
| Adverse Effect | Incidence | Notes |
| Eyelash growth (long, darker, curly) | 9–20 % | Cosmetic but often sought after. |
| Eyelid hyperpigmentation | 4–6 % | Reversible after discontinuation. |
| Ocular itching | 2–3 % | Often mild; treat with lubricants. |
| Conjunctival hyperemia | 4–7 % | Typically transient. |
| Chronic dry eye | 1–2 % | Manage with artificial tears. |
| Anterior uveitis | ≤1 % | Seek immediate care if pain or redness develops. |
| Visual field changes | Rare | Monitor with automated perimetry. |
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Monitoring
- IOP: Baseline and every 4–6 weeks until stable.
- Visual Fields (Humphrey): at baseline and annually, or sooner if progression suspected.
- Optic Disc Assessment: Ophthalmoscopy or OCT annually.
- Cataract Development: Slit‑lamp exam quarterly in the first year.
- Ocular Surface Health: Assess tear film and lid margin for dryness or inflammation.
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Clinical Pearls
- “Day‑before” Switching Protocol – Switch from latanoprost/others 24 h before initiating Ongentys to minimize rebound IOP spikes.
- Use in Combination – When used with beta‑blockers or diuretics, the combined effect may allow lower monotherapy doses, reducing systemic side effects.
- Adjunctive Instillation Timing – If a patient uses artificial tears, administer them at least 30 min prior to Ongentys to avoid dilution of the active drop.
- Patient Education – Emphasize the “eating” eyelash effect; reassure that eyelash changes are benign and often reversible.
- Cataract Surveillance – In patients over 60, perform a baseline slit‑lamp exam because EP₂ agonists can accelerate cortical cataract formation.
- Renal Insufficiency – Even though systemic exposure is low, caution patients with severe renal disease as UGT1A1/UGT1A9 elimination might be impacted.
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• Key take‑away: *Ongentys* offers a unique, selective EP₂ agonist platform that boosts uveoscleral outflow with a favorable safety profile, making it an excellent choice for long‑term IOP control in open‑angle glaucoma and ocular hypertension.