Levobunolol

Registered South African indications:

• Chronic open angle glaucoma
• Ocular hypertension

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Reactive airway disease including bronchial asthma or a history of bronchial asthma
• Severe chronic obstructive pulmonary disease
• Sinus bradycardia
• Sick sinus syndrome
• Sino-atrial block
• Second and third degree atrioventricular block not controlled with a pace maker 
• Overt cardiac failure
• Cardiogenic shock

Cautions 

• Pregnancy
• Breastfeeding 
• Renal impairment 
• Hepatic impairment 
• Cardiac failure 
• Hypotension 
• Coronary heart disease
• Prinzmetal's angina
• First degree atrioventricular block
• Severe peripheral circulatory disturbance disorders
• Asthma 
• Mild to moderate chronic obstructive pulmonary disease
• Hypoglycaemia
• Diabetes mellitus 
• Hyperthyroidism 
• Corneal disease 
• History of atopy
• History of severe anaphylactic reaction
• Concomitant use of soft contact lens
• May impair ability to drive and operate machinery 

Forms avail. in SA and covered in this monograph: opd

Chronic open angle glaucoma 
Ocular hypertension

• Ophthalmic (opd): 1 drop into affected eye(s), 12hrly

Intraocular pressure should be measured approximately 4 weeks after starting treatment

Nasolacrimal occlusion or closing the eyelids for 2 minutes will reduce systemic absorption

Not established for use in children

Pregnancy 

• FDA Pregnancy Category C 

Breastfeeding 

• Caution; not recommended

Renal Impairment 

• Caution; no information available 

Hepatic Impairment 

• Caution; no information available

Elderly 

• No dose adjustment recommended 

Central Nervous System Disorders 

• Depression
• Confusion
• Dizziness
• Somnolence
• Lethargy
• Headache
• Insomnia
• Fatigue
• Memory loss
• Nightmares
• Cerebral ischemia
• Cerebrovascular accident
• Exacerbation of myasthenia gravis
• Paraesthesia
• Decreased libido

Cardiovascular Disorders

• Syncope
• Bradycardia
• Atrioventricular block
• Palpitations
• Hypotension
• Raynaud's phenomenon
• Arrhythmia
• Cardiac arrest
• Cardiac failure
• Chest pain
• Congestive cardiac failure
• Oedema
• Cold hands and feet

Respiratory Disorders

• Asthma
• Dyspnoea
• Throat irritation
• Nasal discomfort
• Cough
• Bronchospasm 

Gastrointestinal Disorders

• Nausea and vomiting 
• Abdominal pain
• Diarrhoea
• Dysgeusia
• Dry mouth
• Dyspepsia

Genitourinary Disorders

• Sexual dysfunction

Endocrine and Metabolic Disorders

• Hypoglycaemia  

Musculoskeletal Disorders

• Myalgia  

Skin and Subcutaneous Tissue Disorders

• Urticaria
• Dermatitis
• Rash
• Erythema of eyelid
• Eyelid eczema
• Skin exfoliation
• Lichenoid keratosis
• Pruritus
• Facial oedema
• Alopecia 
• Psoriasiform rash
• Exacerbation of psoriasis

Immune, Blood and Lymphatic System Disorders

• Anaphylactic reaction
• Systemic allergic reactions

Sensory Disorders 

• Eye irritation
• Eye pain
• Blepharitis
• Conjunctivitis
• Conjunctival hyperemia
• Decreased corneal reflex
• Iridocyclitis
• Keratitis
• Blurred vision
• Punctate keratitis
• Eye/eyelids pruritus
• Eye/eyelid oedema
• Eye discharge
• Decreased lacrimation
• Dry eye
• Choroidal detachment
• Corneal erosion
• Diplopia
• Ptosis
• Corneal calcification 

• Calcium channel blockers
• Beta blockers
• Anti-arrhythmics
• Digoxin
• Parasympathomimetics
• Guanethidine
• Adrenaline 

Heart rate 

Levobunolol is a nonselective beta blocking agent. It lowers intraocular pressure by reducing aqueous humor production and possibly increases the outflow of aqueous humor.

Eye drops (per ml) 5mg

• Betagan 0.5% Liquifilm (Allergan) originator (Discontinued: 27/02/2020)