Thursday, September 22, 2016

Betoptic S eent


Generic Name: Betaxolol Hydrochloride eent
Class: beta-Adrenergic Blocking Agents
ATC Class: S01ED52
VA Class: OP101
Molecular Formula: C18H29NO3•ClH
CAS Number: 63659-19-8

Introduction

β1-selective adrenergic blocking agent.1 2 3 4 5 6 7 8 9 10 121 122


Uses for Betoptic S


Ocular Hypertension and Glaucoma


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.)


Betoptic S Dosage and Administration


General



  • Adjust dosage to individual requirements and response of patient as determined by tonometric readings before and during therapy.1 65




  • Because of diurnal variations in IOP, measure IOP at different times during the day to determine if an adequate hypotensive effect is maintained.107 Since IOP may not stabilize for a few weeks after initiating therapy, determine IOP after about 4 weeks of therapy; thereafter, determine IOP as necessary.1



Administration


Ophthalmic Administration


Apply topically to the eye as an ophthalmic solutionb or suspensiona .


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


Dosage


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


Adults


Ocular Hypertension and Glaucoma

Ophthalmic

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


If further reduction of IOP is required, a topical miotic,1 2 18 74 121 topical dipivefrin,2 12 99 122 topical epinephrine,1 12 18 74 98 121 122 and/or a carbonic anhydrase inhibitor1 2 10 12 121 122 may be added.1 2 10 12 74 121 122


Cautions for Betoptic S


Contraindications


Known hypersensitivity to betaxolol or any ingredient in the formulation.a b


Sinus bradycardia,1 18 121 a b AV block greater than first degree,1 18 121 cardiogenic shock,1 18 121 or overt cardiac failure 1 121 that is not adequately compensated (e.g., with cardiac glycosides and/or diuretics).104


Warnings/Precautions


Warnings


Systemic Effects

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


Cardiovascular Effects

Severe cardiac reactions, including death associated with cardiac failure, have been reported in patients receiving topical (ocular) betaxolol.a b


Minor effects on BP 1 2 8 9 22 23 93 110 121 122 and heart rate reported.1 2 8 9 22 23 93 110


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


Respiratory Effects

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


Sensitivity Reactions


History of Atopy or Anaphylactic Reactions

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


General Precautions


Diabetes Mellitus

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


Thyrotoxicosis

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


Muscle Weakness

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


Major Surgery

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


Angle-closure Glaucoma

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


Specific Populations


Pregnancy

Category C.a b


Lactation

Distributed into milk.83 Caution advised if used in nursing women.1 121


Pediatric Use

Safety and efficacy not established.1 11 121


Geriatric Use

No substantial differences in safety and efficacy relative to younger adults.a


Common Adverse Effects


Ocular stinging and discomfort on instillation.1 2 8 18 74 94 98 121 122 126


Interactions for Betoptic S


Specific Drugs


















Drug



Interaction



Comments



Adrenergic psychotropic agents



Possible antagonism of psychotropic agenta b



Use concomitantly with cautiona b



Catecholamine-depleting drugs (e.g., reserpine)



Possible additive effectsa b



Observe closely for evidence of marked hypotension or bradycardiaa b



Ocular hypotensive agents



Additive IOP-lowering effectsa b



Used to therapeutic advantagea b


Observe for additive effect of IOP reduction or systemic side effectsa b



Systemic β-adrenergic blocking agents



Additive systemic and ocular effectsa b


Betoptic S Pharmacokinetics


Absorption


Bioavailability


Extent of absorption following topical application not elucidated.104


Commercially available solution and suspension are bioequivalent.122 126


Onset


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


Duration


Reduction in IOP persists for ≥12 hours.1 2 121


Distribution


Extent


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


Elimination


Metabolism


Systemically absorbed betaxolol is extensively metabolized to at least 5 metabolites.2 13 46


Stability


Storage


Ophthalmic


Solution

Tight containers at 15–30°C.b


Suspension

Upright at 15–30°C.a


ActionsActions



  • Selective β1-adrenergic blocking agenta b 1 2 3 4 5 6 7 8 9 10 13 16 17 25 45 48 83 121 122 that does not exhibit intrinsic β1-agonist or membrane stabilizing (local anesthetic) activity.1 2 8 9 13 18 25 28 83 121 122




  • One of the most potent2 6 13 16 17 25 45 48 122 and selective2 13 16 17 25 48 122 β1-adrenergic blocking agents currently available.




  • Reduces both elevated1 2 8 9 11 12 14 19 93 94 121 122 and normal1 2 7 IOP8 9 10 11 14 19 93 94 121 without affecting pupillary size1 2 8 9 11 12 18 93 94 99 122 or accommodation2 8 9 11 122 and without producing miosis and/or ciliary spasm associated with miotic agents.1 2 8 9 11 12 18




  • Reduces IOP by about 20–35% from baseline in patients with elevated IOP.a b 1 8 9 11 122




  • Exact mechanism of action not fully elucidated; tonography and fluorophotometric studies suggest that reduced aqueous humor formation is the principal effect. a b 1 2 8 9 11 12 18 93 122




  • May block endogenous catecholamine-stimulated increases in cyclic adenosine monophosphate (AMP) concentrations within the ciliary processes and subsequent formation of aqueous humor.64 65 115 116 117 118




  • Does not appear to affect aqueous outflow resistance.7 19




  • Tolerance may develop with prolonged use;1 however, IOP-lowering effect maintained for ≥4 years of continuous use in some patients.2 104



Advice to Patients



  • Importance of learning and adhering to proper administration techniques to avoid contamination of the product.a




  • Importance of not using suspension while having contact lenses in eyes.a




  • Advise patients to consult a clinician immediately regarding continued use of ophthalmic preparations if an intercurrent ocular condition (e.g., trauma, infection) occurs.




  • Importance of patients informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as concomitant illnesses.a




  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.a




  • Importance of informing patients of other important precautionary information. a (See Cautions.)



Preparations


Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.


* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name


















Betaxolol Hydrochloride

Routes



Dosage Forms



Strengths



Brand Names



Manufacturer



Ophthalmic



Solution



0.5% (of betaxolol)*



Betaxolol Hydrochloride Ophthalmic Solution



Akorn, Apotex, Bausch & Lomb, Falcon



Suspension



0.25% (of betaxolol)



Betoptic S (with benzalkonium chloride)



Alcon


Comparative Pricing


This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 03/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.


Betaxolol HCl 0.5% Solution (FALCON PHARMACEUTICALS): 15/$120 or 30/$235.98


Betoptic-S 0.25% Suspension (ALCON VISION): 15/$193.99 or 45/$568.98


Betoptic-S 0.25% Suspension (ALCON VISION): 10/$133.99 or 30/$378.97



Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.


The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions May 2007. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.




References



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