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Metipranolol ophthalmic Side Effects

Not all side effects for metipranolol ophthalmic 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 metipranolol ophthalmic: ophthalmic solution

In addition to its needed effects, some unwanted effects may be caused by metipranolol ophthalmic. 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 metipranolol ophthalmic:

Incidence not determined
  • Bloody nose
  • blurred vision
  • burning, dry, or itching eyes
  • changes in vision
  • chest pain or discomfort
  • cough producing mucus
  • difficult or labored breathing
  • difficulty in moving
  • difficulty seeing at night
  • difficulty swallowing
  • discharge, excessive tearing
  • fast, slow, irregular, pounding, or racing heartbeat or pulse
  • headache
  • hives
  • increased sensitivity of eyes to sunlight
  • itching
  • lightheadedness, dizziness, or fainting
  • muscle pain or stiffness
  • nausea
  • nervousness
  • pain in forehead
  • pain or discomfort in arms, jaw, back, or neck
  • pain, swelling, or redness in joints
  • pounding in the ears
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • redness, pain, swelling, or itching of the eye, eyelid, or inner lining of eyelid
  • shortness of breath
  • skin rash
  • sweating
  • tightness in chest
  • unusual tiredness or weakness
  • wheezing
  • vomiting

If any of the following symptoms of overdose occur while taking metipranolol ophthalmic, get emergency help immediately:

Symptoms of overdose
  • Confusion
  • dilated neck veins
  • dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
  • extreme fatigue
  • irregular breathing
  • swelling of face, fingers, feet, or lower legs
  • weight gain

Some of the side effects that can occur with metipranolol 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:

Incidence not determined
  • Discouragement
  • feeling sad or empty
  • irritability
  • lack of appetite
  • lack or loss of strength
  • loss of interest or pleasure
  • muscle aching or cramping
  • runny nose
  • sleepiness or unusual drowsiness
  • sneezing
  • stuffy nose
  • tiredness
  • trouble concentrating
  • trouble sleeping

For Healthcare Professionals

Applies to metipranolol ophthalmic: ophthalmic solution


Metipranolol may induce at least three types of ocular inflammation: granulomatous anterior uveitis, combined granulomatous anterior uveitis, and blepharoconjunctivitis. In one study of 247 patients, 50 eyes from 28 patients showed over 70 episodes of ocular inflammation. These types of inflammation are associated with increased intraocular pressure (IOP) in 12% to 15% of normal eyes. The incidence of increased IOP in patients with metipranolol-induced ocular inflammation was approximately 60%. Of 45 cases of ocular inflammation with elevated IOP, 42 (93%) were attributed to metipranolol 0.6%, and 3 (7%) were attributed to metipranolol 0.3% solution. This increased risk of increased IOP suggests that metipranolol may cause secondary elevation of IOP. The mechanism is not known, but may involve drug-induced changes in the trabecular meshwork. Because of this, the drug has been withdrawn from the market in England by the manufacturer.

Metipranolol has caused histamine release in human leukocytes, which may account for its irritant effects.

In most patients stinging and burning upon instillation of the drug is transient and of insufficient severity to warrant discontinuation of the drug.[Ref]

Ocular side effects have included a stinging and burning sensation upon instillation of the drug in 30% to 80% of patients. Hyperemia of the eyelid and conjunctiva, slight reductions in tear production, pruritus, photophobia, or foreign body sensation are reported in up to 25% of patients. Abnormal vision, blepharitis, blurred vision, browache, conjunctivitis, edema, eyelid dermatitis, tearing, and uveitis have been reported rarely. Ocular inflammation with secondary elevation of intraocular pressure has also been reported.[Ref]


In one study of 2,483 patients with glaucoma, the use of ocular metipranolol 0.3% and 0.6% for 12 months was not associated with clinically relevant changes in heart rate or blood pressure. Of note, however, patients with preexisting bradycardia or conduction abnormalities were excluded from study participation.

Reports of changes in heart rate and blood pressure are usually observed 45 minutes after drug administration, and are usually clinically insignificant. Heart rate reductions of 1 to 4 bpm or systolic blood pressure reductions of 11 mmHg may be observed.[Ref]

Cardiovascular side effects have rarely included changes in heart rate and blood pressure, angina, atrial fibrillation, bradycardia, hypertension, palpitation, and myocardial infarct.

Cardiovascular side effects associated with other ophthalmic beta blockers have included heart failure.[Ref]


Respiratory side effects have rarely included bronchitis, coughing, dyspnea, rhinitis, and acute pulmonary edema.

Respiratory side effects associated with other beta blockers and/or metipranolol have included bronchospasm.[Ref]

Patients with a reactive component to their lung disease, such as bronchial asthma, receiving metipranolol ophthalmic therapy should be closely monitored for bronchospasm.

In one study of 10 asthmatic patients (studied between asthmatic episodes and without respiratory infection), an average decrease of 15.1% in the forced expiratory volume in one second (FEV1) was observed after the administration of metipranolol, reaching a nadir at 45 minutes after drug administration. No change in vital capacity was observed.

