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Betoptic S Side Effects

Generic Name: betaxolol ophthalmic

Note: This page contains information about the side effects of betaxolol ophthalmic. Some of the dosage forms included on this document may not apply to the brand name Betoptic S.

Not all side effects for Betoptic S may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to betaxolol ophthalmic: ophthalmic solution, ophthalmic suspension

In addition to its needed effects, some unwanted effects may be caused by betaxolol ophthalmic (the active ingredient contained in Betoptic S). In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking betaxolol ophthalmic:

More common
  • Pain in the eye
  • Blistering, peeling, or loosening of skin
  • blue lips, fingernails, or skin
  • blurred vision
  • change in color vision
  • chest pain or discomfort
  • chills
  • cough
  • crusting of eyelashes
  • decreased urine output
  • decreased vision
  • diarrhea
  • different size pupils of the eyes
  • difficulty in breathing, chewing, swallowing, or talking
  • difficulty seeing at night
  • dilated neck veins
  • double vision
  • drainage from eyes
  • drooping eyelids
  • extreme fatigue
  • fast, slow, or irregular heartbeat
  • feeling of having something in the eye
  • hives
  • increased sensitivity of eyes to sunlight
  • irregular, fast or slow, or shallow breathing
  • irritation or inflammation of eye
  • itching, dryness of eyes
  • itching skin
  • joint or muscle pain
  • lightheadedness, dizziness, or fainting
  • muscle weakness
  • noisy breathing
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • severe tiredness
  • shortness of breath
  • skin rash
  • sore throat
  • sores, ulcers, or white spots in mouth or on lips
  • sweating
  • swelling of eyelids
  • swelling of face, fingers, feet, or lower legs
  • tearing
  • thickened mucous from lungs
  • tightness in chest
  • troubled breathing
  • unusual tiredness or weakness
  • weight gain
  • wheezing

Some of the side effects that can occur with betaxolol ophthalmic may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

  • Bad, unusual, or unpleasant (after) taste
  • change in sense of smell
  • change in taste
  • discouragement
  • feeling of constant movement of self or surroundings
  • feeling sad or empty
  • hair loss
  • headaches
  • irritability
  • lack of appetite
  • loss of interest or pleasure
  • redness, swelling, or soreness of tongue
  • sensation of spinning
  • sleeplessness
  • tiredness
  • trouble concentrating
  • trouble sleeping
  • unable to sleep
  • unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness

For Healthcare Professionals

Applies to betaxolol ophthalmic: ophthalmic solution, ophthalmic suspension


Although systemic adverse events are infrequently reported, topically applied betaxolol ophthalmic (the active ingredient contained in Betoptic S) drops may be absorbed systemically and side effects similar to systemically administered betaxolol or other beta-blockers such as severe respiratory or cardiac reactions may be experienced.[Ref]


Ocular side effects have frequently included transient ocular discomfort and ocular irritation in up to 25% of patients. Blurred vision, corneal punctate keratitis, foreign body sensation, photophobia, tearing, itching, dryness of eyes, erythema, inflammation, discharge, ocular pain, decreased visual acuity, crusty lashes, noninfectious dendritic epithelial keratitis, anisocoria, photophobia, and anterior uveitis have been reported rarely. A smaller number of patients with glaucoma may have corneal sensitivity to betaxolol. In addition, choroidal detachment has been reported after filtration procedures and cases of bacterial keratitis have been reported as a result of inadvertent contamination by patients.[Ref]

Betaxolol has caused histamine release from human leukocytes, which may account for its irritant effects.[Ref]


An 81-year-old man with a history of hypertension and glaucoma suffered an acute myocardial infarction within five minutes after a single drop of betaxolol 0.5% ophthalmic solution. The author believes that betaxolol may have allowed alpha-mediated coronary artery vasospasm, although severe hypotension or an arrhythmia could not be ruled out. Carotid sinus syncope was considered as a result of hyperextension of the patient's neck while using the eyedrops, but was thought to be unlikely since the syncope occurred minutes later.[Ref]

Cardiovascular side effects have included bradycardia, heart block and congestive failure. It should be noted that death due to cardiac failure has been reported following use of topical beta-blockers.

One case of myocardial infarction has been associated with betaxolol.[Ref]


Respiratory side effects are related to the ability of betaxolol to inhibit bronchodilation, which may be important in some patients with reversible airway disease, including asthma or severe obstructive lung disease.

A 74-year-old woman with a subarachnoid hemorrhage developed acute pulmonary edema and wheezing after betaxolol eyedrops and intravenous labetalol were administered for open angle glaucoma and hypertension. Congestive heart failure and hypervolemia were ruled out by hemodynamic measurements. The authors of this case report diagnosed acute bronchospasm based on the clinical picture and low cardiac filling pressures. The patient had never smoked, had no personal or family history of asthma, ruled out for myocardial infarction, developed no new ECG findings, and had no recurrent wheezing or hypoxemia when captopril was substituted for labetalol and betaxolol was discontinued.[Ref]

Respiratory side effects have included dyspnea, bronchospasm, thickened bronchial secretions, asthma. and respiratory failure.[Ref]

Nervous system

Nervous system side effects have included nightmares, insomnia, dizziness, vertigo, headache, depression, lethargy, and increases in the signs and symptoms of myasthenia gravis.[Ref]

A 75-year-old man experienced chronic and frightening nightmares associated with betaxolol eyedrops, which were alleviated after he shut his eyes tightly after administration. By doing so, the lacrimal ducts were occluded, which is thought to significantly decrease the systemic absorption of the eyedrops.[Ref]


Gastrointestinal side effects have rarely included general gastrointestinal disturbances, such as diarrhea or nausea.[Ref]


Hypersensitivity side effects have included dermatitis, hives, and toxic epidermal necrolysis.[Ref]


Dermatologic side effects have included hair loss and glossitis.[Ref]


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4. Weissman SS, Asbell PA "Effects of topical timolol (0.5%) and betaxolol (0.5%) on corneal sensitivity." Br J Ophthalmol 74 (1990): 409-12

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6. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.

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9. Jain S "Betaxolol-associated anterior uveitis." Eye 8 (1994): 708-9

10. Chamberlain TJ "Myocardial infarction after ophthalmic betaxolol." N Engl J Med 321 (1989): 1342

11. Stewart WC, Castelli WP "Systemic side effects of topical beta-adrenergic blockers." Clin Cardiol 19 (1996): 691-7

12. Beresford R, Heel RC "Betaxolol. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in hypertension." Drugs 31 (1986): 6-28

13. Koh KK, Kwon KS, Park HB, Baik SH, Park SJ, Lee KH, Kim EJ, Kim SH, Cho SK, Kim SS "Efficacy and safety of digoxin alone and in combination with low-dose diltiazem or betaxolol to control ventricular rate in chronic atrial fibrillation." Am J Cardiol 75 (1995): 88-90

14. Herschman Z, Kaufman B "Complications arising from the use of ophthalmologic medications in an intensive care unit patient." N Y State J Med 89 (1989): 537-8

15. Adverse Drug Reactions Advisory Committee "Systemic adverse reactions with betaxolol eye drops." Med J Aust 162 (1995): 84

16. Mort JR "Nightmare cessation following alteration of ophthalmic administration of a cholinergic and a beta-blocking agent." Ann Pharmacother 26 (1992): 914-6

17. O'Donnell BF, Foulds IS "Contact allergy to beta-blocking agents in ophthalmic preparations." Contact Dermatitis 28 (1993): 121-2

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