Betaxolol, ophthalmic

Acetazolamide (Diamox) Apraclonidine (lopidine) Betaxolol, Ophthalmic (Betoptic) Brimonidine (Alphagan P)... 

Geriatric Considerations - Summary Systemic absorption of ophthalmic drugs may occur and cause adverse effects in older adults. Since betaxolol is beta-selective, cardiovascular, respiratory and CNS adverse effects occur less frequently than with beta-nonselective topical opthalmics. These effects may still occur therefore close monitoring for systemic side effects is warranted. Betaxolol maybe less effective than the nonselective topical beta-blockers with an average lOP reduction of 18%-26%. Tachyphylaxis may occur after long-term therapy. 

It is nonselective agent with no local anaesthetic activity and having excellent ocular hypotensive effect preferred for ophthalmic use. It is useful in chronic wide-angle and aphakic glaucoma. Levobunolol and betaxolol are other agents used as ophthalmic preparation used in glaucoma. 

Nadolol is noteworthy for its very long duration of action its spectrum of action is similar to that of timolol. Timolol is a nonselective agent with no local anesthetic activity. It has excellent ocular hypotensive effects when administered topically in the eye. Levobunolol (nonselective) and betaxolol (E -selective) are also used for topical ophthalmic application in glaucoma the latter drug may be less likely to induce bronchoconstriction than nonselective antagonists. Carteolol is a nonselective 13-receptor antagonist. 

Figure 10-7 Mean change in forced expiratory volume in 1 second (FEVi) after instillation of timolol, betaxolol, or placebo (vehicle). Timolol induced a significant decrease in airflow, whereas betaxolol produced values no different from those for the placebo. (Reprinted with permission from Am J Ophthalmol 1984 97 86-92. Copyright by the Ophthalmic Publishing Company.)...

Acetylcholine Cl (Miochol) Carbachol intraocular (Miostat) Pilocarpine HCL (Isopto Carpine) Pilocarpine nitrate (Ocusert Pilo-20) Echothiophate iodide (Phospholine Iodide) Physostigmine salicylate (Isopto Eserine) Betaxolol HC1 (Betoptic) Levobunolol HC1 Timolol maleate (Timoptic) Acetazolamide (Diamox) Brinzolamide ophthalmic sus. 1% Dichlorphenamide (Daranide) Dorzolamide (Trusopt) Methazolamide (Neptazane)... 

Suspensions If the drug is not sufficiently soluble, it can be formulated as a suspension. A suspension may also be desired to improve stability, bioavailability, or efficacy. The major topical ophthalmic suspensions include but are not limited to steroid anti-inflammatory agents and lOP-lowering agents prednisolone acetate, dexamethasone, fluorometholone, nepafenac, brinzolamide, betaxolol hydrochloride, and rimexolone. Water-soluble salts of prednisolone phosphate and dexamethasone phosphate are available however, they have a lower steroid potency and are poorly absorbed. 

If a patient with bronchial hyperreactivity requires /3-blocker therapy, one of the selective /3i-blockers (e.g., acehutolol, atenolol, metoprolol, or pindolol) should be used at the lowest possible dose. Celiprolol and betaxolol appear to possess greater cardioselectiv-ity than currently marketed drugs. " Fatal status asthmaticus has occurred with the topical administration of the nonselective timolol maleate ophthalmic solution for the treatment of open-angle glaucoma. Early investigations with ophthalmic hetaxolol suggest that it is well tolerated even in timolol-sensitive asthmatics. - ... 

Dunn TL, Gerber MJ, Shen AS, et al. The effect of topical ophthalmic instillation of timolol and betaxolol on lung function in asthmatic subjects. Am Rev Respir Dis 1986 133 264-268. 

The J3 receptor antagonists are the next most common topical medical treatment. There are two classes of topical J3 blockers. The nonselective ones bind to both j3j and p2 receptors and include timolol, levobunolol, metipranolol, and carteolol. There is one pj-selective antagonist, betaxolol, available for ophthalmic use. It is less likely to cause breathing difficulty than nonselective 15 blockers, but it is less efficacious than the nonselective j5 blockers since the j5 receptors of the ciliary body epithelium and ocular blood vessels are 75—90% p2 subtype. The molecular basis of 15 blockade leading to decreased aqueous production and reduced lOP is uncertain. 

P-Adrenergic blocking dru also can be used topically as ophthalmic eye drops. For example, betaxolol (Betoptic) and timolol (Timoptic) are used in die treatment of aucoma. Glaucoma is a narrowing or blockage of the drain e channels (canals of Schlermn) between the anterior and posterior chambers of the ey This results in a build-up of pressure (increased intraocular pressure) in the eyei Blindness may occur if glaucoma is left untreated. 

Which client would the nurse question administering the beta-adrenergic blocker betaxolol (Betoptic), ophthalmic drops ... 

Comparative studies In 105 children aged under 6 years who were randomized for 12 weeks to betaxolol suspension (n = 34) or timolol maleate ophthalmic gel-forming... 

Plager DA, Whitson JT, Netland PA, Vijaya L, Sathyan P, Sood D, Krishnadas SR, Robin AL, Gross RD, Scheib SA, Scott H, Dickerson JE. BETOPTIC S Pediatric Study Group. Betaxolol hydrochloride ophthalmic suspension 0.25% and timolol gel-forming solution 0.25% and 0.5% in pediatric glaucoma a randomized clinical trial J AAPOS 2009 13(4) 384-90. 

Comparative studies In 105 children who were treated with either betaxolol hydrochloride ophthalmic suspension 0.25% or timolol maleate ophthalmic gel-forming solution 0.25% and 0.5% after randomization, adverse events were mostly non-seri-ous and mild to moderate in intensity [26 ]. No patient stopped treatment because of adverse events, which were hyperemia of the eye, discomfort, irritation of the eye, discharge from the eye, lid margin crusting, pruritus of the eye, a sticky sensation, bradycardia, and hypotension. 

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