Zioptan alternatives: What can I take instead of Zioptan?

Compare Zioptan alternatives | Xalatan | Xelpros | Timoptic in Ocudose | Cosopt PF | Travatan Z | Natural alternatives | How to switch meds

Zioptan (tafluprost) is the brand name of an eye drop that is used to lower eye pressure in people with open-angle glaucoma (the most common form of glaucoma) or ocular hypertension. These eye drops belong to a group of medications called prostaglandin analogs and work to reduce elevated intraocular pressure (IOP), which is the fluid pressure inside the eye. Increased fluid pressure in conditions like glaucoma and ocular hypertension can cause damage to the eye and lead to reduced vision. Zioptan is used in each affected eye once daily in the evening. Zioptan comes as preservative-free, single-use containers that can cause less inflammation of the eyes and be beneficial for those who experience dry eyes.

RELATED: What is Zioptan? 

While an effective treatment for some people, Zioptan may not be the best and safest ophthalmic solution for all people with either glaucoma or ocular hypertension. Some people with elevated eye pressure may require more than one medication and prefer the convenience of a combination eye drop with two medications. Additionally, some people may want to avoid the side effects of Zioptan such as increased pigmentation/darkening of the iris (a change in eye color) and eyelash changes including increased length and thickness. However, one of the biggest advantages of some alternatives is that they are available as generic eye drops that can be more affordable for people.

RELATED: Can medication change your eye color?

What can I take in place of Zioptan?

There are other FDA-approved options available to treat glaucoma and ocular hypertension that do not improve with Zioptan. There are a few other preservative-free options including brand names Cosopt PF (dorzolamide and timolol) and Timoptic in Ocudose (timolol). Eye drops that contain preservatives may cause irritation, redness and overall discomfort. Additionally, there are a variety of single medication eye drops, combination eye drops, and oral medications. While many glaucoma medications have common side effects, some alternatives have unique adverse effects that should be considered before switching from Zioptan.

RELATED: What it’s like living with glaucoma

Other alternatives to Zioptan

For people seeking other alternative IOP-lowering pharmaceuticals, there are a variety of brand name eye drops, generic eye drops, and oral medications.

Ophthalmic Alpha Adrenergic Receptor Agonists

• Iopidine (apraclonidine)

Ophthalmic Beta-blockers

• Betagan (levobunolol hydrochloride)
• Betimol (timolol)
• Betoptic (betaxolol hydrochloride)
• Carteolol hydrochloride
• Istalol (timolol maleate)
• Timoptic (timolol maleate)

Oral Carbonic Anhydrase Inhibitors

• Acetazolamide capsules and tablets
• Methazolamide tablets

Ophthalmic Prostaglandins

• Durysta (bimatoprost implant)
• Vyzulta (latanoprostene bunod)

Ophthalmic Cholinergic Agonists/Miotic Agents

• Isopto carpine
• Miostat (carbachol)
• Phospholine iodide (echothiophate iodide)
• Vuity (pilocarpine hydrochloride)


Ophthalmic Combinations

• Combigan (brimonidine tartrate/timolol maleate)
• Cosopt (dorzolamide hydrochloride/timolol maleate)
• Rocklatan (netarsudil/latanoprost)
• Simbrinza (brinzolamide/brimonidine tartrate)

Top 5 Zioptan alternatives

The following are some of the most common alternatives to Zioptan.

1. Xalatan (latanoprost)

Xalatan is a brand name medication that is available as a generic called latanoprost. Latanoprost is a single medication eye drop that can be used to manage open-angle glaucoma and ocular hypertension. As a generic eye drop, latanoprost may be a less expensive option for people. Xalatan works the same way as Zioptan to lower eye pressure as it is also a prostaglandin analog. Like Zioptan, latanoprost is dosed once daily in the evening and has similar side effects. Xalatan and generic latanoprost both contain benzalkonium chloride (BAK), a preservative commonly used in eye drops. If preservatives are not of concern, Xalatan may be a well-suited alternative with a more affordable generic option.

2. Xelpros (latanoprost)

Xelpros is a brand name medication that also contains latanoprost, however it is the first and only benzalkonium chloride (BAK)-free form of latanoprost. Instead, Xelpros contains potassium sorbate 0.47% as a preservative. Xelpros can be used to manage open-angle glaucoma and ocular hypertension. Xelpros works the same way as Zioptan to lower eye pressure as it is also a prostaglandin analog. Like Zioptan, Xelpros is dosed once daily in the evening and has similar side effects. Xelpros is a well-suited alternative if BAK-free treatment is required, however it currently is not available as a generic. Eye drops like Xelpros and Zioptan may be better tolerated than those that contain preservatives like BAK and lead to better adherence to treatment.

3. Timoptic in Ocudose (timolol)

Timoptic in Ocudose is a brand name medication that contains timolol and is preservative-free. Timoptic can be used to manage ocular hypertension or open-angle glaucoma. This medication works to lower eye pressure as a beta-adrenergic receptor. Timoptic is dosed twice daily and should not be used in people who have asthma, chronic obstructive pulmonary disease (COPD), sinus bradycardia, second or third degree atrioventricular block, overt cardiac failure, or cardiogenic shock. Like Zioptan, Timoptic in Ocudose is a preservative-free treatment option and may be useful for people who are sensitive to the preservatives often found in eye drops. This medication is also available in a preservative dosage form called Timoptic and its generic timolol maleate.

