This page shows what was measured, who it was measured in, and what that does not settle.
What Netarsudil does in the body
Netarsudil blocks the enzyme that keeps those cables under tension.
Fluid leaves the eye mainly through a spongy mesh at the base of the iris. In glaucoma that mesh stiffens, because the cells in it are holding themselves tight with an internal scaffolding of protein cables. The cells relax, the mesh opens, and fluid drains through the route it was always meant to use.
Why people take it. High pressure inside the eye, treated at the blocked drain itself
What happened in people
Non-inferiority to twice-daily timolol in the per-protocol population with maximum baseline IOP below 25 mmHg, across 1,167 randomised patients
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The recorded finding that sits closest to something a person would notice. Written into the record, not signed off, and it carries no population or interval.
Non-inferiority met in the per-protocol population with maximum baseline IOP < 25 mmHg as a POST HOC outcome measure; not met across the full enrolled range
Repeated elsewhere
Partially Replicated
What this does not prove. A study that did not show an effect does not show that no effect exists anywhere.
The limits of this study, and where it came from
Main limit. The population in which the drug can claim to match timolol was defined after the results were seen. Conjunctival hyperemia occurred in 53% (108 of 203) against 8% (17 of 208) on timolol, P < .0001.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Topical ophthalmic solution 0.02%, instilled once daily in the evening
Interval reported. Not recorded in this summary
Written into the record, not signed off as a reviewed claim.
Non-inferiority met; mean IOP at 8 AM 17.9 to 18.8 mmHg (netarsudil once daily), 17.2 to 18.0 (twice daily) and 17.5 to 17.9 (timolol) over 12 months
Repeated elsewhere
Partially Replicated
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. Conjunctival hyperemia 61% and 66% against timolol’s 14%; cornea verticillata 26% and 25% against 1%; conjunctival haemorrhage 20% and 19% against 1%. A separate non-interventional Corneal Observation Study was run for patients developing verticillata.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Topical ophthalmic solution 0.02%, instilled once daily in the evening
Interval reported. Not recorded in this summary
Written into the record, not signed off as a reviewed claim.
Intraocular pressure with once-daily netarsudil against twice-daily timolol in patients with baseline IOP below 30 mmHg
✓ The study showed what it set out to show
Who was studied
ROCKET-4 (NCT02558374)
How many people
708
Study design
Randomised, double-masked, phase 3, 6-month
Compared against
Not recorded for this study
Kind of result
A number that stands in for health
What was found
Reported by the label as demonstrating up to 5 mmHg reductions, with reductions similar to timolol for baseline IOP < 25 mmHg and up to 3 mmHg worse than timolol at morning time points for baseline IOP ≥ 25 mmHg
Repeated elsewhere
Partially Replicated
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. The stratification by baseline pressure at 25 mmHg recurs across all three registration studies and is the boundary of the drug’s demonstrated equivalence. Every comparison is against timolol, never against a prostaglandin analogue.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Topical ophthalmic solution 0.02%, instilled once daily in the evening
Interval reported. Not recorded in this summary
Written into the record, not signed off as a reviewed claim.
RNAWiki holds 3 written-up human studies for this substance, each with the question it asked.
How we know it
Each card names the study, the number of people and what the study set out to measure.
What this does not prove
These summaries were written by a person and have not been signed off as reviewed claims.
Why it matters
A study that failed is as informative as one that worked, and both are here.
What we still do not know
No reviewed claim exists, so no exact population, effect size or interval is published yet.
What it changes in the body◇Read from sources, not yet reviewed
The path through the body
From what a person takes to what changes. A solid line is a step measured in people. A dashed line is a step nobody has measured that way.
Start
Netarsudil
What a person takes: Topical ophthalmic solution 0.02%, instilled once daily in the evening.
The measurement behind this step
A once-daily evening drop of an ester prodrug, cleaved by ocular esterases during corneal passage to the more potent active metabolite netarsudil-M1. Evening dosing was used throughout the registration programme. Supplied as the dimesylate salt.
Getting in
One drop in the evening, containing a disguised molecule
What is in the bottle is not what does the work. A chemical group is attached that gets cut off inside the eye, releasing a more potent version.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Netarsudil dimesylate 0.02% is instilled once daily in the evening. The molecule is an ester of 2,4-dimethylbenzoic acid, and ocular esterases cleave it to netarsudil-M1, which is a more potent Rho kinase inhibitor than the parent. The ester exists to carry the compound across the cornea, as in the prostaglandin analogues.
