II. Indication

  1. Open Angle Glaucoma first line agent

III. Contraindications: Relative (related to systemic absorption risk described below)

  1. Asthma
  2. Chronic Obstructive Pulmonary Disease
  3. Congestive Heart Failure
  4. Cardiac conduction disturbance
  5. Depression
  6. Concurrent systemic Beta Blocker use

IV. Mechanism

  1. Decreases formation of Aqueous Humor
  2. Does not interfere with vision

V. Preparations

  1. Betaxolol (Betoptic): $39
    1. Concentrations: 0.25%, 0.5%
    2. Dose: 1 gtt bid
  2. Levobunolol (Betagan): $29-34
    1. Concentrations: 0.25%, 0.5%
    2. Dose: 1 gtt qd-bid
  3. Metipranolol (OptiPranolol): $24
    1. Concentrations: 0.3%
    2. Dose: 1 gtt bid
  4. Timolol (Timoptic): $30-35
    1. Concentrations: 0.25%, 0.5%
    2. Dose: 1 gtt bid
  5. Timoptic XE: $17-21
    1. Concentration: 0.25%, 0.5%
    2. Dose: 1 gtt qd

VI. Technique: Instillation

VII. Adverse effects

  1. Generally well tolerated
  2. Systemically absorbed (e.g. Timolol 0.5% one drop each eye is equivalent to Timolol 10 mg orally daily)
    1. Systemic cardiopulmonary effects may occur
    2. Fatal bronchospasm has occurred

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Cost: Medications

betaxolol (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
BETAXOLOL 10 MG TABLET Generic $0.70 each
BETAXOLOL HCL 0.5% EYE DROP Generic $10.42 per ml
betoptic (on 7/20/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
BETOPTIC S 0.25% EYE DROPS $26.07 per ml
levobunolol (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
LEVOBUNOLOL 0.5% EYE DROPS Generic $1.93 per ml
timoptic (on 12/23/2015 at Medicaid.Gov Survey of pharmacy drug pricing)
TIMOPTIC 0.5% OCUDOSE DROP $6.14 each