Levobunolol (Betagan) is used to reduce intraocular pressure by increasing the outflow of aqueous humor and decreases its production.

Levobunolol Uses:

• Elevated intraocular pressure:

  • Used for treatment of elevated intraocular pressure in patients having ocular hypertension or chronic open-angle glaucoma

Levobunolol (Betagan) Dose in Adults:

Levobunolol (Betagan) Dose in the treatment of Elevated intraocular pressure:

• Ophthalmic:
  • Instill 1 to 2 drops into the affected eye(s) once a day; dosage may be increased to 1 drop twice a day in patients with severe or uncontrolled glaucoma.
  • Doses more than 1 drop twice a day are generally not more effective.

Use in Children:

Not indicated.

Pregnancy Risk Category: C

• Similar adverse effects to those experienced with systemic beta-blockers can be seen in the ophthalmic administration of levobunolol.
• To reduce the potential exposure of the foetus to glaucoma medication, the maximum effective dosage should be used in conjunction with punctal Occlusion.

Use during breastfeeding:

• It is not known if breast milk contains levobunolol.
• Breast milk is not able to absorb systemic beta-blockers or topical timolol.
• To reduce exposure to breastfeeding infants, use the lowest effective dose combined with punctal obstruction.
• Manufacturer suggests being cautious when giving levobunolol breastfeeding women.

Dose in Kidney Disease:

• No dosage adjustments have been provided in the manufacturer's labeling.

Dose in Liver disease:

• No dosage adjustments have been provided in the manufacturer's labeling.

Common Side Effects of Levobunolol (Betagan):

• Ophthalmic:

  • Burning sensation of eyes
  • Stinging of eyes

Less Common Side Effects of Levobunolol (Betagan):

• Ophthalmic:

  • Blepharoconjunctivitis
  • Blepharoptosis
  • Decreased Corneal Sensitivity
  • Diplopia
  • Iridocyclitis
  • Keratitis
  • Ocular Allergy
  • Visual Disturbance

• Cardiovascular:

  • Bradycardia
  • Cardiac Arrhythmia
  • Cardiac Failure
  • Cerebral Ischemia
  • Cerebrovascular Accident
  • Chest Pain
  • Heart Block
  • Hypotension
  • Palpitations
  • Syncope

• Central Nervous System:

  • Ataxia (Transient)
  • Confusion
  • Depression
  • Dizziness
  • Exacerbation Of Myasthenia Gravis
  • Foreign Body Sensation Of Eye
  • Headache
  • Lethargy
  • Paresthesia

• Dermatologic:

  • Alopecia
  • Pruritus
  • Skin Rash
  • Stevens-Johnson Syndrome
  • Urticaria

• Endocrine & Metabolic:

  • Hypoglycemia (Masked)

• Gastrointestinal:

  • Diarrhea
  • Nausea

• Genitourinary:

  • Impotence

• Hypersensitivity:

  • Hypersensitivity Reaction

• Neuromuscular & Skeletal:

  • Weakness

• Respiratory:

  • Bronchospasm
  • Dyspnea
  • Nasal Congestion
  • Respiratory Failure

Contraindications to Levobunolol (Betagan):

• Hypersensitivity
• Asthma
• Severe COPD
• Sinus bradycardia
• 2nd or 3rd degree AV block
• Overt heart failure
• Cardiogenic shock

Warnings and Precautions

• Anaphylactic reactions

  • Patients with a history of severe allergic reactions to allergens should be treated cautiously. Beta-blockers can make patients more sensitive to repeated challenges.
  • In patients taking beta-blockers, the treatment of anaphylaxis (eg, epinephrine) may be ineffective or promote undesirable effects.

• Choroidal detachment:

  • Following filtration, choroidal detachment has been seen with the use of beta-blockaders and/or other aqueous suppressive therapies.

• Cerebrovascular disease

  • Be cautious if you have cerebrovascular impairment.
  • Patients with reduced cerebral blood flow should consider alternative therapies.

• Diabetes:

  • Patients with diabetes mellitus, especially labile diabetics, should exercise caution when using this medication. It may cause hypoglycemia or mask symptoms.

• Heart failure:

  • Patients with compensated cardiac failure should be treated cautiously and monitored for signs of deterioration.
  • Patients who have not had heart disease in the past should stop using it immediately.
  • It is contraindicated in the presence of severe heart failure.
  • The American heart association has stated that levobunolol may be an agent that can exacerbate underlying myocardial dysfunction.

• Myasthenia gravis:

  • Be careful
  • This could lead to a worsening or other myasthenic symptoms such as diplopia, ptosis and generalized weakness.

• Raynaud and peripheral vascular disease:

  • Patients with Raynaud disease or peripheral vascular disease can experience aggravation or precipitation of symptoms associated with arterial insufficiency.
  • Be careful and avoid aggravating arterial obstruction.

• Respiratory disease

  • Patients with bronchospastic diseases should not take beta-blockers.
  • You should exercise caution and keep an eye on your surroundings if you use it.
  • Patients with asthma can experience severe respiratory reactions, including death due to bronchospasm.
  • It is not recommended for patients with severe COPD or bronchial symptoms.

• Thyroid disease:

  • Tachycardia, a sign of hyperthyroidism, may be hidden.
  • You should be cautious if you suspect thyrotoxicosis.
  • Hyperthyroidism can be worsened, or a thyroid storm may develop with sudden withdrawal.

Levobunolol: Drug Interaction

Monitoring parameters:

Monitor the following parameters during its use;

• Intraocular pressure
• Heart rate
• Funduscopic exam
• Visual field testing

How to administer Levobunolol (Betagan)?

• For ophthalmic topical use only.
• Before and after use hands should be washed.
• Benzalkonium chloride may be present in some solutions; contact lenses should be removed prior to administration.
• Wait 15 mins before reinserting.
• The tip of the applicator should not be touched to the eye or other surfaces.
• 2 or more ophthalmic beta-adrenergic blocking agents should not be administered simultaneously.

Mechanism of action of Levobunolol (Betagan):

• Blockage of beta-1 and beta-2 adrenergic nerves. Causes intraocular pressure to drop by decreasing the production or increasing the flow of aqueous humor.

The beginning of action:

• The onset of action is within one hour.

Peak effect:

• It takes 2 to 6 hours for peak effect

Duration:

• Duration of action is up to 24 hours.

International Brand Names of Levobunolol:

• Betagan
• APO-Levobunolol HCl
• PMS-Levobunolol
• RATIO-Levobunolol
• SANDOZ Levobunolol
• B-Tablock
• Betagan
• Betagen
• Bunolgan
• Evobun
• Glubanol
• Levosan
• Levunolol
• Mascglucom
• Ocupress
• Orbunol
• Vistagan

Levobunolol Brand Names in Pakistan: