Levobunolol

Pronunciation: LEE-voe-BYOO-no-lahl
Class: Beta-adrenergic blocking agent, Ophthalmic

Trade Names

Betagan Liquifilm
- Solution 0.25%
- Solution 0.5%

PMS-Levobunolol (Canada)
ratio-Levobunolol (Canada)

Pharmacology

Reduces IOP by reducing aqueous humor production.

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Pharmacokinetics

Onset

1 h after treatment.

Peak

2 to 6 h.

Duration

Up to 24 h.

Indications and Usage

Treatment of IOP in chronic open-angle glaucoma or ocular hypertension.

Contraindications

Bronchial asthma; severe COPD; sinus bradycardia; second- and third-degree AV block; cardiac failure; cardiogenic shock.

Dosage and Administration

Adults

Topical 1 drop in affected eye(s) once or twice daily.

General Advice

  • Position patient with head tilted back. Instruct patient to look upward. Gently depress conjunctival sac to create small area for medication administration.
  • Compress lacrimal sac for at least 1 min after administration to delay drainage of medication into nasolacrimal duct and to prevent systemic absorption.
  • Have patient tilt head back, pull lower lid out to make pocket, and instill medication into conjunctival sac. Have patient close eyes and apply light finger pressure to bridge of nose for 1 to 2 min. Advise patient to not blink or rub eyes.

Storage/Stability

Store at room temperature. Protect from light.

Drug Interactions

Beta blockers, oral

Additive effects on systemic beta blockade.

Epinephrine, ophthalmic

Hypertension caused by unopposed alpha-adrenergic stimulation.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Arrhythmia; bradycardia; hypotension; syncope; heart block; cerebrovascular accident; cerebral ischemia; CHF; cardiac arrest.

CNS

Headache; depression.

Dermatologic

Rash.

EENT

Keratitis; blepharoptosis; visual disturbances; diplopia; ptosis; transient burning; stinging; blepharoconjunctivitis; decreased corneal sensitivity.

GI

Nausea.

Respiratory

Bronchospasm.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy not established.

Special Risk Patients

Use with caution in patients with cerebrovascular insufficiency and bronchial diseases.

Sulfite Sensitivity

Contains metabisulfite, which may cause allergic-type reactions in susceptible persons.

Diabetes mellitus

May mask hypoglycemic symptoms in patients with insulin-dependent diabetes. Use with caution.

Systemic absorption

Adverse reactions like those seen with systemic beta-blockers may occur, due to absorption.

Thyroid disorders

May mask clinical signs of hyperthyroidism.

Overdosage

Symptoms

Bradycardia, hypotension, bronchospasm, heart failure.

Patient Information

  • Instruct patient in proper administration. Advise patient that if dose is missed, it should be administered as soon as possible unless close to time of next dose. Do not double up.
  • Caution patient not to stop taking medication unless instructed to do so by health care provider.
  • Emphasize importance of washing hands before drug administration and of not allowing dropper to come into contact with any surface, including eyelashes.
  • Instruct patient to report the following symptoms to health care provider: eye infection, inflammation, rash, itching or decreased vision.
  • Instruct patient to notify health care provider immediately if severe or sudden eye pain occurs.
  • Advise diabetic patient that drug may mask signs of hypoglycemia and to monitor glucose levels carefully.
  • Advise patient to inform health care provider or dentist of medication regimen before surgical or dental procedures. Gradual withdrawal of medication may be necessary before procedure.
  • Explain importance of scheduling regular follow-up examinations while taking medication.

Copyright © 2009 Wolters Kluwer Health.

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