The active form reaches the spongy tissue where fluid normally leaves the eye — the tissue that is actually blocked in this disease, and that no earlier drug touched.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Netarsudil-M1 reaches the trabecular meshwork and the inner wall of Schlemm’s canal, the site of the outflow resistance that defines open-angle glaucoma. Every earlier drug class acts either on aqueous production at the ciliary body or on the uveoscleral pathway, both anatomically distinct from this tissue.
It blocks the enzyme holding the cells under tension
The cells in that mesh keep themselves taut with internal protein cables. One enzyme maintains the tension. Netarsudil blocks it.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Netarsudil-M1 inhibits Rho-associated coiled-coil containing protein kinase, which phosphorylates myosin light chain and the myosin phosphatase targeting subunit to sustain actomyosin contractility. Inhibition permits dephosphorylation, disassembling actin stress fibres and focal adhesions in trabecular meshwork cells. The drug also inhibits the norepinephrine transporter, a second and pharmacologically separate activity.
With the tension released, the tissue becomes less stiff and the spaces in it widen. Fluid leaves through the route it was always supposed to use.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Loss of cell contractility and extracellular matrix tension reduces outflow resistance and increases conventional outflow facility. Netarsudil additionally lowers episcleral venous pressure, the back-pressure against which the conventional pathway drains, and reduces aqueous production through norepinephrine transporter inhibition. The label declines to commit to any of this, stating that the exact mechanism is unknown.
Pressure drops by up to five millimetres of mercury and stays down across twelve months. The comparison it was tested against is timolol, not the stronger modern drops.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
The label reports up to 5 mmHg reductions with once-daily evening dosing. In the twelve-month study, mean pressure at 8 AM fell from a baseline of 22.5 to 22.6 mmHg to 17.9 to 18.8 mmHg on once-daily netarsudil against 17.5 to 17.9 on timolol, sustained throughout. Non-inferiority was demonstrated only in the population with maximum baseline pressure below 25 mmHg.
The enzyme being blocked also keeps blood vessels in the white of the eye constricted. Blocking it dilates them, which is why more than half of patients get red eyes.
──Measured in people. Written by a person from the study named beside the step. Not signed off as a reviewed claim.
The measurement behind this step
Rho kinase inhibition relaxes vascular smooth muscle in conjunctival vessels, producing hyperemia in 53% of patients in the controlled trials, 61% at twelve months on once-daily dosing and 66% on twice-daily, against 8% to 14% on timolol. Six per cent of patients discontinued for hyperemia. Cornea verticillata occurred in about a quarter of patients at twelve months and conjunctival haemorrhage in about a fifth, against 1% each on timolol.
No suggested links are held for this record, so nothing is hidden from this path.
What we know
The record describes 6 steps from taking it to an effect in a person.
How we know it
Each step names the study behind it in the technical detail beside it.
What this does not prove
A change inside the body is a reason to look. It is not a result in a person.
Why it matters
A reader can see exactly where the chain stops being measured in people.
What we still do not know
No reviewed claim binds any of these steps to a named population.
What is missing or unclear◇Read from sources, not yet reviewed
Were people like you studied?
RNAWiki cannot tell whether a study fits you. It can show who was in it, and where the result stops carrying.
Who was studied
People similar to this profile were included.
Adults with open-angle glaucoma or ocular hypertension, usually after or alongside a prostaglandin analogue. The label reports it works less well than timolol in patients whose starting pressure is 25 mmHg or above.
Who is missing from the studies
Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
What the label states about particular groups
On pediatric, the label states: “Safety and effectiveness in pediatric patients below the age of 18 years have not been established.”
US prescribing information · 7d4f0e3a-5b86-4c43-982a-813b22ae7e22 · read 2026-08-30
On older people, the label states: “No overall differences in safety or effectiveness have been observed between elderly and other adult patients.”
US prescribing information · 7d4f0e3a-5b86-4c43-982a-813b22ae7e22 · read 2026-08-30
On people who are pregnant, the label states: “Risk Summary There are no available data on RHOPRESSA use in pregnant women to inform any drug associated risk; however, systemic exposure to netarsudil from ocular administration is low [see Clinical Pharmacology ( 12.3 ) ] .”