In one study of 47 patients with open or narrow angle glaucoma, one developed respiratory difficulties. Because patients with preexisting reactive airways disease were excluded from study participation, this incidence may be underestimated.

A 72-year-old woman with no history of pulmonary or cardiac disease developed signs and symptoms consistent with acute cardiogenic pulmonary edema within 1 hour after using metipranolol eyedrops. Inadvertent rechallenge was positive.[Ref]

Nervous system

Headache or fatigue rarely necessitate therapy withdrawal.[Ref]

Nervous system side effects have included headache and fatigue in up to 5% of patients. Anxiety, dizziness, nervousness, and somnolence have been reported rarely.[Ref]


Local side effects have rarely included periorbital dermatitis and marginal keratitis.[Ref]


Hypersensitivity side effects have rarely included allergic reactions.[Ref]

A 52-year-old woman with glaucoma developed bilateral periorbital dermatitis associated with the use of metipranolol 0.6% eye drops. Skin patch testing revealed 2+ sensitivity to racemic metipranolol base and to penbutolol sulfate. Controls were negative.[Ref]


Psychiatric side effects have rarely included depression.[Ref]


Musculoskeletal side effects have rarely included arthritis, asthenia, and myalgia.[Ref]


Other side effects have rarely included epistaxis.[Ref]


Gastrointestinal side effects have rarely included nausea.[Ref]


Dermatologic side effects have rarely included rash.[Ref]


Endocrine side effects associated with ophthalmic beta blockers have included masking of both the signs and symptoms of hypoglycemia in insulin-dependent diabetics, and hyperthyroidism/thyroid storm.[Ref]


Metipranolol is generally well-tolerated. Side effects are usually mild and transient. Systemic side effects are unusual because of the low systemic absorption of ophthalmic metipranolol; however, side effects similar to other systemically administered beta-blockers may be experienced.[Ref]


1. Schultz JS, Hoenig JA, Charles H "Possible bilateral anterior uveitis secondary to metipranolol (optipranolol) therapy." Arch Ophthalmol 111 (1993): 1606-7

2. "Product Information. OptiPranolol (metipranolol)." Bausch and Lomb, Tampa, FL.

3. vanBeek LM, Mulder M, vanHaeringen NJ, Kijlstra A "Topical ophthalmic beta blockers may cause release of histamine through cytotoxic effects on inflammatory cells." Br J Ophthalmol 84 (2000): 1004-7

4. Akingbehin T, Villada JR "Metipranolol-induced adverse reactions: II. Loss of intraocular pressure control." Eye 6(Pt 3) (1992): 280-3

5. Kebler C "Possible bilateral anterior uveitis secondary to metipranolol (optipranolol) therapy." Arch Ophthalmol 112 (1994): 1277

6. Melles RB, Wong IG "Metipranolol-associated granulomatous iritis." Am J Ophthalmol 118 (1994): 712-5

7. Krieglstein GK, Novack GD, Voepel E, Schwarzbach G, Lange U, Schunck KP, Lue JC, Glavinos EP "Levobunolol and metipranolol: comparative ocular hypotensive efficacy, safety, and comfort." Br J Ophthalmol 71 (1987): 250-3

8. Akingbehin T, Villada JR, Walley T "Metipranolol-induced adverse reactions: I. The rechallenge study." Eye 6(Pt 3) (1992): 277-9

9. Serle JB, Lustgarten JS, Podos SM "A clinical trial of metipranolol, a noncardioselective beta- adrenergic antagonist, in ocular hypertension." Am J Ophthalmol 112 (1991): 302-7

10. Akingbehin T, Villada JR "Metipranolol-associated granulomatous anterior uveitis." Br J Ophthalmol 75 (1991): 519-23

11. Battershill PE, Sorkin EM "Ocular metipranolol. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in glaucoma and ocular hypertension." Drugs 36 (1988): 601-15

12. Kinshuck D "Glauline (metipranolol) induced uveitis and increase in intraocular pressure." Br J Ophthalmol 75 (1991): 575

13. Mills KB, Wright G "A blind randomised cross-over trial comparing metipranolol 0.3% with timolol 0.25% in open-angle glaucoma: a pilot study." Br J Ophthalmol 70 (1986): 39-42

14. Hickey-Dwyer M, Campbell SH, Harding S "Doubled-masked three-period crossover investigation of metipranolol in control of raised intraocular pressure." J Ocul Pharmacol 7 (1991): 277-83

15. Bacon PJ, Brazier DJ, Smith R, Smith SE "Cardiovascular responses to metipranolol and timolol eyedrops in healthy volunteers." Br J Clin Pharmacol 27 (1989): 1-5

16. Le Jeunne CL, Hugues FC, Dufier JL, Munera Y, Bringer L "Bronchial and cardiovascular effects of ocular topical B-antagonists in asthmatic subjects: comparison of timolol, carteolol, and metipranolol." J Clin Pharmacol 29 (1989): 97-101

17. Johns MD, Ponte CD "Acute pulmonary edema associated with ocular metipranolol use." Ann Pharmacother 29 (1995): 370-3

18. de Groot AC, Conemans J "Contact allergy to metipranolol." Contact Dermatitis 18 (1988): 107-8

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