Description and Brand Names

Drug information provided by: Merative, Micromedex®

US Brand Name

1. Betagan

Canadian Brand Name

1. Ratio-Levobunolol

Descriptions

Levobunolol eye drops is used alone or together with other medicines to lower pressure inside the eye that is caused by open-angle glaucoma or ocular (eye) hypertension. This medicine is a beta-blocker.

This medicine is available only with your doctor's prescription.

This product is available in the following dosage forms:

• Solution

Before Using

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 this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of levobunolol eye drops in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of levobunolol eye drops in the elderly.

Drug Interactions

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. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Albuterol
• Ceritinib
• Crizotinib
• Darunavir
• Diltiazem
• Dronedarone
• Epinephrine
• Fenoldopam
• Fingolimod
• Formoterol
• Indacaterol
• Iobenguane I 131
• Iohexol
• Lacosamide
• Levalbuterol
• Olodaterol
• Oxymetazoline
• Ponesimod
• Rivastigmine
• Salmeterol
• Terbutaline
• Verapamil
• Vilanterol

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Acarbose
• Aceclofenac
• Acemetacin
• Acetyldigoxin
• Albiglutide
• Alfuzosin
• Alogliptin
• Amtolmetin Guacil
• Aspirin
• Bromfenac
• Bufexamac
• Bunazosin
• Canagliflozin
• Celecoxib
• Chlorpropamide
• Choline Salicylate
• Clonixin
• Dapagliflozin
• Deslanoside
• Dexibuprofen
• Dexketoprofen
• Diclofenac
• Diflunisal
• Digitoxin
• Digoxin
• Dipyrone
• Doxazosin
• Droxicam
• Dulaglutide
• Empagliflozin
• Ertugliflozin
• Etodolac
• Etofenamate
• Etoricoxib
• Exenatide
• Felbinac
• Fenoprofen
• Fepradinol
• Feprazone
• Floctafenine
• Flufenamic Acid
• Flurbiprofen
• Glimepiride
• Glipizide
• Glyburide
• Ibuprofen
• Indomethacin
• Insulin Aspart, Recombinant
• Insulin Degludec
• Insulin Detemir
• Insulin Glargine, Recombinant
• Insulin Glulisine
• Insulin Human Inhaled
• Insulin Human Isophane (NPH)
• Insulin Human Regular
• Insulin Lispro, Recombinant
• Ketoprofen
• Ketorolac
• Linagliptin
• Liraglutide
• Lixisenatide
• Lornoxicam
• Loxoprofen
• Lumiracoxib
• Meclofenamate
• Mefenamic Acid
• Meloxicam
• Metformin
• Metildigoxin
• Miglitol
• Morniflumate
• Moxisylyte
• Nabumetone
• Naproxen
• Nateglinide
• Nepafenac
• Niflumic Acid
• Nimesulide
• Nimesulide Beta Cyclodextrin
• Oxaprozin
• Oxyphenbutazone
• Parecoxib
• Phenoxybenzamine
• Phentolamine
• Phenylbutazone
• Piketoprofen
• Pioglitazone
• Piroxicam
• Pramlintide
• Pranoprofen
• Prazosin
• Proglumetacin
• Propyphenazone
• Proquazone
• Repaglinide
• Rofecoxib
• Rosiglitazone
• Salicylic Acid
• Salsalate
• Saxagliptin
• Sitagliptin
• Sodium Salicylate
• St John's Wort
• Sulindac
• Tamsulosin
• Tenoxicam
• Terazosin
• Tiaprofenic Acid
• Tolazamide
• Tolbutamide
• Tolfenamic Acid
• Tolmetin
• Trimazosin
• Urapidil
• Valdecoxib
• Vildagliptin

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Asthma, or history of or
• Bradycardia (slow heartbeat) or
• Chronic obstructive pulmonary disease (COPD), severe or
• Heart block or
• Heart failure—Should not be used in patients with these conditions.

• Blood vessel disease, especially blood vessels in the brain (eg, Raynaud’s disease) or
• Lung or breathing problems or
• Stroke, history of—Use with caution. May make these conditions worse.

• Diabetes or
• Hyperthyroidism (overactive thyroid) or
• Hypoglycemia (low blood sugar)—May cover up some of the signs and symptoms of these diseases, such as a fast heartbeat.

• Myasthenia gravis—Use with caution. May cause side effects to become worse.

• Sulfite allergy—Use with caution. This medicine contains sodium metabisulfite.

Proper Use

Use this medicine exactly as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

Shake the medicine well just before each use.

