Ophthalmology Book

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Intraocular Beta Blocker

Aka: Intraocular Beta Blocker, Betaxolol, Betoptic, Levobunolol, Betagan, Metipranolol, OptiPranolol, Intraocular Timolol, Timoptic, Timoptic XE
  1. Indication
    1. Open Angle Glaucoma first line agent
  2. Contraindications: Relative (related to systemic absorption risk described below)
    1. Asthma
    2. Chronic Obstructive Pulmonary Disease
    3. Congestive Heart Failure
    4. Cardiac conduction disturbance
    5. Depression
    6. Concurrent systemic Beta Blocker use
  3. Mechanism
    1. Decreases formation of Aqueous Humor
    2. Does not interfere with vision
  4. Preparations
    1. Betaxolol (Betoptic): $39
      1. Only selective Beta Blocker eye drop (may be used in COPD, Asthma)
      2. Concentrations: 0.25%, 0.5%
      3. Dose: 1 gtt bid
    2. Levobunolol (Betagan): $29-34
      1. Concentrations: 0.25%, 0.5%
      2. Dose: 1 gtt qd-bid
    3. Metipranolol (OptiPranolol): $24
      1. Concentrations: 0.3%
      2. Dose: 1 gtt bid
    4. Timolol (Timoptic): $30-35
      1. Concentrations: 0.25%, 0.5%
      2. Dose: 1 gtt bid
    5. Timoptic XE: $17-21
      1. Concentration: 0.25%, 0.5%
      2. Dose: 1 gtt qd
  5. Technique: Instillation
    1. See Don't Open Eyes Technique for Eye Drop Instillation
      1. Reduces systemic absorbtion
  6. Adverse effects
    1. Generally well tolerated
    2. Systemically absorbed (e.g. Timolol 0.5% one drop each eye is equivalent to Timolol 10 mg orally daily)
      1. Systemic cardiopulmonary effects may occur
      2. Fatal bronchospasm has occurred (avoid in Asthma and COPD, except Betaxolol which is selective)
  7. Reference
    1. (1995) Med Lett Drugs Ther 37:(956):76-77 [PubMed]
Medication Costs
Levobunolol (on 6/18/2017 at Walmart.com)
Levobunolol 0.5% op soln (5ml) #1 bottle for $4.00 $4.00 each
Levobunolol 0.5% op soln (5ml) #3 bottles for $10.00 $3.33 each
betaxolol (on 5/17/2017 at Medicaid.Gov Pharmacy Drug pricing)
BETAXOLOL 10 MG TABLET Generic $0.67 each
BETAXOLOL HCL 0.5% EYE DROP Generic $8.84 per ml
betoptic (on 2/22/2017 at Medicaid.Gov Pharmacy Drug pricing)
BETOPTIC S 0.25% EYE DROPS $27.57 per ml
levobunolol (on 5/17/2017 at Medicaid.Gov Pharmacy Drug pricing)
LEVOBUNOLOL 0.5% EYE DROPS Generic $1.94 per ml
timoptic (on 1/6/2017 at Medicaid.Gov Pharmacy Drug pricing)
TIMOPTIC 0.5% OCUDOSE DROP $6.65 each
TIMOPTIC-XE 0.5% EYE SOLN Generic $16.83 per ml
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

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