levobunolol (Ophthalmic route)

lee-voe-BUE-noe-lol

Commonly used brand name(s)

In the U.S.

  • Betagan

In Canada

  • Ratio-Levobunolol

Available Dosage Forms:

  • Solution

Therapeutic Class: Antiglaucoma

Pharmacologic Class: Beta-Adrenergic Blocker, Nonselective

Uses For levobunolol

Levobunolol is used alone or together with other medicines to treat increased pressure in the eye that is caused by open-angle glaucoma or a condition called ocular (eye) hypertension. levobunolol is a beta-blocker .

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levobunolol is available only with your doctor's prescription .

Before Using levobunolol

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For levobunolol, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to levobunolol or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of levobunolol in the pediatric population. Safety and efficacy have not been established .

Geriatric

Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of levobunolol in the elderly .

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking levobunolol, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using levobunolol with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Albuterol
  • Amiodarone
  • Arformoterol
  • Bambuterol
  • Clenbuterol
  • Colterol
  • Crizotinib
  • Diltiazem
  • Dronedarone
  • Epinephrine
  • Fenoldopam
  • Fenoterol
  • Fingolimod
  • Formoterol
  • Hexoprenaline
  • Indacaterol
  • Isoetharine
  • Levalbuterol
  • Metaproterenol
  • Pirbuterol
  • Procaterol
  • Reproterol
  • Ritodrine
  • Salmeterol
  • Terbutaline
  • Tretoquinol
  • Tulobuterol
  • Verapamil
  • Vilanterol

Using levobunolol with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acarbose
  • Aceclofenac
  • Acemetacin
  • Acetohexamide
  • Alfuzosin
  • Amlodipine
  • Amtolmetin Guacil
  • Arbutamine
  • Aspirin
  • Benfluorex
  • Bromfenac
  • Bufexamac
  • Bunazosin
  • Celecoxib
  • Chlorpropamide
  • Choline Salicylate
  • Clonixin
  • Dexibuprofen
  • Dexketoprofen
  • Diclofenac
  • Diflunisal
  • Dipyrone
  • Doxazosin
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Felbinac
  • Felodipine
  • Fenoprofen
  • Fepradinol
  • Feprazone
  • Floctafenine
  • Flufenamic Acid
  • Flurbiprofen
  • Gliclazide
  • Glimepiride
  • Glipizide
  • Gliquidone
  • Glyburide
  • Guar Gum
  • Ibuprofen
  • Ibuprofen Lysine
  • Indomethacin
  • Insulin
  • Insulin Aspart, Recombinant
  • Insulin Glulisine
  • Insulin Lispro, Recombinant
  • Ketoprofen
  • Ketorolac
  • Lacidipine
  • Lercanidipine
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Manidipine
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Metformin
  • Mibefradil
  • Miglitol
  • Morniflumate
  • Moxisylyte
  • Nabumetone
  • Naproxen
  • Nepafenac
  • Nicardipine
  • Nifedipine
  • Niflumic Acid
  • Nilvadipine
  • Nimesulide
  • Nimodipine
  • Nisoldipine
  • Nitrendipine
  • Oxaprozin
  • Oxyphenbutazone
  • Parecoxib
  • Phenoxybenzamine
  • Phentolamine
  • Phenylbutazone
  • Piketoprofen
  • Piroxicam
  • Pranidipine
  • Pranoprofen
  • Prazosin
  • Proglumetacin
  • Propyphenazone
  • Proquazone
  • Repaglinide
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Sodium Salicylate
  • St John's Wort
  • Sulindac
  • Tamsulosin
  • Tenoxicam
  • Terazosin
  • Tiaprofenic Acid
  • Tolazamide
  • Tolbutamide
  • Tolfenamic Acid
  • Tolmetin
  • Trimazosin
  • Troglitazone
  • Urapidil
  • Valdecoxib

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of levobunolol. Make sure you tell your doctor if you have any other medical problems, especially:

  • Asthma or
  • Bradycardia (slow heartbeat) or
  • Chronic obstructive pulmonary disease (COPD), severe or
  • Heart block or
  • Heart failure—Should not use in patients with these conditions .
  • Blood vessel disease (especially blood vessels in the brain) or
  • Stroke, history of—Use with caution. levobunolol may worsen these conditions .
  • Diabetes or
  • Hyperthyroidism (overactive thyroid) or
  • Hypoglycemia (low blood sugar)—May cover up some of the signs and symptoms of these diseases, such as a fast heartbeat .
  • Lung disease—Use with caution. May cause difficulty with breathing in patients with this condition .
  • Myasthenia gravis—May worsen symptoms of this condition, such as muscle weakness .
  • Sulfite allergy—Use with caution. levobunolol contains a small amount of sodium metabisulfite .

