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Drug Profile

The information on this site is intended to supplement and enhance, not replace, the advice of a physician who is familiar with your medical history. Decisions about your health should always be made ONLY after detailed conversation with your doctor.

Generic drug name: betaxolol - eye (bait AX o lole)
Brand name(s): BETOPTIC, BETOPTIC S
GENERIC: available FAMILIES: Drugs for Glaucoma, Beta Blockers
Find the drug label by searching at DailyMed.

Generic drug name: levobunolol (lev o BEWN o lole)
Brand name(s): BETAGAN
GENERIC: available FAMILIES: Drugs for Glaucoma, Beta Blockers
Find the drug label by searching at DailyMed.

Generic drug name: timolol [eye drops] (TIM oh lole)
Brand name(s): TIMOPTIC
GENERIC: available FAMILIES: Drugs for Glaucoma, Beta Blockers
Find the drug label by searching at DailyMed.

Pregnancy and Breast-feeding Warnings [top]

Pregnancy Warning

Data from animal studies indicated toxicity to developing fetuses. Use during pregnancy only for clear medical reasons. Tell your doctor if you are pregnant or thinking of becoming pregnant before you take these drugs.

Breast-feeding Warning

Timolol, taken as eye drops, was excreted into breast milk. Because it is likely that the other beta-blockers are also excreted into breast milk and because of the potential for serious adverse effects in nursing infants, you should not take these drugs while nursing.

Safety Warnings For This Drug [top]

If these eye drops are absorbed into the body, older people have an increased risk of hypothermia. Early signs are shivering, cold hands and feet, and memory lapse. Stay indoors, especially when it is cold and windy. Keep warm with extra clothes and blankets. If you must go outdoors, dress to protect yourself from the wind and cold. Avoid getting wet. Take along something to eat suitable to your diet, such as trail mix.

Facts About This Drug [top]

Betaxolol (BETOPTIC, BETOPTIC S), levobunolol (BETAGAN) and timolol (TIMOPTIC) belong to the beta-blocker family of drugs. When used as oral tablets, both betaxolol and timolol can be used to treat heart disease. As eye drops, these medications are used for the treatment of glaucoma. This profile discusses the antiglaucoma use of these drugs.

Becausethe beneficial effect of these drugs may diminish over time, it is sometimes necessary to supplement their use with other antiglaucoma...

Betaxolol (BETOPTIC, BETOPTIC S), levobunolol (BETAGAN) and timolol (TIMOPTIC) belong to the beta-blocker family of drugs. When used as oral tablets, both betaxolol and timolol can be used to treat heart disease. As eye drops, these medications are used for the treatment of glaucoma. This profile discusses the antiglaucoma use of these drugs.

Becausethe beneficial effect of these drugs may diminish over time, it is sometimes necessary to supplement their use with other antiglaucoma medications such as pilocarpine (ADSORBOCARPINE, ISOPTO CARPINE, PILOCAR, SALAGEN), dipivefrin (PROPINE) or acetazolamide (DIAMOX).

Because beta-blocking drugs, including the topical products, affect the heart and the lungs, these drugs should not be used in patients with bronchial asthma or a history of that disease; severe COPD; or certain types of heart problems, such as bradycardia (slow heart rate), heart block or heart failure.[1]

Timolol taken by mouth has been shown to cause an increased number of cases of adrenal, lung, uterine and breast cancer in rats. This has not been shown for the eye drops.

Side effects

The beta-blocker family of antiglaucoma eye drops is well-tolerated by most people, especially those who have cataracts or who have problems using pilocarpine. Although these medications are prepared as eye drops, some can be absorbed from the eyes into the bloodstream and the rest of the body. If this happens, patients may experience some of the general side effects listed in the "Adverse Effects" section. Three cases of syncope (lightheadedness or dizziness) and falls associated with timolol use were reported in an April 2006 British Medical Journal article.

