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Metipranolol

Pronunciation: (meh-tih-PRAN-oh-lahl)
Class: Beta-adrenergic blocking agent

Trade Names:
OptiPranolol
- Ophthalmic solution 0.3%

Pharmacology

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Reduces IOP, probably by reducing aqueous humor production and to a minor extent by slightly increasing outflow.

Pharmacokinetics

Onset

30 min after a single administration.

Peak

Max effect occurs at about 2 h.

Duration

Reduced IOP can be demonstrated 24 h after a single application.

Indications and Usage

Treatment of elevated IOP in patients with ocular hypertension or glaucoma.

Contraindications

Patients with bronchial asthma, history of bronchial asthma, or severe COPD; symptoms of sinus bradycardia; greater than first degree AV block; cardiogenic shock; overt cardiac failure; hypersensitivity to any component.

Dosage and Administration

Adults

Ophthalmic 1 gtt in affected eye(s) twice daily.

Storage/Stability

Store at room temperature (59° to 86°F). Keep dropper bottle tightly closed.

Drug Interactions

Adrenergic psychotropic drugs

Use with caution.

Calcium channel antagonists, digoxin

May prolong AV conduction time.

Calcium channel antagonists (eg, diltiazem)

May precipitate left ventricular failure and hypotension.

Catecholamine-depleting drugs (eg, reserpine)

Possible additive effects and the production of hypotension and/or bradycardia.

Oral beta-adrenergic blockers (eg, propranolol)

Possible additive effects.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Angina; atrial fibrillation; bradycardia; hypertension; MI; palpitation.

CNS

Headache; anxiety; depression; dizziness; nervousness; somnolence.

Dermatologic

Rash.

EENT

Transient discomfort; abnormal vision; blepharitis; blurred vision; brow ache; conjunctivitis; edema; eyelid dermatitis; photophobia; tearing; uveitis; epistaxis; rhinitis.

GI

Nausea.

Musculoskeletal

Arthritis; asthenia; myalgia.

Respiratory

Bronchitis; coughing; dyspnea.

Miscellaneous

Allergy.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy not established.

Special Risk Patients

Use with caution in patients with history of cardiac failure, cerebrovascular insufficiency, diabetes, or COPD.

Anaphylaxis

Patients with a history of severe anaphylactic reaction to a variety of allergens may be more reactive to repeated challenge, either accidental, diagnostic, or therapeutic. Such patients are unresponsive to the usual doses of epinephrine used to treat allergic reactions.

Angle-closure glaucoma

To effectively reduce elevated IOP in angle-closure glaucoma, use with miotic agent.

Surgery

Some authorities recommend gradual withdrawal of beta-adrenergic receptor blocking agents in patient undergoing elective surgery.

Systemic absorption

Ophthalmic solution may produce same adverse reactions seen with systemic use because of absorption.

Thyrotoxicosis

May mask signs of developing or continuing hyperthyroidism. Abrupt withdrawal may exacerbate symptoms of hyperthyroidism, including thyroid storm.

Overdosage

Symptoms

Bradycardia, hypotension, acute cardiac failure.

Patient Information

Advise patient that usual dose is 1 gtt instilled into the affected eye(s) twice daily.
Teach patient proper technique for instilling eye gtt: wash hands; do not allow dropper tip to touch eye. Tilt head back; look up; pull lower eyelid down; instill prescribed number of gtt. Close eye for 1 to 2 min and apply gentle pressure to bridge of nose for 3 to 5 min. Do not rub eye.
Advise patient that if more than 1 topical ophthalmic drug is being used, to administer the drugs at least 10 min apart.
Advise patient who wears contact lenses to remove lenses before instilling this medicine and to wait at least 15 min after instilling eye gtt before reinserting lenses.
Inform patient that temporary stinging or eye discomfort are the most common adverse reactions and to contact health care provider if they occur and are bothersome.
Advise patient that medication may cause temporary blurring of vision and to use caution driving or performing other tasks requiring good vision until tolerance is determined.
Advise patient to discontinue therapy and immediately notify health care provider if serious or unusual reactions occur in the eye (eg, eye or eyelid inflammation).
Advise patient to contact eye doctor if eye is injured or if having eye surgery.