Levobunolol (Betagan eye drops)
How does it work?
Betagan eye drops contain the active ingredient levobunolol hydrochloride, which is a type of medicine called a beta-blocker. (NB. Levobunolol eye drops are also available without a brand name, ie as the generic medicine.) Levobunolol is used to reduce the pressure inside the eyeball. It works by blocking beta-receptors in the eye.
The pressure within the eyeball is naturally maintained by a continuous flow of liquid called aqueous humour through the eyeball. Aqueous humour is produced by a part of the eye called the ciliary body, and it drains out of the eyeball through channels called the trabecular meshwork. If the outflow of aqueous humour is blocked, the aqueous humour builds up inside the eye, increasing the pressure within the eyeball. This pressure needs to be reduced, as otherwise it can damage the optic nerve and impair vision.
Levobunolol blocks beta-receptors that are found on the ciliary body. This action reduces the amount of aqueous humour that is secreted into the eyeball by the ciliary body. Levobunolol also blocks beta-receptors found on the blood vessels that supply the ciliary body. This causes these blood vessels to constrict, which reduces the amount of watery fluid that filters out of the blood vessels to form aqueous humour.
The overall effect of levobunolol is to reduce the inflow of aqueous humour into the eyeball, which decreases the pressure within the eye. It is used to treat conditions where there is raised pressure in the eye, such as glaucoma.
What is it used for?
- Open angle glaucoma.
- Raised pressure in the eye (ocular hypertension).
How do I use it?
- Wash your hands before using the eye drops.
- One drop should be put into the affected eye(s) once or twice a day, as directed by your doctor. Click here for instructions on how to put in the eye drops.
- When using the eye drops you should take care to not touch the dropper tip to any surface, or to your eye, in order to avoid contaminating the eye drops with germs that could cause eye infections.
- You can minimise the amount of medicine that is absorbed into your bloodstream and increase the local action in the eye, by pressing on your tear duct (the corner of the eye closest to the nose) while putting in the eye drops and for a few minutes after. It is recommended that you do this after putting in each drop. This is because sufficient levobunolol may be absorbed from the eye into the bloodstream to cause side effects on other parts of the body, or to react with medicines being taken by mouth, injection or suppository.
- Betagan eye drops are available in multi-dose bottles or preservative-free single-dose containers.
- The multi-dose bottles contain the preservative benzalkonium chloride, which can be absorbed by soft contact lenses and cause eye irritation. If you wear soft contact lenses, you should remove them before putting in these eye drops. You should wait at least 15 minutes after using the drops before putting your contact lenses back in. The preservative helps keep the eye drops sterile once they are in use. However, any medicine remaining in the bottle after it has been open for four weeks or more is likely to be contaminated with germs and should no longer be used. Dispose of carefully, preferably by returning to your pharmacy. You may find it helpful to write the date of first opening on the bottle.
- The preservative-free single-use drops can be used while you are wearing contact lenses. Each single-use vial contains enough solution to put one drop in both eyes. However, only treat both eyes if you have been told to do so by your doctor. If there is any medicine remaining in the vial after you have used it this should be thrown away and not kept for future use.
- Betagan eye drops are for use in the eye only and must not be taken by mouth.
- As with all eye drops, your vision may be blurred after putting the drops in. Wait until your vision is clear before driving or using machines. You should also take into account that this medicine can sometimes cause other visual disturbances, eg double vision, and dizziness or fatigue, all of which may affect your ability to drive or operate machinery.
- If you go into hospital or to the dentist to have an operation you should tell the person treating you that you are using these eye drops. This is because your blood pressure may fall too low if you are given certain types of anaesthetics while using this medicine.
- While using this medicine you should have regular eye examinations. If your eye(s) become irritated or any new eye problems occur, tell your doctor immediately.
Use with caution in
- People with a history of heart disease, inlcuding heart failure or a weak heart.
- People with slowed conduction of electrical messages between the chambers of the heart (1st degree heart block).
- People with a severe form of angina pectoris, not caused by exertion (Prinzmetal's angina).
- People with poor blood circulation in the arteries of the extremities, eg hands and feet (peripheral arterial disorders such as Raynaud's syndrome or intermittent claudication).
- Low blood pressure (hypotension).
- Decreased liver function.
- Decreased kidney function.
- People with an untreated tumour of the adrenal gland (phaeochromocytoma).
- Diabetes mellitus. (Beta-blockers such as levobunolol can be absorbed into the bloodstream after being applied into the eye. They may mask the symptoms of low blood sugar (hypoglycaemia) such as increased heart rate, sweating, tremor and nausea. For this reason, people with diabetes should carefully monitor their blood sugar while using these eye drops.)
