Metipranolol ophthalmic Side Effects
Some side effects of metipranolol ophthalmic may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
For the Consumer
Applies to metipranolol ophthalmic: ophthalmic solution
Along with its needed effects, metipranolol ophthalmic 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 while 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
- increased sensitivity of eyes to sunlight
- lightheadedness, dizziness, or fainting
- muscle pain or stiffness
- 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
- tightness in chest
- unusual tiredness or weakness
Get emergency help immediately if any of the following symptoms of overdose occur while taking metipranolol ophthalmic:Symptoms of overdose
- 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 side effects of metipranolol ophthalmic 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
- feeling sad or empty
- lack of appetite
- lack or loss of strength
- loss of interest or pleasure
- muscle aching or cramping
- runny nose
- sleepiness or unusual drowsiness
- stuffy nose
- trouble concentrating
- trouble sleeping
For Healthcare Professionals
Applies to metipranolol ophthalmic: ophthalmic solution
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.
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.
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.
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.
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.
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.
Headache or fatigue rarely necessitate therapy withdrawal.
Nervous system side effects have included headache and fatigue in up to 5% of patients. Anxiety, dizziness, nervousness, and somnolence have been reported rarely.
Local side effects have rarely included periorbital dermatitis and marginal keratitis.
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.
Hypersensitivity side effects have rarely included allergic reactions.
Psychiatric side effects have rarely included depression.
Musculoskeletal side effects have rarely included arthritis, asthenia, and myalgia.
Other side effects have rarely included epistaxis.
Gastrointestinal side effects have rarely included nausea.
Dermatologic side effects have rarely included rash.
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.
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.
More metipranolol ophthalmic resources
- metipranolol ophthalmic Concise Consumer Information (Cerner Multum)
- OptiPranolol drops MedFacts Consumer Leaflet (Wolters Kluwer)
- OptiPranolol Prescribing Information (FDA)
- Optipranolol Advanced Consumer (Micromedex) - Includes Dosage Information
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