Levobunolol


Generic Medicine Info
Indications and Dosage
Ophthalmic
Chronic open-angle glaucoma, Ocular hypertension
Adult: As 0.5% solution: Instil 1 drop into the affected eye(s) 1-2 times daily. Alternatively, may instil 1-2 drops into the affected eye(s) once daily; in patients with severe or uncontrolled glaucoma, dosage may be increased to 1 drop bid.
Contraindications
History or active bronchial asthma; severe COPD; sinus bradycardia, sick sinus syndrome, sinoatrial block, 2nd- or 3rd-degree atrioventricular block (not controlled with a pacemaker), cardiogenic shock, overt heart failure.
Special Precautions
Patient with history of atopy or severe anaphylaxis to a variety of allergens; known hypersensitivity to other β-adrenergic blocking agents, cerebrovascular disease, predisposition to spontaneous hypoglycaemia, diabetes mellitus (especially labile diabetes); compensated heart failure, CHD, Prinzmetal's angina, 1st-degree atrioventricular block, hypotension; myasthenia gravis, severe peripheral circulatory disorder (e.g. severe Raynaud's disease); known diminished pulmonary function, mild to moderate COPD, history or active bronchospastic disease (other than bronchial asthma); corneal disease, thyroid disease. Patient undergoing major surgery. Avoid abrupt withdrawal. Not indicated to be used alone in the treatment of angle-closure glaucoma. May mask the signs and symptoms of hypoglycaemia and hyperthyroidism (e.g. tachycardia). Concomitant administration with systemic β-adrenergic blocking agents. Pregnancy and lactation.
Adverse Reactions
Significant: Choroidal detachment following filtration procedures, cardiac failure, exacerbation of myasthenic symptoms (e.g. ptosis, diplopia, generalised weakness); may precipitate or aggravate symptoms of vascular insufficiency.
Cardiac disorders: Bradycardia, heart block, palpitations, arrhythmia, chest pain, cardiac arrest.
Eye disorders: Eye pain or irritation, blepharitis, conjunctivitis or allergic conjunctivitis, conjunctival or ocular hyperaemia, iridocyclitis, keratitis, blurred vision, punctate keratitis, eye discharge, decreased corneal reflex; eye/eyelid pruritus or oedema; increased lacrimation; dry eye, foreign body sensation in eyes, corneal erosion.
Gastrointestinal disorders: Nausea.
General disorders and administration site conditions: Asthenia, face oedema.
Immune system disorders: Hypersensitivity reaction including signs and symptoms of eye and skin allergy.
Nervous system disorders: Dizziness, confusion, lethargy, somnolence, headache, paraesthesia, cerebral ischaemia, CVA. Rarely, transient ataxia.
Psychiatric disorders: Depression, insomnia.
Reproductive system and breast disorders: Impotence.
Respiratory, thoracic and mediastinal disorders: Dyspnoea, asthma, nasal discomfort, throat irritation, cough.
Skin and subcutaneous tissue disorders: Urticaria, rash, pruritus, alopecia, eyelid eczema, erythema of the eyelid, contact dermatitis (including allergic contact dermatitis), lichenoid keratosis, skin exfoliation, Stevens-Johnson syndrome.
Vascular disorders: Hypotension, syncope.
Potentially Fatal: Severe respiratory reactions (including bronchospasm in patients with asthma).
Patient Counseling Information
This drug may cause transient blurred vision, fatigue, or drowsiness; if affected, do not drive or operate machinery. Remove contact lenses prior to administration and wait at least 15 minutes before reinsertion.
Monitoring Parameters
Monitor heart rate and intraocular pressure. Perform funduscopic exam and visual field testing.
Overdosage
Symptoms: If accidentally ingested, systemic symptoms may occur such as symptomatic bradycardia, bronchospasm, hypotension, and acute cardiac failure. Management: Supportive treatment. Consider gastric lavage to decrease further absorption. Administer IV atropine (0.25-2 mg) to induce vagal blockade. Conventional treatment for bronchospasm, hypotension, heart block, and cardiac failure may also be necessary. If ocular overdosage occurs, flush the eye(s) with water or normal saline.
Drug Interactions
Possible additive effects on systemic β-blockade and intraocular pressure with oral β-adrenergic blocking agents. Mydriasis may occur when used with epinephrine. Risk of additive effects leading to marked bradycardia and/or hypotension with oral Ca channel blockers, antiarrhythmics (including amiodarone), guanethidine, reserpine, digitalis glycosides, or parasympathomimetic drugs. May enhance the hypoglycaemic effect of antidiabetic agents. May attenuate compensatory tachycardia and increase the risk of hypotension with anaesthetic drugs. May have additive effects on prolonging atrioventricular conduction time when used concomitantly with digitalis and Ca antagonists. Concomitant use with phenothiazine-related compounds may result in additive hypotensive effects.
Action
Description: Levobunolol is a non-cardioselective β-blocker, equipotent at both β1- and β2-adrenergic receptors. It decreases intraocular pressure by reducing the production of aqueous humour or possibly increasing the aqueous humour outflow.
Onset: Within 1 hour.
Duration: Up to 24 hours.
Pharmacokinetics:
Absorption: Systemic absorption may occur following topical application to the eye.
Chemical Structure

Chemical Structure Image
Levobunolol

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 39468, Levobunolol. https://pubchem.ncbi.nlm.nih.gov/compound/Levobunolol. Accessed June 27, 2022.

Storage
Store between 15-25°C. Protect from light.
MIMS Class
Antiglaucoma Preparations
ATC Classification
S01ED03 - levobunolol ; Belongs to the class of beta blocking agents. Used in the treatment of glaucoma.
References
Allergan New Zealand Ltd. Betagan 5 mg/mL Eye Drops data sheet 29 March 2017. Medsafe. http://www.medsafe.govt.nz. Accessed 09/06/2022.

Anon. Levobunolol. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 09/06/2022.

Betagan 0.5% w/v Unit Dose Eye Drops, Solution (AbbVie Ltd). MHRA. https://products.mhra.gov.uk. Accessed 09/06/2022.

Betagan Solution/Drops (Allergan, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 09/06/2022.

Buckingham R (ed). Levobunolol Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 09/06/2022.

Joint Formulary Committee. Levobunolol Hydrochloride. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 09/06/2022.

Disclaimer: This information is independently developed by MIMS based on Levobunolol from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2022 MIMS. All rights reserved. Powered by MIMS.com
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