levobunolol
Levobunolol, also known under the brand name Betagan, is an ophthalmic (eye) medication that helps lower the pressure within the eye. It's approved for adults with glaucoma or ocular hypertension (high pressure in the eye). This medication is a beta blocker that helps lower the amount of fluid in the eye. Levobunolol (Betagan) comes as 0.5% eye drops that used once or twice a day. Potential side effects include temporary burning and stinging in the eye.
What is Levobunolol (Betagan)?
What is Levobunolol (Betagan) used for?
High pressure in the eye caused by open-angle glaucoma or ocular hypertension
How Levobunolol (Betagan) works
Levobunolol (Betagan) is a beta blocker. It works by lowering the amount of fluid that's made in the eye. When there's less fluid inside the eye, the eye pressure goes down.
Drug Facts
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What are the side effects of Levobunolol (Betagan)?
Common Side Effects
- Temporary burning or stinging in the eye (up to 33%)
Other Side Effects
- Inflammation of the eye or eyelid
- Inflammation of the iris (the colored part of the eye)
- Lower heart rate
- Lower blood pressure
- Headache
- Dizziness
- Tiredness
- Temporary movement or coordination problems
- Hives
- Itching
Serious Side Effects
- Trouble breathing: shortness of breath, wheezing, chest tightness
- Heart failure: shortness of breath; fatigue; swelling in the legs, ankles and feet
- Stroke or "mini-stroke": weakness on one side of the body, changes in vision or speech, headache, confusion
- Allergic reaction: rash around the eyes or face, hives, closing of the throat, swelling around the eyes or face
Source: DailyMed
The following side effects have also been reported
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 as soon as possible if any of the following side effects occur:
More common
Redness of eyes or inside of eyelids
Less common or rare
Blurred vision or other change in vision
different size pupils of the eyes
discoloration of the eyeball
droopy upper eyelid
redness or irritation of the tongue
seeing double
swelling, irritation or inflammation of eye or eyelid
Symptoms of too much medicine being absorbed into the body
Ankle, knee, or great toe joint pain
ankle, knee, or great toe joint swelling
anxiety or nervousness
bloody or cloudy urine
breast pain
burning or prickling feeling on body
change in taste
chills
clumsiness or unsteadiness
confusion or mental depression
coughing, wheezing, or troubled breathing
decreased sexual ability
difficult, burning, or painful urination
dizziness or feeling faint
drowsiness
dryness or soreness of throat
ear pain
feeling of constant movement
hallucinations (seeing, hearing, or feeling things that are not there)
headache
hoarseness
irregular, fast, slow, or pounding heartbeat
lightheadedness
lower back or side pain
muscle or joint aches or pain
muscle tightness or stiffness
nausea or vomiting
raw, red, blistering, scaly, or crusted areas of the skin
ringing or buzzing in the ears
runny, stuffy, or bleeding nose
swelling of feet, ankles, or lower legs
trouble in sleeping
unusual tiredness or weakness
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:
More common
Blurred vision, temporary
decreased night vision
stinging of eye or other eye irritation (when medicine is applied)
The side effect of blurred vision is associated primarily with levobetaxolol and the timolol gel-forming solution and usually lasts from thirty seconds to five minutes.
Less common or rare
Acid or sour stomach
belching
browache
crusting of eyelashes
dryness of eye
feeling of something in the eye
increased sensitivity of eye to light
indigestion
itching, stinging, burning, or watering of eye or other eye irritation
pain, redness, warmth, or swelling of muscles
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.
Pros and cons of Levobunolol (Betagan)
Pros
Typically used once a day for mild glaucoma
Doesn't need to be refrigerated
Can use together with other eye drops to lower eye pressure if it doesn't work well enough on its own
Cons
Can cause some burning and stinging in the eye
Can't use if you have asthma or other lung problems
Might be difficult for some people to place the drops in the eye
Pharmacist tips for Levobunolol (Betagan)
Wash your hands before you put levobunolol (Betagan) drops in your eye(s). Don't touch the dropper tip with your hands, and don't let the tip touch your eye or any other surface. This will help avoid you from getting germs into the eye and a possible eye infection.
Remember to take out any soft contact lenses from the eye before each time you use levobunolol (Betagan). The eye drop contains a preservative called benzalkonium chloride, which can cause damage to the contacts. Wait at least 15 minutes after you use levobunolol (Betagan) before you put your contacts back in.
After you place a drop of levobunolol (Betagan) in the eye, close your eye and press a finger to the inner corner of your eye by the nose for 2 to 3 minutes. This helps make sure the medication gets absorbed into the eye instead of draining into your tear duct.
If you need to use other eye drop medications with levobunolol (Betagan), wait at least 5 minutes between each drop so that your eye absorbs each medication fully.
Let your prescribers know about the medications you're taking, especially if you're any other beta blockers (e.g., pills for heart conditions, other glaucoma eye drops). Taking more than one beta blocker can possibly raise your risk for side effects, like low blood pressure and dizziness.
It's not easy to tell whether your eye pressure is improving at home. Make sure to use levobunolol (Betagan) as prescribed, even if you don't notice any difference in your symptoms or vision right away. Follow up with your prescriber for eye exams to see how well levobunolol (Betagan) is working for you.
Frequently asked questions about Levobunolol (Betagan)
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What are the risks and warnings for Levobunolol (Betagan)?