US prescribing information · 7d4f0e3a-5b86-4c43-982a-813b22ae7e22 · read 2026-08-30
On people who are breastfeeding, the label states: “Risk Summary There are no data on the presence of RHOPRESSA in human milk, the effects on the breastfed infant, or the effects on milk production.”
US prescribing information · 7d4f0e3a-5b86-4c43-982a-813b22ae7e22 · read 2026-08-30
Where the result stopped carrying
ROCKET-1 did not meet non-inferiority across its full enrolled range; the claim rests on a post hoc restricted population
The label states that above 25 mmHg baseline pressure, netarsudil gives smaller morning reductions than timolol, by as much as 3 mmHg
More than half of patients develop red eyes and 6% stop the drug for that alone
About a quarter develop corneal deposits over a year, a finding that required its own dedicated observational sub-study
This is a scope explorer, not a diagnosis engine.
It shows who was studied so you can see whether people similar to you were included.
RNAWiki cannot tell whether a study fits you. It can show who was in it.
What it would be like to take◇Read from sources, not yet reviewed
Why it might seem to do nothing
A real effect and a noticed effect are different things. These are the recorded reasons the two come apart.
It was studied in different people
The people in the studies were not much like the reader.
On this record: Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
The evidence may simply be wrong
Small early studies often do not hold up.
On this record: RNAWiki has not yet published a reviewed conclusion for this use.
Other reasons RNAWiki checked and found nothing for (11)
It was studied for a different goal
The studies measured something else entirely. Nothing in this record points to this reason.
A different form was studied
The studied form is not the form on the shelf. Nothing in this record points to this reason.
There was nothing to correct
Where a level is already normal, topping it up may change nothing. Nothing in this record points to this reason.
Something else had to happen too
In the studies it was paired with training, a diet or another treatment. Nothing in this record points to this reason.
The change is too small to feel
A real change can still sit below what a person notices. Nothing in this record points to this reason.
Day-to-day swing hides it
Sleep, food, stress and time of day move most numbers more than this would. Nothing in this record points to this reason.
Not enough time yet
The studies ran longer than the person has waited. Nothing in this record points to this reason.
It was not taken as studied
Missed days change the result, and studies count them. Nothing in this record points to this reason.
Something else changed at the same time
Two changes at once cannot be told apart afterwards. Nothing in this record points to this reason.
The product may not be what it says
Contents of a sold product are not always what the label states. Nothing in this record points to this reason.
No recorded reason
RNAWiki has nothing stored that would explain it. Nothing in this record points to this reason.
None of these is a reason to take more. Taking more is not a step this page ever suggests.
What it would be like to take◇Read from sources, not yet reviewed
What taking it involves
The recorded facts about getting hold of it and using it. Nothing here is a suggestion about what you should do.
How it is supplied
Prescription only
❝ Quoted from a source
Where this came from
Copied from a source RNAWiki stored, with the source named.
Read from the recorded approval status.
No source is stored against this line.
Form and route
Topical ophthalmic solution 0.02%, instilled once daily in the evening
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The form and route recorded on this substance.
No source is stored against this line.
Who oversees it
RNAWiki has not recorded a supervision or regulatory status for this substance.
❝ Quoted from a source
Where this came from
Copied from a source RNAWiki stored, with the source named.
No register row and no identity class settled the question.
No source is stored against this line.
What is in the pack
A once-daily evening drop of an ester prodrug, cleaved by ocular esterases during corneal passage to the more potent active metabolite netarsudil-M1. Evening dosing was used throughout the registration programme. Supplied as the dimesylate salt.
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
Recorded notes on how this is sold and what that means for what is in the pack.
No source is stored against this line.
Where it is registered
Regulatory records are listed in the technical disclosure at the foot of this page.
# Counted from records
Where this came from
A count of rows RNAWiki holds. It describes our records, not your body.
Register entries are stored per jurisdiction and shown with their dates.
No source is stored against this line.
Why people stop
Not recorded.
∅ Nothing recorded
Where this came from
RNAWiki holds nothing here and says so rather than guessing.
No record of why people stopped taking it is stored for this substance.
No source is stored against this line.
What it would be like to take◇Read from sources, not yet reviewed
What can go wrong
Sorted by where each line came from. A regulator's label and a report somebody sent in are not the same kind of fact.
