No

Beta Blocker, Nonselective; Ophthalmic Agent, Antiglaucoma

To lower intraocular pressure in chronic open-angle glaucoma or ocular hypertension

C

Known hypersensitivity to levobunolol; bronchial asthma, severe COPD, sinus bradycardia, second or third degree A-V block, cardiac failure, cardiogenic shock

Use with caution in patients with congestive heart failure, diabetes mellitus, hyperthyroidism; contains metabisulfite. Because systemic absorption does occur with ophthalmic administration, the elderly with other disease states or syndromes that may be affected by a beta-blocker (CHF, COPD, etc) should be monitored closely.

>10%: Ocular: Stinging/burning eyes

1% to 10%:

Cardiovascular: Bradycardia, arrhythmia, hypotension

Central nervous system: Dizziness, headache

Dermatologic: Alopecia, erythema

Local: Stinging, burning

Ocular: Blepharoconjunctivitis, conjunctivitis

Respiratory: Bronchospasm

<1%: Rash, itching, visual disturbances, keratitis, decreased visual acuity

Symptoms of intoxication include cardiac disturbances, CNS toxicity, bronchospasm, hypoglycemia and hyperkalemia. The most common cardiac symptoms include hypotension and bradycardia; atrioventricular block, intraventricular conduction disturbances, cardiogenic shock, and asystole may occur with severe overdose, especially with membrane-depressant drugs (eg, propranolol); CNS effects include convulsions, coma, and respiratory arrest is commonly seen with propranolol and other membrane-depressant and lipid-soluble drugs

Treatment includes symptomatic treatment of seizures, hypotension, hyperkalemia and hypoglycemia; bradycardia and hypotension resistant to atropine, isoproterenol or pacing may respond to glucagon; wide QRS defects caused by the membrane-depressant poisoning may respond to hypertonic sodium bicarbonate; repeat-dose charcoal, hemoperfusion, or hemodialysis may be helpful in removal of only those beta-blockers with a small V_d, long half-life or low intrinsic clearance (acebutolol, atenolol, nadolol, sotalol).

Increased toxicity:

Ophthalmic epinephrine (increased blood pressure/loss of IOP effect)

Quinidine (sinus bradycardia)

Verapamil (bradycardia and asystole have been reported)

A nonselective beta-adrenergic blocking agent that lowers intraocular pressure by reducing aqueous humor production and possibly increases the outflow of aqueous humor

Onset of action: Decreases in intraocular pressure (IOP) can be noted within 1 hour

Peak effect: 2-6 hours

Duration: 1-7 days

Elimination: Not well defined

Adults: Instill 1 drop in the affected eye(s) 1-2 times/day

Intraocular pressure, heart rate, funduscopic exam, visual field testing

May cause dizziness

May increase the effects of oral beta-blockers

No information available to require special precautions

No effects or complications reported

May sting on instillation, do not touch dropper to eye; visual acuity may be decreased after administration; night vision may be decreased; distance vision may be altered; apply finger pressure between the bridge of the nose and corner of the eye to decrease systemic absorption; assess patient's or caregiver's ability to administer

Apply finger pressure over nasolacrimal duct to decrease systemic absorption

Solution, ophthalmic, as hydrochloride: 0.25% (5 mL, 10 mL, 15 mL); 0.5% (2 mL, 5 mL, 10 mL, 15 mL)