4. Cosopt PF (dorzolamide and timolol)

Cosopt PF is a combination eye drop that can be used to manage open-angle glaucoma and ocular hypertension. The “PF” formulation of Cosopt is the “preservative-free” eye drop. Cosopt PF contains two different medications, a carbonic anhydrase inhibitor (dorzolamide) and a beta-adrenergic receptor (timolol). Cosopt PF is dosed twice daily into the affected eyes. Cosopt PF should not be used in people who have asthma, chronic obstructive pulmonary disease (COPD), sinus bradycardia, second or third degree atrioventricular block, overt cardiac failure, or cardiogenic shock. As a preservative-free treatment option, Cosopt PF can cause less inflammation of the eyes and be beneficial for those who experience dry eyes. Cosopt PF may be best suited for individuals who require more than one medication to manage their intraocular pressure (IOP) and want the convenience of a combination eye drop. This medication is also available in a preservative formulation called Cosopt and its generic dorzolamide–timolol. 

5. Travatan Z (travoprost)

Travatan Z is a brand name medication that is available as a generic called travoprost. Travatan Z can be used to manage open-angle glaucoma and ocular hypertension. Like Zioptan, this medication works to lower eye pressure as a prostaglandin analog. Travatan Z is dosed once daily in the evening and has similar side effects to Zioptan. While this eye drop is not preservative-free, it doesn’t contain the preservative benzalkonium chloride (BAK) commonly found in eye drops. Travatan Z contains the preservative sofZia that was designed to help lessen the chance of conjunctival hyperemia (eye inflammation and redness) and keratopathy (disorder of the outer lens of the eye). Travatan Z may be useful for people who are sensitive to the preservative BAK. Travatan Z may be a well-suited alternative with a more affordable generic option.

Natural alternatives to Zioptan

Alternative remedies for Zioptan include supplements, lifestyle changes, and diet modifications to keep the eyes healthy. According to the American Optometric Association, proper nutrition for eye health includes a diet that has zinc, copper, essential fatty acids, lutein, vitamin C, vitamin E, and vitamin A. The oral supplement, PreserVision, includes many of these nutrients and is available as an over-the-counter medication.

Omega-3 supplementation has evidence of lowering intraocular pressure (IOP). A 2018 study determined omega-3 supplementation for 3 months significantly reduced IOP in normotensive (normal pressure) adults with an average reduction of 8%. Omega-3 supplementation is available over-the-counter in a few formulations including capsules and softgels.

Lifestyle modifications include incorporating physical exercise into a routine that can have a positive impact on reducing some glaucoma risk factors such as high blood pressure and diabetes. Diet modifications include reducing caffeine intake as caffeine may have an impact on raising intraocular eye pressure.

RELATED: How to protect vision and keep your eyes healthy

How to switch to a Zioptan alternative

1. Discuss all health conditions with a healthcare provider

Before switching from Zioptan to an alternative, it’s important the prescribing doctor has reviewed all health conditions. Some alternatives such as Combigan, Cosopt PF, Betagan (levobunolol), carteolol, and Betimol (timolol) must not be used in people who have asthma, chronic obstructive pulmonary disease (COPD), sinus bradycardia, second or third degree atrioventricular block, overt cardiac failure, and cardiogenic shock. It’s best to seek medical advice prior to changing medication therapy.

2. Do not suddenly stop taking Zioptan

Before stopping Zioptan, make an eye care plan with the prescribing doctor to avoid increases in intraocular pressure. Once a plan has been established, Zioptan can be safely discontinued and replaced with the new glaucoma treatment.

3. Determine if a preservative-free eye drop is needed

Preservatives play an important antimicrobial role in multidose eye drops, but they may also cause irritation, redness and overall discomfort. People with conditions such as dry eye disease or Sjogren’s Syndrome may need to avoid eye drops that contain preservatives. Additionally, people who have had allergic reactions to preservatives in eye drops should use preservative-free dosage forms. It’s best to have a discussion with an ophthalmologist to determine if preservative-free eye drops are the best treatment.

4. Continue proper eye drop administration

Using eye drops correctly ensures proper drug administration and absorption into the eye. It’s important to make sure contact lenses are taken out of the eye prior to using eye drops, unless the eye doctor has instructed to keep them in. Make sure hands are washed and tilt the head backward while sitting, standing, or lying down. Place the index finger below the lower lid to gently pull down and form a pocket, look up, and squeeze drop into the pocket. It’s important to keep the eye closed after the drop has been administered. Try to keep the eye closed for one to three minutes without blinking. If using more than one drop or more than one type of eye drop, wait five minutes before putting the next drop in. This will keep the first drop from being washed out by the second drop before it has had time to work.

If an eye ointment is used, place a 1/4 inch line of ointment into the lower lid pouch. If using an eye drop and an eye ointment at the same time, use the eye drop first, wait a few minutes, and then use the ointment. Eye ointments typically cause blurred vision that is normal and should go away in a few minutes.

5. Keep and maintain eye doctor appointments

People with glaucoma and ocular hypertension should be regularly checked by their eye doctor. At these appointments, the intraocular eye pressure (IOP) can be measured to determine the effectiveness of the medication regimen. It’s important for people managing their IOP to be aware of the normal eye pressure range (12-22 mm Hg) and the high pressure range (greater than 22 mm Hg). Vision tests may also be performed for glaucoma patients to check for any loss of sight or optic nerve damage.