Adult Dosing

Treatment of elevated IOP (intraocular pressure) in patients with chronic open-angle glaucoma or ocular hypertension

• Instill 1-2 drops of 0.5% solution qd or 1-2 drops of 0.25% solution bid in the affected eye(s)
• Severe or uncontrolled glaucoma: Instill 1-2 drops of 0.5% solution bid in the affected eye(s)

Pediatric Dosing

• Safety and effectiveness in pediatric patients have not been established

[Outline]

• Adult Dosing
• Pediatric Dosing

• Treatment of elevated IOP (intraocular pressure) in patients with chronic open-angle glaucoma or ocular hypertension

• Hypersensitivity to any of the ingredients of the product
• Bronchial asthma or history of bronchial asthma
• Severe COPD
• Sinus bradycardia
• Second and third degree atrioventricular block
• Overt cardiac failure
• Cardiogenic shock

• N/A

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• Levobunolol may be absorbed systemically. Adverse reactions similar to those associated with systemic administration of beta-adrenergic blockers, such as severe respiratory and cardiac reactions including death due to bronchospasm in patients with asthma and rarely death in association with cardiac failure, have been reported
• Patients with diminished myocardial contractility may require sympathetic stimulation for circulation; and inhibition of myocardial contractility by beta-adrenergic receptor blockade may precipitate more severe failure
• Discontinue therapy at the appearance of first sign or symptom of cardiac failure
• Not recommended in patients with COPD of mild to moderate severity, bronchospastic disease or a history of bronchospastic disease (other than bronchial asthma or a history of bronchial asthma, where it is contraindicated)
• In patients undergoing elective surgery, gradual withdrawal of the drug may be appropriate as beta-adrenergic blockade impairs with the ability of the heart to respond to beta-adrenergic mediated reflex stimuli. Difficulty in restarting and maintaining the heartbeat has also been reported
• Use cautiously in diabetic patients receiving insulin or oral hypoglycemic agents because these agents may mask the signs and symptoms of acute hypoglycemia
• Certain clinical signs (e.g. tachycardia) of hyperthyroidism may be masked in patients using beta-adrenergic blocking agents. Patients suspected of developing thyrotoxicosis should be managed carefully to avoid abrupt withdrawal of the drug as it may precipitate a thyroid storm
• The drug products contain sodium metabisulfite, which may precipitate allergic-type reactions such as anaphylactic symptoms and fatal or less severe asthmatic episodes in susceptible individuals
• Avoid use of two or more topical ophthalmic beta-adrenergic blocking agents simultaneously
• Beta-adrenergic blocking agents have been reported to potentiate muscle weakness consistent with certain myasthenic symptoms (e.g., diplopia, ptosis, and generalized weakness)
• When used to reduce elevated IOP in angle-closure glaucoma, it should be followed with a miotic and not used alone

Use cautiously in

• Patients receiving oral beta-adrenergic blocking agent
• Cerebrovascular insufficiency
• Patients with known diminished pulmonary function

Akbeta, Betagan interacts with :

	Actos
	Adrenaclick
	Adrenalin
	Amaryl
	Aricept
	Aricept ODT
	Auvi-Q
	Avandia
	Chlorpropamide
	DiaBeta
	Diabinese
	Donepezil
	Epinephrine
	Epipen
	Epipen JR
	Exelon
	Fortamet
	Galantamine
	Glimepiride
	Glipizide
	Glucophage
	Glucophage XR
	Glucotrol
	Glucotrol XL
	Glucovance
	Glumetza
	Glyburide
	Glynase
	Insulin
	Metformin
	Nateglinide
	Onglyza
	Orinase
	Pioglitazone
	Prandin
	Razadyne
	Razadyne ER
	Repaglinide
	Riomet
	Rivastigmine
	Rosiglitazone
	Saxagliptin
	Starlix
	Systemic doses
	Tolbutamide
	Twinject

Pregnancy Category:C

Breastfeeding: There exists a moderately low risk to the breastfed infant on the basis of physicochemical properties and the ophthalmic route of administration of levobunolol. To reduce the excess amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 25 March 2011. As per manufacturer's data, caution should be exercised when administering to a nursing woman.

• CV: Bradycardia, arrhythmia, hypotension, syncope, heart block, cerebral vascular accident, cerebral ischemia, congestive heart failure, palpitation, cardiac arrest, chest pain
• CNS: Headache, dizziness, transient ataxia, asthenia
• PSYCHIATRY: Depression, confusion
• NEURO: Paresthesia, increase in signs and symptoms of myasthenia gravis
• RESP: Bronchospasm, respiratory failure, dyspnea
• DERM: Urticaria, pruritus, rash, alopecia
• EENT: Blepharoconjunctivitis, iridocyclitis, nasal congestion, visual disturbances, blepharoptosis, diplopia, ptosis, keratitis, transient ocular burning, decreased corneal sensitivity (prolonged use)
• ENDO: Masks the symptoms of hypoglycemia
• GI: Nausea, diarrhea
• GU: Impotence
• IMMU: Hypersensitivity reactions, Stevens-Johnson syndrome

• Noncardioselective beta-adrenoceptor antagonist; decreases IOP by reducing aqueous humor production
• Metabolism: Unknown
• Excretion: Unknown
• Half-life: Unknown

US Trade Name(s)

• Akbeta
• Betagan

US Availability

levobunolol (generic)

• OPTH SOLN: 0.25%, 0.5%

Akbeta, Betagan

• OPTH SOLN: 0.25%, 0.5%

Canadian Trade Name(s)

• Betagan

Canadian Availability

levobunolol (generic)

• OPTH SOLN: 0.25%, 0.5%

Betagan

• OPTH SOLN: 0.25%, 0.5%

UK Trade Name(s)

• Betagan

UK Availability

levobunolol (generic)

• OPTH SOLN: 0.5%

Betagan

• OPTH SOLN: 0.5%

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

[Outline]

Ophthalmic

Ophthalmic Glaucoma Agents

Beta-adrenergic Blocking Agents

Pricing data from www.DrugStore.com in U.S.A.

• Levobunolol HCl 0.5 % SOLN [Bottle] (BAUSCH & LOMB)
  10 % = $47.99
  30 % = $135.97
• Levobunolol HCl 0.5 % SOLN [Bottle] (BAUSCH & LOMB)
  15 % = $65.99
  45 % = $175.97
• Betagan 0.5 % SOLN [Bottle] (ALLERGAN)
  15 % = $99.74
  45 % = $285.57
• Levobunolol HCl 0.25 % SOLN [Bottle] (PACIFIC PHARMA)
  10 % = $22.99
  30 % = $45.97
• Betagan 0.5 % SOLN [Bottle] (ALLERGAN)
  10 % = $69.99
  30 % = $199.98
• Levobunolol HCl 0.5 % SOLN [Bottle] (BAUSCH & LOMB)
  5 % = $29.99
  15 % = $75.97
• Levobunolol HCl 0.25 % SOLN [Bottle] (PACIFIC PHARMA)
  5 % = $15.99
  15 % = $29.97

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.