·Worth asking a clinician aboutWritten into the record from the studies named on this page
Conjunctival hyperemia in 53% of patients, with 6% discontinuing because of it, rising to 61% and 66% for once- and twice-daily dosing at twelve months against 14% on timolol. Corneal verticillata, instillation site pain and conjunctival haemorrhage each at approximately 20% in the label, with verticillata at 26% and haemorrhage at 20% in the twelve-month study against 1% each on timolol. Instillation site erythema, corneal staining, blurred vision, increased lacrimation, eyelid erythema and reduced visual acuity also reported. No systemic beta-blockade and no respiratory or cardiac contraindications. The hyperemia and the corneal deposits are both direct consequences of the mechanism rather than formulation problems, so neither is addressable by reformulation.
Nobody counted how many people took this and were fine, so this cannot be turned into a rate.
Over a long time. No completed tested study window is recorded, so long-term effects are not established by the registry record.
Groups the studies covered thinly. Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
What is missing or unclear◇Read from sources, not yet reviewed
Does the exact form matter?
Evidence belongs to the exact thing that was tested. A different salt, a different mixture or a different preparation is a different question.
The form that was studied
Topical ophthalmic solution 0.02%, instilled once daily in the evening
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The form used in the studies cited on this page.
No source is stored against this line.
What is sold
Evening dosing was used throughout the registration programme. Supplied as the dimesylate salt.
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
Recorded notes on which forms are sold and how they compare.
No source is stored against this line.
What is recorded as being sold
4 products list this as an active ingredient in the United States drug directory. 3 of them contain it and nothing else.
FDA National Drug Code directory · 70727-497 · read 2026-08-29
They are sold as powder and solution/ drops, taken ophthalmic and topical.
FDA National Drug Code directory · 70727-497 · read 2026-08-29
The regulator's established pharmacologic class for it is rho kinase inhibitor [epc] and rho kinase inhibitors [moa].
FDA National Drug Code directory · 70727-497 · read 2026-08-29
2 published labels name it as an active ingredient. 1 of them describe this substance alone, which is where its own label text on this page comes from.
US prescribing information · 7d4f0e3a-5b86-4c43-982a-813b22ae7e22 · read 2026-08-29
Those labels are classed as human prescription drug.
US prescribing information · 7d4f0e3a-5b86-4c43-982a-813b22ae7e22 · read 2026-08-29
Rhopressa is ophthalmic at 3 DOSAGE FORMS AND STRENGTHS Ophthalmic solution containing netarsudil 0.02% (0.2 mg/mL)., recorded as fda label in effect 2026-01-20 in the United States.
US prescribing information · 7d4f0e3a-5b86-4c43-982a-813b22ae7e22 · read 2026-08-30
Evidence carries across two names for one substance. It does not carry across a salt, a mirror form or a mixture.
What it would be like to take◇Read from sources, not yet reviewed
What you could measure
This one is decided with a clinician, so this section holds questions to ask rather than a plan to run.
RNAWiki could not confidently classify this substance, so no self-experiment plan is offered.
Questions worth asking
Which of the trials of Netarsudil studied people like me?
What was measured, and for how long?
Was the result a laboratory value or a health outcome?
What would we watch for, and when would we stop?
Tracking can show whether something changed for you. It cannot show what caused it.
RNAWiki records evidence. It does not say whether this substance is right for you.
What is missing or unclear◇Read from sources, not yet reviewed
Claims that go past the evidence
Things said about this substance that sound reasonable, and the exact step that is missing between the evidence and the claim.
✗Goes past the evidence
That netarsudil works by relaxing the trabecular meshwork — the approved label states the exact mechanism is unknown
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That a novel outflow mechanism justifies 84 times the acquisition cost of generic latanoprost, which lowers pressure more in indirect comparison
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That the ROCKET-1 non-inferiority result is equivalent in weight to ROCKET-2’s; one was pre-specified and the other post hoc
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That non-inferiority to timolol implies comparability with the prostaglandin analogues, which the drug has never been tested against as a primary comparison
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
What is missing or unclear◇Read from sources, not yet reviewed
What nobody knows yet
Open questions, each with why it is open and what would close it.
Missing populations
Which groups were under-represented in the studies has not been recorded.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Missing long-term data
No completed tested study window is recorded.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
No reviewed conclusion
RNAWiki has not yet published a reviewed conclusion for this use.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Missing interaction studies
No interaction was found in the registers checked. Not finding one is not the same as showing there is none.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Formulation uncertainty
Several salts, forms or products of Netarsudil are recorded. Results from one form may not transfer to another.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Mechanism not reviewed
No reviewed mechanism story exists for this substance.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
What happened in people◇Read from sources, not yet reviewed
Check any of this yourself
Every line above traced back to the study it came from. This is the technical layer, and the vocabulary changes here.
Every line above can be traced to the study named beside it. Follow the link and read it.
ROCKET-1 met its endpoint only as a post hoc analysis in a subgroup
In plain words
Two trials in 1,167 patients tested whether netarsudil matched timolol. In the first one, the answer across the full pressure range was no, and the claim of non-inferiority comes from an analysis of a narrower group decided on after the results were in.
What was measured
Non-inferiority to timolol in the per-protocol population with maximum baseline IOP below 25 mmHg
Effect estimate
No reviewed effect estimate exists for this record.
Limits
This entry records a failure.
From the source
ROCKET-1 (411 patients) and ROCKET-2 (756 patients) were double-masked randomised non-inferiority trials enrolling 1,167 patients in total, comparing netarsudil 0.02% once daily against timolol 0.5% twice daily, with an additional netarsudil twice-daily arm in ROCKET-2. The published report states that netarsudil once daily was non-inferior to timolol in the per-protocol population with maximum baseline intraocular pressure below 25 mmHg in both studies — and specifies that this was the primary outcome measure and population in ROCKET-2, and a post hoc outcome measure in ROCKET-1. ROCKET-1 did not meet non-inferiority across its full enrolled range. The restriction is not a footnote: it defines the population in which the drug can claim to match a sixty-year-old generic.
Written into the record, not signed off as a reviewed claim
The label says it works worse than timolol above 25 mmHg
In plain words
The prescribing information states it plainly: in patients whose starting pressure was 25 millimetres of mercury or higher, netarsudil lowered morning pressure less than timolol did, by as much as three millimetres.
What was measured
Mean intraocular pressure reduction at morning time points, stratified by baseline pressure above and below 25 mmHg
Effect estimate
No reviewed effect estimate exists for this record.
Limits
This entry records a failure.
From the source
The Clinical Studies section states that across three randomised controlled trials — Study 301 (NCT02207491), Study 302 (NCT02207621) and Study 304 (NCT02558374) — netarsudil 0.02% once daily in the evening produced up to 5 mmHg reductions in pressure. For patients with baseline pressure below 25 mmHg, reductions were similar to timolol 0.5% twice daily. For patients at or above 25 mmHg, netarsudil resulted in smaller mean reductions at the morning time points than timolol at the Day 43 and Day 90 visits, with the difference as high as 3 mmHg favouring timolol. Studies 301 and 302 enrolled patients with baseline pressure below 27 mmHg and Study 304 below 30 mmHg. A drug that underperforms a generic beta-blocker at the pressures where treatment is most urgent has a narrower place than its approval implies.
Written into the record, not signed off as a reviewed claim
Half the eyes go red, and 6% of patients stop because of it
In plain words
Conjunctival redness affected 53% of patients in the controlled trials and 61% over twelve months. On timolol it was 8% to 14%. Six in a hundred patients stopped the drug because of the redness alone.
What was measured
Incidence of conjunctival hyperemia and discontinuation for hyperemia, netarsudil against timolol
Effect estimate
No reviewed effect estimate exists for this record.
Limits
This entry records a failure.
From the source
In the ROCKET-1 and ROCKET-2 three-month report, conjunctival hyperemia was the most frequent adverse event, ranging from 50% (126 of 251, ROCKET-2) to 53% (108 of 203, ROCKET-1) for netarsudil once daily, 59% (149 of 253, ROCKET-2) for twice daily, against 8% (17 of 208, ROCKET-1) to 11% (27 of 251, ROCKET-2) for timolol (P<.0001 for netarsudil against timolol). At twelve months in ROCKET-2 the figures were 61% once daily, 66% twice daily and 14% for timolol. The label records 53% and states that 6% of patients discontinued therapy because of conjunctival hyperemia. The hyperemia follows directly from Rho kinase inhibition relaxing conjunctival vascular smooth muscle, so it is inseparable from the mechanism.