- People with a history of sudden drops in blood sugar levels (hypoglycaemia).
- Overactive thyroid gland (this medicine may mask the symptoms of a thyroid storm or thyrotoxicosis).
- People with high acid levels in the blood (metabolic acidosis).
- People with a history of allergies. (Beta-blockers such as levobunolol can increase sensitivity to substances which cause allergy and the seriousness of severe allergic reactions (anaphylaxis). People who experience an anaphylactic reaction while using this medicine may need larger than normal doses of adrenaline to treat the reaction. Seek further medical advice from your doctor if you have a history of allergies.)
- Abnormal muscle weakness (myasthenia gravis).
- People with chronic eye inflammation and defects of the transparent part of the front of the eyeball (cornea).
Not to be used in
- History of asthma.
- Severe chronic obstructive pulmonary disease (COPD).
- People with a slow heart rate caused by the pacemaker of the heart (sinus bradycardia).
- A problem common in the elderly, related to poor control of the working of the heart (sick sinus syndrome).
- People who have problems with the electrical impulse that causes the heart to beat, resulting in decreased heart function (sino-atrial heart block).
- People with a serious defect in the heart's electrical message pathways resulting in decreased function of the heart (2nd or 3rd degree heart block), when this is not controlled with a pacemaker.
- Uncontrolled heart failure.
- Failure of the heart to maintain adequate circulation of blood (cardiogenic shock).
This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine should not be used during pregnancy unless considered essential by your doctor. Beta-blockers taken by mouth can restrict the baby's growth in the womb and if used near term can cause the baby to have a slow heart rate, low blood pressure, low blood sugar or slow breathing after birth. If you think you could be pregnant while taking this medicine, or want to try for a baby, it is important to seek medical advice from your doctor or midwife. If you have been using this medicine before delivery the baby may need extra monitoring after the birth.
- This medicine can pass into breast milk after application into the eye. The manufacturer states that it should not be used by mothers who are breastfeeding. Seek further medical advice from your doctor.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
Very common (affect more than 1 in 10 people)
Common (affect between 1 in 10 and 1 in 100 people)
- Inflammation of the membrane covering the eyeball (conjunctivitis).
- Inflammation of the eyelid(s) (blepharitis).
- Dry eyes.
- Watery eyes.
- Visual disturbances.
- Itching or swelling of the eyelids/eyes.
- Inflammation of the surface of the eye (keratitis).
- Irritation of the nose and throat.
- Low blood pressure (hypotension).
- Slow heart rate or heart block.
- Awareness of your heart beat (palpitations).
- Asthma or shortness of breath.
- Swelling of the face.
- Skin reactions such as rash, itching, redness, itchy rash (urticaria) and flaking of skin.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
The levobunolol in these eye drops can be absorbed into the bloodstream after application to the eye and it is possible they could affect other medicines that you are taking by mouth. It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while using this one, to make sure that the combination is safe.
If you are using more than one type of eye drop you should administer them at least five minutes apart, to prevent the second drop washing away the first. Use eye gels or ointments last.
Levobunolol may have an additive effect with medicines that decrease blood pressure, particularly medicines that are used to treat high blood pressure (antihypertensives). This may cause dizziness, which can usually be relieved by lying down until the symptoms pass. If you feel dizzy while using this medicine in combination with medicines that can lower blood pressure you should let your doctor know, as your doses may need adjusting.
There may be an increased risk of a slowed heart rate or drop in blood pressure if these eye drops are used in combination with any of the following medicines:
- medicines for an abnormal heartbeat (antiarrhythmics), eg amiodarone, quinidine
- beta-blocker medicines taken by mouth, eg atenolol, propranolol
- calcium channel blockers such as diltiazem, nifedipine or verapamil
If this medicine is used with clonidine, there is a risk of a rebound increase in blood pressure if the clonidine is stopped suddenly. If the clonidine needs to be stopped, this medicine should be stopped several days before slowly stopping the clonidine.
Cimetidine may increase the amount of levobunolol in your blood and could increase the chance of getting side effects.
In people with diabetes, levobunolol can prolong the lowering of blood sugar (hypoglycaemia) caused by insulin or other antidiabetic medicines. People with diabetes should monitor their blood sugar, as levobunolol can also mask the signs of hypoglycaemia.
Other medicines containing the same active ingredient
Levobunolol hydrochloride eye drops are also available without a brand name, ie as the generic medicine.