Beta-Adrenergic Blocking Agents (Ophthalmic)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For ophthalmic beta-adrenergic blocking agents, the following should be considered:

Allergies - Tell your doctor if you have ever had any unusual or allergic reaction to any of the beta-adrenergic blocking agents, either ophthalmic or systemic, such as acebutolol, atenolol, betaxolol, bisoprolol, carteolol, labetalol, levobetaxolol, levobunolol, metipranolol, metoprolol, nadolol, oxprenolol, penbutolol, pindolol, propranolol, sotalol, or timolol. Also tell your health care professional if you are allergic to any other substances, such as sulfites or preservatives.

Pregnancy - Ophthalmic beta-adrenergic blocking agents may be absorbed into the body. These medicines have not been studied in pregnant women. Studies in animals have not shown that betaxolol, levobunolol, metipranolol, or timolol causes birth defects. However, high doses of levobetaxolol given by mouth to pregnant rabbits have been shown to cause birth defects in rabbit babies, and very large doses of carteolol given by mouth to pregnant rats have been shown to cause wavy ribs in rat babies. In addition, some studies in animals have shown that beta-adrenergic blocking agents increase the chance of death in the animal fetus. Before using ophthalmic beta-adrenergic blocking agents, make sure your doctor knows if you are pregnant or if you may become pregnant.

Breast-feeding - Betaxolol and timolol, and maybe other beta-adrenergic blocking agents, when taken by mouth, may pass into the breast milk. Since ophthalmic beta-adrenergic blocking agents may be absorbed into the body, they, too, may pass into the breast milk. However, it is not known whether ophthalmic beta-adrenergic blocking agents pass into the breast milk, and these medicines have not been reported to cause problems in nursing babies.

Children - Infants may be especially sensitive to the effects of ophthalmic beta-adrenergic blocking agents. This may increase the chance of side effects during treatment.

Older adults - Elderly people are especially sensitive to the effects of ophthalmic beta-adrenergic blocking agents. If too much medicine is absorbed into the body, the chance of side effects during treatment may be increased.

Other medicines - Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your health care professional if you are using any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Other medical problems - The presence of other medical problems may affect the use of ophthalmic beta-adrenergic blocking agents. Make sure you tell your doctor if you have any other medical problems, especially:

• Allergic reactions, severe (history of) - Use of an ophthalmic beta-adrenergic blocking agent may reduce the effectiveness of the medicine (epinephrine) used to treat severe allergic reactions
• Asthma (or history of), chronic bronchitis, emphysema, or other lung disease - Severe breathing problems, including death due to bronchospasm (spasm of the bronchial tubes), have been reported in patients with asthma following use of some ophthalmic beta-adrenergic blocking agents (carteolol, levobunolol, metipranolol, and timolol). Although most often not a problem, the possibility of wheezing or troubled breathing also exists with betaxolol and levobetaxolol

• Diabetes mellitus (sugar diabetes) or
• Hypoglycemia (low blood sugar) - Ophthalmic beta-adrenergic blocking agents may cover up some signs and symptoms of hypoglycemia (low blood sugar), such as fast heartbeat and trembling, although they do not cover up other signs, such as dizziness or sweating

• Heart or blood vessel disease - Ophthalmic beta-adrenergic blocking agents may decrease heart activity

• Myasthenic conditions - Ophthalmic beta-adrenergic blocking agents may worsen muscle weakness caused by diseases such as myasthenia gravis.

• Overactive thyroid - Ophthalmic beta-adrenergic blocking agents may cover up certain signs and symptoms of hyperthyroidism (overactive thyroid). Suddenly stopping the use of ophthalmic beta-adrenergic blocking agents may cause a sudden and dangerous increase in thyroid symptoms