Cardiovascular and respiratory complications

Long-term use can exacerbate serious heart problems, even in people who did not previously have heart disease. Betaxolol can result in decreased blood flow to the brain or hands, particularly in patients with vascular disease.Cardiovascular and respiratory complications.[2]

Levobunolol and timolol can decrease lung function by 30 percent, an adverse effect not seen as much with use of betaxolol.[3] Very rarely, serious harm and even fatalities have occurred, mostly in tpatients with asthma or heart problems.[4] Elderly patients and patients with pre-existing cardiovascular conditions should use beta-blocker eye drops with caution.[5] (See “Application of Eye Drops and Ointments; Glaucoma” article.)

A commentary published in The Lancet in 2006 reviewed the cardiovascular and respiratory complications associated with beta-blocker eye drops. The Lancet commentators noted that it is a mistake to consider the beta-blocker eye drops totally safe.[6] Many cardiovascular side effects are attributed to these eye drops, including falls, hypotension (low blood pressure), arrhythmia (abnormal heart rhythm), syncope (fainting) and myocardial infarction (heart attack). It was noted in the article that beta-blocker eye drops are the most common cause of falls in elderly glaucoma patients.[7]

New breathing problems

Beta-blocker eye drugs also can cause breathing problems in patients without a history of asthma or chronic obstructive pulmonary disease. The August 1995 issue of Worst Pills, Best Pills News reported on research published in The Lancet on June 25, 1995, that found that timolol eye drops caused a decrease in breathing function and the ability to exercise in older adults, even in those without a previous history of asthma or breathing problems.

The February 2003 issue of Worst Pills, Best Pills News presented research from the Dec. 14, 2002, British Medical Journal showing that 12 months after being prescribed beta-blocker eye drops, 1.9 percent more patients in a group of study participants with no previous breathing problems were receiving a new drug to treat asthma. This translates to one patient in 55 being treated with a topical beta-blocker developing a breathing disorder that required treatment with a new drug.[8]

Studies show ...

An Australian study published in the July 2006 issue of the medical journal Ophthalmology suggested an increased risk of cardiovascular death in glaucoma patients using beta-blocker eye drops.[9] It also concluded that further studies should be done in glaucoma patients using topical timolol; there was a suggestion of higher cardiovascular mortality in these patients.[10]

Before You Use This Drug [top]

Do not use if you have or have had:

  • bronchial asthma
  • congestive heart failure, slow heartbeat, or heart block
  • previous allergic reaction to beta-blockers used for eyes
  • severe chronic lung disease

Tell your doctor if you have or have had:

  • allergies to drugs
  • bronchitis
  • diabetes
  • heart problems
  • low blood sugar (hypoglycemia)
  • lung disorder
  • myasthenia gravis
  • pregnancy or are breast-feeding
  • stroke
  • mental depression
  • emphysema or chronic bronchitis
  • history of smoking
  • thyroid problems
  • impotence

Tell your doctor about any other drugs you take, including aspirin, herbs, vitamins, and other nonprescription products.

When You Use This Drug [top]

  • Restrict your use of caffeine, since it may add to the effect of these drugs on the heart.[11]
  • Caution diabetics: Be aware that these drugs may mask trembling and pulse rate used to signal low blood sugar. They also may cause changes in blood glucose.
  • Remove any soft contact lenses prior to administering this drug for products containing benzalkonium as a preservative.[12]
  • If you plan to have any surgery, including dental, tell your doctor that you take this drug.
  • Check with your doctor immediately if having eye surgery or if you get an eye injury or infection.
  • Wear sunglasses and avoid too much exposure to bright light.
  • Be cautious driving until the effect of the drug is complete (about two weeks)[4] and no blurred vision occurs.
  • Do not take other drugs without talking to your doctor first—especially nonprescription drugs for appetite control, asthma, colds, coughs, hay fever, or sinus problems.

How to Use This Drug [top]

  • If you use the suspension form, shake it well first.
  • Wash your hands before using this drug.
  • After opening, avoid touching the tip against your eye or anything else.
  • Do not share your medication with others.
  • Take the drug at the same time(s) each day.
  • Store at room temperature with lid on tightly. Do not store in the bathroom. Do not expose to heat, moisture, or strong light. Keep out of reach of children.
  • If you miss a dose, use the following guidelines: If you are using betaxolol only once a day, apply the missed dose as soon as you remember, but skip it if you don’t remember until the next day. If you are using any of these drugs more than once a day, apply the missed dose as soon as you remember, but skip it if it is almost time for the next dose. Do not take double doses.

Interactions with Other Drugs [top]

The following drugs, biologics (e.g., vaccines, therapeutic antibodies), or foods are listed in Evaluations of Drug Interactions 2003 as causing “highly clinically significant” or “clinically significant” interactions when used together with any of the drugs in this section. In some sections with multiple drugs, the interaction may have been reported for one but not all drugs in this section, but we include the interaction because the drugs in this section are similar to one another. We have also included potentially serious interactions listed in the drug’s FDA-approved professional package insert or in published medical journal articles. There may be other drugs, especially those in the families of drugs listed below, that also will react with this drug to cause severe adverse effects. Make sure to tell your doctor and pharmacist the drugs you are taking and tell them if you are taking any of these interacting drugs:

arbutamine, DELTASONE, prednisone.

Adverse Effects [top]

These drugs can be absorbed into the body through the eye. All adverse effects for oral beta-blockers are possible with the eye-drop preparation.

Call your doctor immediately if you experience the following local problems:

  • eyes with different-sized pupils (betaxolol)
  • irritation or inflammation of eyelid (timolol)
  • irritation or inflammation of eye and eyelid (levobunolol)
  • irritation or inflammation of eye (betaxolol and timolol)
  • droopy upper eyelid (timolol)
  • eyeball discoloration (betaxolol)
  • decreased corneal sensitivity
  • seeing double (timolol)
  • eye pain (betaxolol)
  • tongue redness or irritation (betaxolol)
  • blurred or decreased vision

There are, in addition, many other symptoms of systemic absorption listed in beta-blockers; some of these are listed below:

  • coughing, wheezing, difficulty breathing
  • chest pain
  • hallucinations[13]
  • cold hands or feet
  • depression, confusion
  • dizziness, fainting
  • headache
  • slow or irregular heartbeat
  • irritation, severe swelling, or inflammation of eye or eyelids
  • blurred vision or other vision changes
  • difficulty swallowing or painful tongue
  • unusual tiredness or weakness
  • insomnia
  • nausea, vomiting, or diarrhea
  • droopy upper eyelid
  • unsteadiness or clumsiness
  • decreased sexual ability
  • hair loss
  • eye pain
  • raw or red areas of skin
  • different-size pupils or discoloration of eyeball
  • skin rash, hives, or itching
  • numbness or tingling of limbs
  • bloody, stuffy, or runny nose
  • swelling of feet, ankles, or lower legs

Call your doctor immediately if you experience the following total-body problems:

  • burning or prickling feeling on body (timolol)
  • chest pain (timolol)
  • clumsiness or unsteadiness (levobunolol)
  • confusion or mental depression (betaxolol, timolol)
  • coughing, wheezing, or troubled breathing
  • decreased sexual ability (timolol)
  • diarrhea (timolol)
  • dizziness or feeling faint
  • drowsiness (timolol)
  • hair loss (betaxolol, timolol)
  • hallucinations (timolol)
  • headache
  • heart disorder (betaxolol, timolol)
  • high blood pressure (timolol)
  • nausea or vomiting (timolol)
  • nosebleed (timolol)
  • raw or red areas of the skin (betaxolol)
  • ringing in ears (levobunolol)
  • runny nose (timolol)
  • skin rash, hives, or itching (betaxolol, timolol)
  • stuffy nose (timolol)
  • swelling of feet, ankles, or lower legs (betaxolol, timolol)
  • systemic lupus erythematosus (timolol)
  • trouble sleeping (betaxolol)
  • unusual tiredness or weakness

Call your doctor if these symptoms continue:

  • transient blurred vision (levobunolol and timolol gel-forming solution)
  • transient stinging of eye or other eye irritation upon administration of drug (betaxolol, levobunolol)
  • eyelash crusting (betaxolol)
  • dryness of eye (betaxolol, timolol)
  • feeling of having something in the eye (betaxolol)
  • increased sensitivity of eye to light (betaxolol)
  • redness, itching, stinging, burning, or watering of eye or other eye irritation

Periodic Tests[top]

Ask your doctor which of these tests should be done periodically while you are taking this drug:

  • eye pressure exams

last reviewed July 31, 2020