Written into the record, not signed off as a reviewed claim
A quarter of patients develop deposits in the cornea
In plain words
Whorl-shaped deposits build up in the surface layer of the cornea in about a quarter of patients over a year. On timolol it happens to one in a hundred. Patients do not notice them; a clinician has to look.
What was measured
Incidence of cornea verticillata and conjunctival haemorrhage at 12 months, netarsudil against timolol
Effect estimate
No reviewed effect estimate exists for this record.
Limits
This entry records a failure.
From the source
In the twelve-month ROCKET-2 study of 756 patients — netarsudil once daily 251, twice daily 254, timolol 251 — corneal deposits (cornea verticillata) occurred in 26%, 25% and 1% respectively. Conjunctival haemorrhage, typically petechial, occurred in 20%, 19% and 1%. All three findings were generally scored as mild. The study ran a separate non-interventional Corneal Observation Study specifically for patients who developed verticillata, which is an acknowledgement that the finding needed dedicated follow-up rather than routine adverse event capture. The label summarises corneal verticillata, instillation site pain and conjunctival haemorrhage together at approximately 20%. Verticillata are asymptomatic in most patients and reported as reversible on discontinuation, which is reassuring and also means the true incidence outside a trial depends entirely on whether anyone is looking.
Written into the record, not signed off as a reviewed claim
Twelve-month durability with no loss of effect
In plain words
Over a full year, netarsudil held pressure in the same range as timolol, without the drift that beta-blockers can show. The pressures achieved were within about a millimetre of each other throughout.
What was measured
Mean intraocular pressure at 8 AM sustained over 12 months, three arms
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
In the twelve-month ROCKET-2 study, mean intraocular pressure at 8 AM decreased from a baseline of 22.5 to 22.6 mmHg to 17.9 to 18.8 mmHg with netarsudil once daily, 17.2 to 18.0 mmHg with netarsudil twice daily and 17.5 to 17.9 mmHg with timolol, sustained across twelve months. ROCKET-4 separately compared once-daily netarsudil against twice-daily timolol over six months in patients with baseline pressure below 30 mmHg. The durability result is real and is the strongest thing on this page. It is also a comparison against timolol, which the independent pooled analysis of 114 trials ranks sixth of fourteen first-line agents, more than a millimetre below the prostaglandin analogues.
Written into the record, not signed off as a reviewed claim
The first drug aimed at the tissue that actually fails
In plain words
For a hundred years, glaucoma drugs turned down fluid production or opened a side route. None of them touched the drain that is the actual problem. This is the first one that does, and the label still says the exact mechanism is unknown.
What was measured
That netarsudil works by relaxing the trabecular meshwork — the design rationale for the whole drug class, supported by cell and perfusion work, and described by the approved label as unknown
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
Open-angle glaucoma is a disease of increased outflow resistance at the trabecular meshwork and the inner wall of Schlemm’s canal. Beta-blockers and carbonic anhydrase inhibitors reduce aqueous production. Prostaglandin analogues increase uveoscleral outflow, a secondary route. Neither addresses the conventional pathway. Rho kinase inhibition disassembles actin stress fibres and focal adhesions in trabecular meshwork cells, reducing cell contractility and tissue stiffness and increasing conventional outflow facility, and netarsudil additionally inhibits the norepinephrine transporter and lowers episcleral venous pressure. The FDA label commits to none of this in detail: its Mechanism of Action section reads in full that netarsudil is a Rho kinase inhibitor believed to reduce intraocular pressure by increasing outflow of aqueous humour through the trabecular meshwork, and that the exact mechanism is unknown. A field-changing target and an explicitly unresolved mechanism are stated on the same page.
Source
RHOPRESSA (netarsudil ophthalmic solution) 0.02% US prescribing information, Mechanism of Action 12.1 (NDA 208254)
Role in the trial
Not matched to a registered study
Identity check
no open identity hold
Audit mark
contested
Review state
Written into the record, not signed off as a reviewed claim
Eighty-four times generic latanoprost, for non-inferiority to timolol
In plain words
A millilitre costs pharmacies US$131.76. A millilitre of generic latanoprost costs US$1.57 and lowers pressure more in indirect comparison. The clinical case for the difference is the mechanism, not the measurement.
