levobunolol (Rx)

Brand and Other Names:Betagan, AKBeta
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

ophthalmic solution

  • 0.25%
  • 0.5%

Open-angle Glaucoma

0.25%: 1-2 gtt in affected eye(s) q12hr

0.5%: 1-2 gtt in affected eye(s) qDay, may increase to q12hr; >1 gtt q12hr generally not more effective; consider concomitant therapy if IOP not at satisfactory level on this regimen

Safety & efficacy not established

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Adverse Effects

Frequency Not Defined

Mild ocular stinging

Ataxia

Burning

Lethargy

Discomfort

Band keratopathy

Respiratory failure

Blepharitis

Impotence

Blepharoconjunctivitis

Conjunctivitis

Decreased visual acuity

Erythema

Iridocyclitis

Itching sensation

Decreased corneal sensitivity

Tearing

Urticaria

Paresthesia

Ptosis

Cerebral ischemia

Decreased blood pressure

Hypersensitivity reactions

Heart block

Syncope

Reduction of resting heart rate

Postmarketing Reports

Special senses: Signs and symptoms of keratitis or eye allergy, blepharoptosis, visual disturbances including refractive changes (due to withdrawal of miotic therapy in some cases), diplopia, and foreign body sensation in eye

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Warnings

Contraindications

Asthma, uncompensated CHF, any beta-blocker side effects, COPD, sinus bradycardia, 2°/3° AV block, hypersensitivity

Cardiogenic shock or with overt cardiac failure not adequately compensated (eg, treated with cardiac glycosides &/or diuretics)

Cautions

Caution on inadequate cardiac function, latent cardiac insufficiency, cerebrovascular insufficiency, sick sinus syndrome, peripheral vascular disease, history of psychiatric illness, heart failure, diminished pulmonary function, nonallergic bronchospasm, diabetes mellitus, myasthenia gravis

Ophthalmic beta-blockers may impair compensatory tachycardia and increase risk of hypotension

Patients receiving topical levobunolol & a systemic ß-adrenergic blocking agent concomitantly should be observed carefully for potential additive effects on IOP &/or systemic effects of ß-adrenergic blockade

May mask signs of hyperthyroidism (ie, tachycardia)

May potentiate syndromes associated with vascular insufficiency (i.e. Raynaud’s phenomenon); use with caution

Choroidal detachment after filtration procedures reported with administration of aqueous suppressant therapy

Preservative benzalkonium chloride may be absorbed by soft contact lenses; patients wearing soft (hydrophilic) contact lenses should be instructed to remove contact lenses before administration of the solution and wait at least 15 minutes after instilling therapy before reinserting soft contact lenses

Use with a miotic in angle-closure glaucoma

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Pregnancy & Lactation

Pregnancy

There are no adequate and well-controlled studies in pregnant women; ophthalmic solution should be used during pregnancy only if potential benefit justifies potential risk to fetus

Lactation

It is not known whether drug is excreted in human milk; systemic beta-blockers and topical timolol maleate are known to be excreted in human milk; exercise caution when administered to a nursing woman

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

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Pharmacology

Mechanism of Action

Nonselective beta-adrenergic receptor blocker; reduces IOP by reducing production of aqueous humor

Pharmacokinetics

Peak Plasma Time: 30 min

Onset of action: 1hr

Peak effect: 2-6hr

Duration: Up to 24hr

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Images

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Formulary

FormularyPatient Discounts

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The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

Tier Description
1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC NOT COVERED – Drugs that are not covered by the plan.
Code Definition
PA Prior Authorization
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL Quantity Limits
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST Step Therapy
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR Other Restrictions
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.