Proper Use of levobunolol

Shake the medicine well just before each use .

To use the eye drops (solution):

  • First, wash your hands. Tilt the head back and, pressing your finger gently on the skin just beneath the lower eyelid, pull the lower eyelid away from the eye to make a space. Drop the medicine into this space. Let go of the eyelid and gently close the eyes. Do not blink. Keep the eyes closed and apply pressure to the inner corner of the eye with your finger for 1 or 2 minutes to allow the medicine to be absorbed by the eye.
  • Immediately after using the medicine, wash your hands to remove any medicine that may be on them.
  • To keep the medicine as germ-free as possible, do not touch the applicator tip to any surface (including the eye). Also, keep the container tightly closed. Serious damage to the eye and possible loss of vision may result from using contaminated eye medicines .

If your doctor ordered two different eye medicines to be used together, wait several minutes before using the second medicine. This will help prevent the second medicine from “washing out” the first one .

Dosing

The dose of levobunolol will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of levobunolol. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For ophthalmic solution dosage form (eye drops):
    • For glaucoma or ocular hypertension:
      • Adults—One to two drops in the affected eye(s) once a day. Your doctor may increase your dose to 1 to 2 drops two times a day, if needed.
      • Children—Use and dose must be determined by your doctor .

Missed Dose

If you miss a dose of levobunolol, apply it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using levobunolol

It is very important that your doctor check your progress at regular visits to make sure levobunolol is working properly and to check for unwanted effects .

If itching, redness, swelling, or other signs of eye or eyelid irritation occur, stop using levobunolol and check with your doctor. These signs may mean that you are allergic to levobunolol .

Levobunolol may cause heart failure in some patients. Check with your doctor right away if you are having chest pain or discomfort; dilated neck veins; extreme fatigue; irregular breathing; an irregular heartbeat; shortness of breath; swelling of the face, fingers, feet, or lower legs; weight gain; or wheezing .

levobunolol may cause changes in your blood sugar levels. Also, levobunolol may cover up signs of low blood sugar, such as a rapid pulse rate. Check with your doctor if you have these problems or if you notice a change in the results of your blood or urine sugar tests .

Make sure any doctor or dentist who treats you knows that you are using levobunolol. You may need to stop using levobunolol several days before having surgery .

levobunolol Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • Burning or stinging in eye
  • drainage from the eye
  • redness, swelling, and/or itching of eye and eyelid
Less common
  • Blurred vision
  • chest pain or discomfort
  • confusion
  • dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
  • shortness of breath
  • slow or irregular heartbeat
  • sweating
  • unusual tiredness or weakness
Rare
  • Eye pain
  • headache
  • hives or welts
  • itching skin
  • redness of skin
  • shakiness and unsteady walk
  • skin rash
  • tearing
  • unsteadiness, trembling, or other problems with muscle control or coordination
  • unusual drowsiness, dullness, or feeling of sluggishness
Incidence not determined
  • Blistering, peeling, loosening of skin
  • blue lips, fingernails, or skin
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • chills
  • cough
  • decreased urine output
  • diarrhea
  • difficult or labored breathing
  • difficulty in chewing, swallowing, or talking
  • dilated neck veins
  • disturbed color perception
  • double vision
  • drooping eyelids
  • extreme fatigue
  • fast, pounding, or racing heartbeat or pulse
  • fever
  • halos around lights
  • hoarseness
  • inability to speak
  • irregular, fast or slow, or shallow breathing
  • irritation
  • joint pain, stiffness, or swelling
  • muscle pain
  • muscle weakness
  • night blindness
  • no blood pressure or pulse
  • noisy breathing
  • overbright appearance of lights
  • red skin lesions, often with a purple center
  • seeing double
  • seizures
  • severe numbness, especially on one side of the face or body
  • severe or sudden headache
  • severe tiredness
  • slurred speech
  • sore throat
  • sores, ulcers, or white spots in mouth or on lips
  • stopping of heart
  • swelling of eyelids, face, lips, hands, fingers, feet, or lower legs
  • temporary blindness
  • tightness in chest
  • troubled breathing
  • tunnel vision
  • unconsciousness
  • weakness in arm and/or leg on one side of the body, sudden and severe
  • weight gain
  • wheezing

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not determined
  • Decreased interest in sexual intercourse
  • discouragement
  • feeling sad or empty
  • inability to have or keep an erection
  • irritability
  • lack of appetite
  • lack or loss of strength
  • loss in sexual ability, desire, drive, or performance
  • loss of interest or pleasure
  • nausea
  • stuffy nose
  • tiredness
  • trouble concentrating
  • trouble sleeping

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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