What was measured
That a novel mechanism justifies an eighty-four-fold price difference against the incumbent, when the supporting trial claims non-inferiority to a still cheaper drug in a restricted population
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
In the CMS acquisition-cost survey effective 19 August 2026, netarsudil is listed as a single brand product at US$131.76 per millilitre. In the same survey on the same date, generic latanoprost is US$1.57 across 13 products, generic timolol US$1.06 across 65, and generic dorzolamide US$0.8910 across 23 — ratios of 84, 124 and 148. The clinical evidence supporting that price is non-inferiority to timolol in the population with baseline pressure below 25 mmHg, with the ROCKET-1 non-inferiority analysis being post hoc. Netarsudil is absent from the network meta-analysis of 114 randomised trials that ranks the first-line drops, because it was approved after that analysis was published, so no independent pooled estimate places it against the alternatives. The argument for the drug is that it acts on a pathway nothing else reaches and therefore adds to a prostaglandin analogue rather than overlapping with it. That argument is mechanistically sound and it is not the same thing as a measured comparative advantage.
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What is not here
7 questions this page could not answer
These sections were prepared and left out because there was nothing to put in them. They are listed rather than hidden, so the gaps in this record are visible.
What was measured, goal by goal — found nothing in the sources checked.
How close this is to real life — found nothing in the sources checked.
Felt, measured, or meaningful — found nothing in the sources checked.
How long anything takes — found nothing in the sources checked.
What it may clash with — found nothing in the sources checked.
Other ways to the same goal — found nothing in the sources checked.
What changed on this page — found nothing in the sources checked.
The record as stored
The full record, for auditing
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The older medicine-wide conclusion held in this record
Written for a clinical reader, and about the medicine as a whole rather than about one indication, population and set of trials. RNAWiki does not treat it as a programme conclusion and no reviewer has signed it off in that form. It is here word for word because it is what the record holds.
A Rho kinase and norepinephrine transporter inhibitor that relaxes the trabecular meshwork to open the eye’s main drain, non-inferior to timolol only in the restricted population with baseline pressure below 25 mmHg — a post hoc analysis in ROCKET-1 and the pre-specified one in ROCKET-2 — while causing conjunctival hyperemia in 53% of patients, corneal deposits in around a quarter, and costing US$131.76 per millilitre against generic latanoprost’s US$1.57.
Recorded evidence blocks (7)
Q1
On the Netarsudil label: indicated for what?
"RHOPRESSA is indicated for the reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. RHOPRESSA ® is a Rho kinase inhibitor indicated for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension.": indications and usage on Netarsudil's label. DailyMed label · 7d4f0e3a-5b86-4c43-982a-813b22ae7e22 · 2026-01-20
Q2
20 registered trials of Netarsudil — at which phases?
At the median, Netarsudil's trials enrolled 107.5 people — anything larger?
Median enrolment
107.5
Largest enrolment
756
Registered trials counted
20
Q6
What do 141 spontaneous reports say about Netarsudil — and not say?
These are reports people sent to a regulator. They do not show the medicine caused the reaction. Nobody counted how many people took the medicine and reported nothing. The same event can be reported more than once, and many reports are incomplete. News coverage, lawsuits and new warnings change how often people report. A count is not a rate and not a risk.
Netarsudil appears in spontaneous reports to regulators. Across the 10 most-reported reaction terms, 141 reaction mentions were counted: conjunctival hyperaemia 33; visual acuity reduced 24; corneal oedema 20; intraocular pressure increased 14. FAERS via Open Targets · CHEMBL4594250 · 2026-06-24
Show the evidence
conjunctival hyperaemia
33
visual acuity reduced
24
corneal oedema
20
intraocular pressure increased
14
vision blurred
13
cornea verticillata
8
4 more recorded rows
eye irritation
8
conjunctivitis allergic
7
eye pruritus
7
lacrimation increased
7
recorded 2026-06-24 · last checked 2026-09-04
Q7
Which 10 reactions does Netarsudil's label not list?
ChEMBL 37 — CC BY-SA 3.0 Unported · ChEMBL ATC CC BY-SA · ClinicalTrials.gov — US Government work · Open Targets 26.06 — CC0 · mixed register set; per-register licences in docs/specs/corpus-20k-sources.md · openFDA / DailyMed — US Government work
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✓ source coverage passed: 6 source rows
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