Docosanoid Compounds
A new class of IOP-lowering compounds
was ushered into American medicine by the FDA in August 2000.
Docosanoid drugs have been in clinical use in Japan and other
countries since 1994. Although the exact mechanism of action
is unknown, docosanoids are thought to enhance trabecular outflow.
Unoprostone
 Docosahexaenoic acid (DHA) is the sole docosanoid (unoprostone
isopropyl), known by the band name Rescula (0.15% ophthalmic
solution) by Novartis Ophthalmics.
Although Rescula, the prototypic representative of the docosanoid
class, is not indicated for first-line therapy, studies have
shown that it is equitherapeutic to brimonidine, beta-blockers
and topical CAIs as adjunctive therapy. As monotherapy, it
reduces IOP similarly to betaxolol. Currently, there are no
known systemic side effects, which makes Rescula the safest
known topical glaucoma drug.
Because of its efficacy and safety, Rescula’s main role is
additive to primary therapy of all drug classes when monotherapy
fails to achieve target IOP, and combination therapy is needed.
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