Levobunolol (Betagan) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of heart failure
Risk factors: History of heart failure
Beta blockers like levobunolol (Betagan) can cause new or worsening heart failure. Talk to your healthcare team right away if you notice swelling in your feet or ankles, if your pulse feels fast or irregular, or if you have shortness of breath when you lie down or exercise. These can be signs of heart failure.
Caution in people with blood circulation problems
Risk factors: Raynaud's syndrome | Blood circulation problems affecting the brain
Let your prescriber know if you have any conditions that cause blood circulation problems, such as Raynaud's syndrome or reduced blood flow to the brain. Beta blockers like levobunolol (Betagan) can make your condition worse.
Contact your care team if you have worsening symptoms of your condition while you're using levobunolol (Betagan). Get medical help as soon as possible if you have weakness on one side of the body, changes in speech or vision, confusion, or headache because these can be signs of a stroke or "mini-stroke."
Not recommended for people with breathing problems
Risk factors: History of asthma | History of chronic obstructive pulmonary disease (COPD) | History of other lung problems
Beta blocker medications like levobunolol (Betagan) aren't recommended for people with lung problems, like asthma and chronic obstructive pulmonary disease (COPD). Beta blockers can cause trouble breathing by making the airways narrower.
To be safe, it's important that your prescriber knows if you have or have ever had any lung conditions before you start using levobunolol (Betagan). Your prescriber can check whether this medication is safe for you. Be sure you have a rescue inhaler like albuterol ready in case you need it if you have lung problems and your prescriber says it's okay for you to use levobunolol (Betagan).
Hidden symptoms of low blood sugar
Risk factors: Diabetes | Taking insulin or other diabetes medications by mouth
Beta blockers can hide symptoms of low blood sugar, except for sweating and dizziness. People with diabetes might not be able to notice symptoms when their blood sugar drops too low. Although the risk is low, a small amount of levobunolol (Betagan) from the eye drop to get absorbed into the bloodstream and cause this effect. Talk to your primary care provider if you have concerns about using levobunolol (Betagan) if you have diabetes.
Hidden symptoms of overactive thyroid
Beta blockers can hide signs of hyperthyroidism (high thyroid hormone levels), such as a fast heart rate. This means that people with an overactive thyroid might not be able to recognize worsening symptoms of their thyroid problem. Although uncommon, it's possible for a small amount of levobunolol (Betagan) from the eye drop to get absorbed into the bloodstream and cause this to happen. Make sure your prescriber knows if you have hyperthyroidism before you start levobunolol (Betagan).
Worsening of myasthenia gravis
Rarely, beta blockers like levobunolol (Betagan) can worsen muscle weakness in people who have myasthenia gravis. Watch out for worsening symptoms if you have myasthenia gravis and let your care team know if this happens to you.
Risk of allergic reaction
Risk factors: History of asthma | Allergy to other beta blockers
Levobunolol (Betagan) contains a sulfite. People who are sensitive to sulfites can have an allergic reaction, including asthma attack or anaphylaxis (throat closing up and/or dangerously low blood pressure), to the medication. Let your care team know if you're allergic to sulfites because levobunolol (Betagan) might not be the best medication for you.
Get medical attention right away if you notice symptoms of an allergic reaction, such as rash, itching, eye swelling, or difficulty breathing.
Levobunolol (Betagan) dosage forms
Typical dosing for Levobunolol (Betagan)
The typical dose is 1 to 2 drops in the affected eye(s) once a day. People with more severe glaucoma might need to use the eye drops twice a day.
Interactions between Levobunolol (Betagan) and other drugs
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 any of these medicines, 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 medicines in this class 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
- Clonidine
- Crizotinib
- Diltiazem
- Dronedarone
- Epinephrine
- Fenoldopam
- Fingolimod
- Formoterol
- Indacaterol
- Iohexol
- Lacosamide
- Levalbuterol
- Olodaterol
- Oxymetazoline
- Paroxetine
- Ponesimod
- Rivastigmine
- Salmeterol
- Terbutaline
- Verapamil
- Vilanterol
How much does Levobunolol (Betagan) cost?
Levobunolol (Betagan) contraindications
Sinus bradycardia (slow heart rate)
Second- or third-degree heart block
What are alternatives to Levobunolol (Betagan)?
High pressure in the eye caused by open-angle glaucoma or ocular hypertension
High pressure in the eye caused by ocular hypertension (high blood pressure inside the eye) or open-angle glaucoma (the most common type of glaucoma)
High pressure in the eye caused by ocular hypertension (high pressure inside the eye) or open-angle glaucoma (the most common type of glaucoma)
What is the latest news about Levobunolol (Betagan)?
Levobunolol (Betagan) images
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References
Best studies we foundAmerican Academy of Allergy, Asthma & Immunology. (2024). Sulfite and sulfa drugs.
American Optometric Association. (n.d.). Ocular hypertension.
Bausch & Lomb Incorporated. (2024). Levobunolol hydrochloride solution/drops [package insert]. DailyMed.
Hafez, Y., et al. (2023). Sinus bradycardia. StatPearls.
Huang, K. Y., et al. (2021). Do beta-adrenergic blocking agents increase asthma exacerbation? A network meta-analysis of randomized controlled trials. Scientific Reports.
National Heart, Lung, and Blood Institute. (2022). What is cardiogenic shock?
SafeMedication. (n.d.). How to use eye drops.
Sidjanin, D. J., et al. (2008). Pharmacogenetics of ophthalmic topical beta-blockers. Personalized Medicine.
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