Reduction of elevated intraocular pressure (IOP) in patients with chronic open-angle glaucoma1 2 8 12 18 19 20 74 93 94 121 a b 122 and ocular hypertension.1 2 9 10 11 94 a b Used alone or in conjunction wth a topical miotic121 122 (e.g., pilocarpine),1 2 12 18 122 topical dipivefrin,1 2 99 122 topical epinephrine, 1 12 18 74 98 121 122 and/or a carbonic anhydrase inhibitor.1 2 10 12 121 122
May be used safely in selected patients with reactive airway disease (e.g., asthma, chronic bronchitis, COPD).1 2 20 21 30 97 (See Respiratory Effects under Cautions.)
Avoid contamination of the solution or suspension container.1 103 121 a b
Shake suspension well prior to use.121 122
Suspension should not be administered while wearing contact lenses.121
Available as betaxolol hydrochloride; dosage expressed in terms of betaxolol.a
Suspension is therapeutically equivalent (in terms of magnitude and duration of hypotensive effect) to solution.121 122 126
Each 2.8 or 5.6 mg of betaxolol hydrochloride is equivalent to about 2.5 or 5 mg of betaxolol, respectively.1 2 121 a b
Betaxolol solution: 1–2 drops of a 0.5% solution in affected eye(s) twice daily. b 8 2 121 122
Betaxolol suspension: 1–2 drops of a 0.25% suspension in affected eye(s) twice daily. 1 a 8 2 121 122
Known hypersensitivity to betaxolol or any ingredient in the formulation.a b
May be absorbed systemically following topical application to the eye; consider the usual precautions associated with systemic use of β-adrenergic blocking agents when using topical betaxolol.1 119 121 a
Severe cardiac reactions, including death associated with cardiac failure, have been reported in patients receiving topical (ocular) betaxolol.a b
Use with caution in patients with a history of cardiac failure or heart block.1 119 121 Discontinue therapy at the first sign or symptom of cardiac failure.1 119 121
Severe respiratory reactions, including death resulting from bronchospasm, have been reported in patients with asthma receiving topical (ocular) betaxolol.1 2
Increased airway resistance and pulmonary distress (i.e., dyspnea, bronchospasm, thickened bronchial secretions, asthma, respiratory failure) reported.1 21 95 121 122 Use caution in patients with evidence of reactive airway disease on pulmonary function testing or excessive restriction of pulmonary function.1 113 121 122
Possible increased reactivity to repeated accidental, diagnostic, or therapeutic challenges with a variety of allergens while taking β-adrenergic blocking agents.a b Such patients may be unresponsive to usual doses of epinephrine used to treat anaphylactic reactions.a b
β-Adrenergic blocking agents may mask sings and symptoms of acute hypoglycemia; administer with caution in patients subject to spontaneous hypoglycemia and in diabetic patients (especially those with labile diabetes) who are receiving hypoglycemic agents.1 88 121
β-Adrenergic blocking agents may mask signs of hyperthyroidism (e.g., tachycardia).1 121
Possible thyroid storm if β-adrenergic blocking agent is abruptly withdrawn; carefully monitor patients having or suspected of developing thyrotoxicosis.1 121
β-Adrenergic blocking agents reported to potentiate muscle weakness consistent with certain myasthenic symptoms (e.g., diplopia, ptosis, generalized weakness).1 121
Betaxolol reported rarely to increase muscle weakness in patients with myasthenia gravis or myasthenia symptoms.a b
Possible increased risks associated with general anesthesia (e.g., severe hypotension, difficulty restarting or maintaining heart beat) due to decreased ability of the heart to respond to reflex β-adrenergic stimuli.1 121 Some clinicians recommend gradual withdrawal of β-adrenergic blocking agents prior to elective surgery.1 121
Betaxolol has little to no effect on pupil size.1 2 8 9 11 12 18 93 99 121 122 Do not use alone in patients with angle-closure glaucoma; use only in combination with a miotic in these patients.1 121
Category C.a b
Distributed into milk.83 Caution advised if used in nursing women.1 121
Safety and efficacy not established.1 11 121
No substantial differences in safety and efficacy relative to younger adults.a
Ocular stinging and discomfort on instillation.1 2 8 18 74 94 98 121 122 126
Extent of absorption following topical application not elucidated.104
Commercially available solution and suspension are bioequivalent.122 126
Following topical application to the eye with either the 0.25% suspension or the 0.5% solution, reduction in IOP usually evident within 0.5–1 hour and reaches a maximum within 2 hours.1 2 121
Reduction in IOP persists for ≥12 hours.1 2 121
Distribution into human ocular tissues and fluids has not been characterized to date.104
Betaxolol crosses the placenta and is distributed into milk.83 108
Systemically absorbed betaxolol is extensively metabolized to at least 5 metabolites.2 13 46
Tight containers at 15–30°C.b
Upright at 15–30°C.a
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
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