Levobunolol

A to Z Drug Facts

(LEE-voe-BYOO-no-lahl)

AK-Beta, Betagan Liquifilm,  Betagan, Novo-Levobunolol, Ophtho-Bunolol

Class: Ophthalmic/glaucoma/betaadrenergic blocker

 Action Reduces IOP by reducing aqueous humor production.

 Indications Treatment of IOP in chronic open-angle glaucoma or ocular hypertension.

 Contraindications Bronchial asthma; severe chronic obstructive pulmonary disease; sinus bradycardia; second-degree and third-degree atrioventricular (AV) block; cardiac failure; cardiogenic shock.

 Route/Dosage

ADULTS: Topical 1 drop in affected eye(s) qd or bid.

 Interactions

Beta blockers, oral: Additive effects on systemic beta blockade. Epinephrine, ophthalmic: Hypertension due to unopposed alpha-adrenergic stimulation.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Arrhythmia; bradycardia; hypotension; syncope; heart block; cerebral vascular accident; cerebral ischemia; CHF; cardiac arrest. CNS: Headache; depression. DERM: Rash. EENT: Keratitis; blepharoptosis; visual disturbances; diplopia; ptosis; transient burning; stinging; blepharoconjunctivitis; decreased corneal sensitivity. GI: Nausea. RESP: Bronchospasm.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. Special-risk patients: Use with caution in patients with cerebrovascular insufficiency and bronchial diseases. Diabetes mellitus: May mask hypoglycemic symptoms in patients with insulin-dependent diabetes. Use with caution. Sulfite sensitivity: Contains metabisulfite, which may cause allergic-type reactions in susceptible persons. Systemic absorption: Adverse effects like those seen with systemic beta-blockers may occur, due to absorption. Thyroid disorders: May mask clinical signs of hyperthyroidism.

 Administration/Storage

• Position patient with head tilted back. Instruct patient to look upward. Gently depress conjunctival sac to create small area for medication administration.
• Instill medication from ½ to 1 inch from eye. Instilling from greater distance may cause pain and injury.
• Avoid eyelash and eyelid contamination of medication dispenser.
• Compress lacrimal sac for at least 1 min after administration to delay drainage of medication into nasolacrimal duct and to prevent systemic absorption.
• Wait ³ 5 min before administering other types of ophthalmic solution.
• Discard medication that has become contaminated by foreign material.
• Store at room temperature. Protect from light.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note history of cerebrovascular accident, cardiac disease, chronic obstructive pulmonary disease or diabetes mellitus.
• Monitor BP and pulse throughout course of therapy.
• Monitor IOP periodically during therapy to determine effectiveness of therapy.
• Observe for loss of corneal sensitivity.
• Be alert for systemic effects, including bradycardia, CHF, cardiac arrhythmias, bronchospasm and dyspnea.

 Patient/Family Education

• Instruct patient in proper administration. Advise patient that if dose is missed, it should be administered as soon as possible unless close to time of next dose. Do not double up.
• Caution patient not to stop taking medication unless instructed to do so by physician.
• Emphasize importance of washing hands before drug administration and of not allowing dropper to come into contact with any surface including eyelashes.
• Instruct patient to report the following symptoms to physician: Eye infection, inflammation, rash, itching or decreased vision.
• Instruct patient to notify physician immediately if severe or sudden eye pain occurs.
• Advise diabetic patient that drug may mask signs of hypoglycemia and to monitor glucose levels carefully.
• Instruct patient not to take otc medications or allergy medications without consulting physician.
• Advise patient to inform physician or dentist of medication regimen before surgical or dental procedures. Gradual withdrawal of medication may be necessary before procedure.
• Explain importance of scheduling regular follow-up examinations while taking medication.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts