Betagan

The recommended starting dose is one to two drops of Levobunolo ophthalmic solution 0.5% in the affected eye(s) once a day. Typical dosing with Levobunolol 0.25% is one to two drops twice daily. In patients with more severe or uncontrolled glaucoma, Levobunolo 0.5% can be administered b.i.d. As with any new medication, careful monitoring of patients is advised. Dosages above one drop of Levobunolol 0.5% b.i.d. are not generally more effective. If the patient's IOP is not at a satisfactory level on this regimen, concomitant therapy with dipivefrin and/or epinephrine, and/or pilocarpine and other miotics, and/or systemically administered carbonic anhydrase inhibitors, such as acetazolamide, can be instituted. Patients should not typically use two or more topical ophthalmic beta-adrenergic blocking agents simultaneously.

Levobunolol is a nonselective β-adrenergic blocking agent. It causes the reduction of intraocular pressure by decreasing the production of aqueous humour.

Common side effects are ocular stinging, burning, blepharoconjunctivitis, blepharitis, decreased visual acuity, band keratopathy, erythema, iridocyclitis, conjunctivitis and itching sensation; bradycardia, CVA, syncope, arrhythmia, heart block, hypotension, cerebral ischaemia, bronchospasm. Rarely, reduced corneal sensitivity and tearing.

Levobunolol ophthalmic solution is contraindicated in those individuals with bronchial asthma, or with a history of bronchial asthma, or severe chronic obstructive pulmonary disease; sinus bradycardia; second and third degree atrioventricular block; overt cardiac failure; cardiogenic shock; or hypersensitivity to any component of these products.

Patients with diminished pulmonary function, nonallergic bronchospasm, inadequate cardiac function, DM, myasthenia gravis. May mask signs and symptoms of hypoglycaemia and hyperthyroidism. Avoid abrupt withdrawal as it may precipitate thyroid storm. Pregnancy and lactation.

Additive hypotensive effect with catecholamine-depleting drug (e.g. reserpine), Ca channel blockers, β-adrenergic blockers, digitalis glycosides, antiarrhythmics, guanethidine, parasympathomimetics. Mydriasis may occur when used with epinephrine.