Avro0.004%

Approved Indication

Avro ophthalmic solution is indicated for the reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension.

• First-line / monotherapy use (established, FDA-approved): Avro is used alone as a once-daily topical therapy to lower IOP in adults with open-angle glaucoma or ocular hypertension.
• Adjunct/combination use (guideline-supported): Avro may be added to other IOP-lowering eye drops (e.g., topical beta-blockers, carbonic anhydrase inhibitors, alpha-agonists) when a single agent does not achieve target IOP; this requires combination therapy under specialist supervision.

Avro is not approved for and should not be used to treat angle-closure glaucoma, congenital glaucoma, or other acute causes of raised intraocular pressure that require different management.

Each mL of ophthalmic solution contains Travoprost 0.004% (40 micrograms/mL) as the active ingredient, formulated as a sterile, isotonic, buffered aqueous solution for topical ocular use.

Inactive ingredients typically include a preservative (such as benzalkonium chloride or an alternative ionic-buffered preservative system), tonicity agents, and pH-adjusting agents; exact excipients vary by manufacturer/brand.

Avro is a synthetic prostaglandin F2-alpha analogue used in ophthalmology to lower intraocular pressure. It is formulated as a topical ophthalmic solution and is administered as eye drops.

Avro is a prodrug: after instillation, corneal esterases hydrolyze it to its biologically active free acid, which acts as a selective agonist at the FP (prostaglandin F) receptor to increase outflow of aqueous humor from the eye, thereby lowering intraocular pressure.

Prostaglandin analogue — ophthalmic anti-glaucoma / ocular hypotensive agent

Mechanism of Action

Travoprost is a prodrug that is hydrolyzed by corneal esterases to its active acid form. This active metabolite is a selective agonist of the FP prostanoid receptor.

Activation of FP receptors in the ciliary muscle and sclera increases the uveoscleral (and to a lesser degree trabecular) outflow of aqueous humor, without significantly affecting aqueous humor production. The net effect is a sustained reduction in intraocular pressure.

Pharmacokinetics

Systemic absorption after ocular administration of Travoprost is minimal. Peak IOP-lowering effect occurs within approximately 12 hours of dosing, with a duration of action that supports once-daily dosing. The active acid is further metabolized (beta-oxidation, glucuronide conjugation) and excreted primarily in urine.

Avro is for topical ophthalmic (eye drop) use only and must not be injected or taken orally. Wash hands before use, tilt the head back, pull down the lower eyelid to form a small pocket, and instill one drop without letting the dropper touch the eye. Close the eye gently for 1–2 minutes and apply light pressure over the tear duct to reduce systemic absorption. Full instillation technique and spacing from other eye drops are detailed in Dosage and Administration.

Because ocular absorption of Avro into the systemic circulation is minimal, clinically significant systemic drug interactions are unlikely.

• Other prostaglandin analogue eye drops: Concurrent use of Avro with other topical prostaglandin analogues (e.g., latanoprost, bimatoprost, tafluprost) is not recommended, as both act via the same FP-receptor pathway; combining them provides no added IOP-lowering benefit and may increase the risk of side effects.
• Other topical ophthalmic medicines: When Avro is used with other eye drops, separate instillation by at least 5 minutes to prevent one drop washing out the other.

Common and Characteristic Adverse Effects

Less commonly, Avro has been associated with intraocular inflammation (iritis/uveitis) and macular edema (including cystoid macular edema) in susceptible patients — see Precautions and Warnings.

Pregnancy: There are no adequate and well-controlled studies of Avro in pregnant women. Avro should be used during pregnancy only if clearly needed and if the potential benefit to the mother justifies the potential risk to the fetus. A physician should always be consulted before use in pregnancy.

Lactation: It is not known whether Avro or its metabolites are excreted in human breast milk. Because many drugs are excreted in breast milk, caution should be exercised and a physician consulted before using Avro while breastfeeding; the decision should weigh the benefit of treatment against the potential risk to the infant.

• Pigmentation changes: Avro can gradually change eye colour by increasing brown pigment in the iris, and can also darken eyelashes and periorbital skin. Iris colour change is usually permanent and may be more noticeable when only one eye is treated. Patients should be counselled about this possibility before starting treatment.
• Intraocular inflammation and macular edema: Avro should be used with caution in patients with a history of intraocular inflammation (iritis/uveitis) and in aphakic or pseudophakic patients with a torn posterior lens capsule, or known risk factors for macular edema, as prostaglandin analogues have been associated with these conditions.
• Contact lenses: Contact lenses may absorb the preservative in Avro; lenses should be removed prior to instillation and may be reinserted 15 minutes later.
• Contamination risk: Multidose ophthalmic containers, including Avro, can become contaminated with bacteria causing keratitis or corneal ulceration if the dropper tip touches the eye or another surface. Serious harm to the eye and resultant vision loss may occur if the contaminated solution is used.
• Eyelash/periorbital changes: These changes are generally reversible for eyelashes upon discontinuation but pigmentation changes to the iris are usually permanent.

Ocular overdose of Avro is unlikely to cause significant systemic toxicity due to minimal systemic absorption; excessive dosing may increase local irritation, redness, or discomfort. If Avro is accidentally ingested, systemic effects are not well characterized but supportive/symptomatic treatment should be given. In case of accidental over-instillation, eye(s) may be flushed with lukewarm water. Any suspected overdose or ingestion, especially in a child, warrants prompt contact with a physician, emergency services, or a poison control centre for guidance; do not attempt unsupervised home treatment beyond basic eye flushing.

Store unopened Avro ophthalmic solution as directed on the pack (typically at controlled room temperature, or refrigerated at 2–8°C per some manufacturers, prior to opening). Once opened, store at room temperature (below 30°C), protect from light, and discard any remaining solution after the period stated on the label (commonly 4–6 weeks after first opening) even if some solution remains. Keep out of reach of children.

Pediatric Patients

The safety and efficacy of Avro in pediatric patients have not been established; its use in children and adolescents is generally not recommended outside specialist supervision.

Elderly (Geriatric) Patients

No overall differences in safety or effectiveness have been observed between elderly and younger adult patients; no dose adjustment is required based on age alone.

Renal and Hepatic Impairment

Specific dose adjustment has not been established as necessary in renal or hepatic impairment, since systemic absorption of Avro after ocular administration is minimal.

Pregnancy and Lactation

See Pregnancy and Lactation section above for detailed guidance.

Glaucoma and ocular hypertension are chronic conditions; Avro is generally used as a long-term, continuous once-daily therapy to control intraocular pressure, not as a short course. The duration of treatment should be determined by the prescribing ophthalmologist based on regular monitoring of intraocular pressure, optic nerve status, and visual fields, and treatment is typically continued indefinitely unless side effects, lack of efficacy, or a change in the treatment plan warrant discontinuation.

Prostaglandin F2-alpha analogues; ophthalmic anti-glaucoma / ocular hypotensive agents

Travoprost is a prodrug that is hydrolyzed by corneal esterases into its active free acid. This active form acts as a selective agonist at the FP (prostaglandin F) receptor, increasing uveoscleral outflow of aqueous humor from the eye. Because it enhances drainage rather than reducing production of aqueous humor, Travoprost produces a sustained, once-daily-dosing-compatible reduction in intraocular pressure.

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The safety and efficacy of Avro in pediatric patients have not been formally established in well-controlled studies. Because data are limited, Avro is generally not recommended for use in infants, children, or adolescents unless specifically directed by a pediatric ophthalmologist who has weighed the potential benefits against the unknown risks in this population.