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.
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.
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.
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).
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.
Monitor heart rate and intraocular pressure. Perform funduscopic exam and visual field testing.
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.
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.
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.