To use the eye drops (solution):

• Wash your hands with soap and water before and after you use this medicine.
• Tilt the head back. Press your finger gently on the skin just beneath the lower eyelid and pull the lower eyelid away from the eye to make a space. Drop the medicine into this space. Let go of the eyelid and gently close the eyes. Do not blink. Keep the eyes closed and apply pressure to the inner corner of the eye with your finger for 1 or 2 minutes to allow the medicine to be absorbed by the eye.
• To keep the medicine as germ-free as possible, do not touch the applicator tip to any surface (including the eye). Also, keep the container tightly closed. Serious damage to the eye and possible loss of vision may result from using contaminated eye medicines.

You should not use the eye drops if you have contact lenses in your eyes. Remove your contact lenses before you use this medicine. Wait at least 15 minutes after you use the medicine before putting the contact lenses back in.

If your doctor ordered two different eye medicines to be used together, wait several minutes before using the second medicine. This will help prevent the second medicine from “washing out” the first one.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For ophthalmic solution dosage form (eye drops):
  • For glaucoma or ocular hypertension:
    • Adults—One to two drops in the affected eye(s) once a day. Your doctor may increase your dose to 1 to 2 drops two times a day, as needed.
    • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, apply it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions

It is very important that your eye doctor (ophthalmologist) check your progress at regular visits to make sure this medicine is working properly and to check for unwanted effects.

Do not use this medicine if you are also using a beta-blocker medicine that is taken by the mouth.

If itching, redness, swelling, or other signs of eye or eyelid irritation occur, check with your doctor right away. This may mean that you are allergic to this medicine.

Levobunolol may cause heart failure in some patients. Check with your doctor right away if you are having chest pain or discomfort, dilated neck veins, extreme fatigue, irregular breathing, an irregular heartbeat, shortness of breath, swelling of the face, fingers, feet, or lower legs, or weight gain.

This medicine may cause changes in your blood sugar levels. It may also cover up signs of low blood sugar, such as a rapid pulse rate. Check with your doctor if you have these problems or if you notice a change in the results of your blood or urine sugar tests.

This medicine may cause choroidal detachment (bleeding inside the eye). Talk to your doctor if you have concerns.

Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

1. Burning or stinging in the eye
2. drainage from the eye
3. redness, swelling, or itching of the eye and eyelid

Less common

1. Blurred vision
2. chest pain or discomfort
3. confusion
4. dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
5. slow or irregular heartbeat
6. sweating
7. unusual tiredness or weakness

Rare

1. Eye pain
2. headache
3. hives or welts, itching, or skin rash
4. redness of the skin
5. shakiness and unsteady walk
6. tearing
7. unsteadiness, trembling, or other problems with muscle control or coordination
8. unusual drowsiness, dullness, or feeling of sluggishness

Incidence not determined

1. Blistering, peeling, or loosening of the skin
2. blue lips, fingernails, or skin
3. burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
4. chills
5. cough
6. decreased urine output
7. diarrhea
8. difficult or labored breathing
9. difficulty in chewing, swallowing, or talking
10. dilated neck veins
11. disturbed color perception
12. double vision
13. drooping eyelids
14. extreme tiredness or weakness
15. fast, pounding, or racing heartbeat or pulse
16. fever
17. halos around lights
18. hoarseness
19. inability to speak
20. irregular, fast or slow, or shallow breathing
21. joint pain, stiffness, or swelling
22. muscle pain or weakness
23. night blindness
24. no blood pressure or pulse
25. noisy breathing
26. overbright appearance of lights
27. red skin lesions, often with a purple center
28. seeing double
29. seizures
30. severe numbness, especially on one side of the face or body
31. severe or sudden headache
32. slurred speech
33. sore throat
34. sores, ulcers, or white spots in the mouth or on the lips
35. stopping of the heart
36. swelling of the eyelids, face, lips, hands, fingers, feet, or lower legs
37. temporary blindness
38. tightness in the chest
39. tunnel vision
40. unconsciousness
41. weakness in the arm or leg on one side of the body, sudden and severe
42. weight gain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not determined

1. Decreased interest in sexual intercourse
2. discouragement
3. feeling of having something in the eye
4. feeling sad or empty
5. inability to have or keep an erection
6. irritability
7. lack of appetite
8. lack or loss of strength
9. loss in sexual ability, desire, drive, or performance
10. loss of interest or pleasure
11. nausea
12. stuffy nose
13. trouble concentrating
14. trouble sleeping

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Portions of this document last updated: Feb. 01, 2024

Original article: https://www.mayoclinic.org/drugs-supplements/levobunolol-ophthalmic-route/side-effects/drg-20071154