Rhopressa
Rhopressa, also known by its generic name, netarsudil, is an eye drop medication used to lower eye pressure in people with glaucoma or ocular hypertension. It received FDA approval in December 2017 and belongs to a newer class of medications called ROCK (rho kinase) inhibitors. The medication is given as a drop into the affected eye(s) once every night. Common side effects include eye redness and blurry vision.
What is Rhopressa (netarsudil)?
What is Rhopressa (netarsudil) used for?
Lowering pressure in the eye in people with ocular hypertension (high pressure in the eye) or open-angle glaucoma
How Rhopressa (netarsudil) works
Rhopressa (netarsudil) is a ROCK (rho-kinase) inhibitor, which means it blocks a protein in the eye called rho kinase. By blocking this protein, it helps to drain fluid from the eye, leading to lower eye pressure.
Drug Facts
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What are the side effects of Rhopressa (netarsudil)?
Common Side Effects
- Eye redness (53%)
- Cornea deposits (20%)
- Eye pain when putting the drop in the eye (20%)
- Red spot on the white of your eye (20%)
Other Side Effects
- Cornea staining
- Blurry vision
- Watery eyes
- Red eyelids
- Lowered vision sharpness
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Change in vision
- New or worsening eye pain, redness, irritation, or discharge
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Blurry vision
- Change in eye, eyelash, or eyelid color
- Eye irritation or itching
- Increased tears after use
Pros and cons of Rhopressa (netarsudil)
Pros
Can be used with other glaucoma medications to further lower eye pressure
Doesn't cause the color of your eye to darken like other eye drops
Only needs to be used once in the evening
Cons
Eye redness is a very common side effect
No lower-cost generic available
Its role in treatment isn't clear yet
Pharmacist tips for Rhopressa (netarsudil)
You'll need regular eye exams so that your eye specialist can check how well Rhopressa (netarsudil) is working for you and whether there are any side effects related to the eyes.
If you're using other eye drops besides Rhopressa (netarsudil), wait 5 minutes between each medication to give your eyes time to absorb each one.
If you wear soft contact lenses, take them out before using Rhopressa (netarsudil). The eye drops contain a preservative called benzalkonium chloride that can damage your contact lenses. You can put your contacts back in 15 minutes after using the eye drops.
If you wake up in the morning and realize you forgot to use your Rhopressa (netarsudil) drops last night, just skip that dose and wait until evening for your regularly scheduled dose. Using two drops in one day can lead to more side effects and isn't recommended.
How to use Rhopressa (netarsudil):
Make sure you know how to use the Rhopressa (netarsudil) eye drops to avoid accidentally hurting yourself or wasting any of the medication. Review the steps on how to use eye drops, and ask your eye specialist or pharmacist if you have any questions about using the medication.
Wash your hands before putting the drops in your eyes. Don't touch the dropper tip with your eye, hands, or any other surface. This will help you avoid eye infections by preventing contamination of the solution.
After placing a drop in the eye, close your eye and press one finger to the inner corner of your eye by the nose and press lightly for 1 minute. This helps make sure your eye absorbs the drop.
You can wipe away any extra liquid that might be on your skin with a clean tissue.
Frequently asked questions about Rhopressa (netarsudil)
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What are the risks and warnings for Rhopressa (netarsudil)?
Rhopressa (netarsudil) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk for bacterial eye infection when using contaminated medication
Risk factors: Corneal disease | Injury or damage to the surface of the eye
Eye infections can happen if the medication inside your Rhopressa (netarsudil) bottle gets contaminated with germs. Some people who used contaminated eye drops developed bacterial keratitis, an infection of the cornea (the protective covering on the front of the eye). It's important to wash your hands before each time you use Rhopressa (netarsudil). Be careful not to let the dropper tip touch your eye or to any other surface.
Not for use with contact lenses
Rhopressa (netarsudil) contains a preservative called benzalkonium chloride. This preservative can be absorbed by soft contact lenses and cause damage to the lenses. Take out your soft contact lenses each time before you place Rhopressa (netarsudil) drops into your eye(s). Wait at least 15 minutes after your dose before putting your contacts back in.
Rhopressa (netarsudil) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 2.5ml of 0.02% | 1 eye dropper | $326.79 | $326.79 |
Typical dosing for Rhopressa (netarsudil)
The typical dose is 1 drop in the affected eye(s) once daily in the evening.
How much does Rhopressa (netarsudil) cost?
What are alternatives to Rhopressa (netarsudil)?
Lowering pressure in the eye in people with ocular hypertension (high pressure in the eye) or open-angle glaucoma
Lowering pressure in the eye in people with ocular hypertension (high pressure in the eye) or open-angle glaucoma
Lowering pressure in the eye in people with ocular hypertension (high pressure in the eye) or open-angle glaucoma
Rhopressa (netarsudil) images
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References
Best studies we foundAhn, J., et al. (2021). Binding affinity of benzalkonium chloride on contact lens surfaces and the effects on their physical properties. Colloids and Surfaces B: Biointerfaces.
Alcon Laboratories, Inc. (2024). Rhopressa- netarsudil solution/ drops [package insert]. DailyMed.
Boyd, K. (2024). What is ocular hypertension? American Academy of Ophthalmology.
Centers for Medicare and Medicaid Services. (2015). Pharmacy auditing and dispensing job aid: Billing other dosage forms.
Gedde, S. J., et al. (2020). Primary open-angle glaucoma PPP 2020. American Academy of Ophthalmology.
Mathur, M. C., et al. (2023). Netarsudil monotherapy as the initial treatment for open-angle glaucoma and ocular hypertension in Indian patients: A real-world evaluation of efficacy and safety. Indian Journal of Ophthalmology.
Merchel Piovesan Pereira, B., et al. (2019). Benzalkonium chlorides: Uses, regulatory status, and microbial resistance. Applied and Environmental Microbiology.
National Eye Institute. (2021). How to put in eye drops.
Patel, P., et al. (2024). Netarsudil ophthalmic solution. StatPearls.
Teus, M. A., et al. (2002). Incidence of iris colour change in latanoprost treated eyes. The British Journal of Ophthalmology.
Turbert, D., et al. (2024). What is bacterial keratitis? American Academy of Ophthalmology.
U.S. Food and Drug Administration. (2020). Drug trials snapshots: Rhopressa.
Villegas, N. C., et al. (2021). Effectiveness of netarsudil as an additional therapy for glaucoma in patients already on maximally tolerated medical therapy. Clinical Ophthalmology.
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