II. Indications

  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 (lowers IOP 20-25%)
  2. Does not interfere with Vision

V. Medications (Yellow Caps)

  1. Betaxolol (Betoptic): $39
    1. Only selective Beta Blocker eye drop (may be used in COPD, Asthma)
    2. Concentrations: 0.25%, 0.5%
    3. 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. Corneal hypesthesia (decreased Sensation)
  3. Burning or stinging
  4. 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 (Bradycardia, AV Block, CHF exacerbation)
    2. Fatal bronchospasm has occurred (avoid in Asthma and COPD, except Betaxolol which is selective)

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Cost: Medications

betoptic (on 7/27/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
BETOPTIC S 0.25% EYE DROP $34.45 per ml
BETOPTIC S 0.25% EYE DROPS $31.35 per ml
levobunolol (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
LEVOBUNOLOL 0.5% EYE DROPS Generic $2.16 per ml
timoptic (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
TIMOPTIC 0.5% OCUDOSE DROP Generic $4.67 each