terminology and guidelines for glaucoma ii - Kwaliteitskoepel

3.3.1.2 - Category: ADRENERGIC ANTAGONISTS 36,43
ß-Blockers
Generics
Tradenames
Beta-1 selective: Betaxolol 0.5 - 0.25% Betoptic, Betoptic S, Betoptima
Non-selective: Befunolol 0.5% Betaclar
Levobunolol 0.25, 0.5%
Betagan , Vistagan
Metipranolol 0.1, 0.3%
Betaman, Beta-ophtiole, Glausyn,
Optipranolol, Turoptin
Timolol 0.1, 0.25, 0.5%
Aquanil, Arutimol, Cusimolol, Nyogel,
Optimol, Oftamolol, Timoptic, Timoptic-XE,
Timoptol, Timoptol, Timabak, Timogel,
Timolabak, Timosine XE, Timosan Depot
With ISA*: Carteolol 0.5-2.0% Carteolol 0.5%,1%, 2% Carteol,
Carteabak
Ocupress, Teoptic, Arteoptic
Pindolol 2%
Pindoptic
*ISA: Intrinsic Sympathomimetic Activity. The clinical relevance of ISA in glaucoma therapy has not yet been proven.
Action
Decreases intraocular pressure by reduction of the aqueous humor production. Peak effect in 2 hrs.
Dosage and administration
Starting dose is one drop of lowest concentration of solution in the affected eye once or twice a day. If the clinical
response is not adequate, the dosage may be increased to one drop of a higher concentration. Nyogel, Timolol in gelrite
(Timoptic-XE, Timacar Depot, Timoptol XE, and Timosan Depot) is given once daily.
No dose response curves for the different beta-blocker treatments have been established. The lowest concentration
that would give the expected clinical effect should be used to avoid side defects. Dosing more than twice daily will
not give any further pressure lowering effect.
Minimal extra effect with dipivefrine. No extra effect with adrenaline (epinephrine). Additive effect with most other
IOP-lowering agents.
Preservativa-free preparations are available and may be considered
Indications
Elevation of intraocular pressure in patients where the IOP can be deleterious for the preservation of visual function.
Beta-1 selective adrenergic antagonist despite lowering IOP less than non selective, protect visual field as well as non
selective ones.
Major Contraindications
Non-selective: Asthma, history of obstructive pulmonary disease, sinus bradycardia (< 60 beats/min), heart block, or
cardiac failure
Beta-1 selective:Relative contraindication in asthma, history of obstructive pulmonary disease, sinus bradycardia (<
60 beats/min), heart block, or cardiac failure
Major side effects
Non-selective: Systemic: Bradycardia, arrhythmia, heart failure, syncope, bronchospasm, and airways obstruction.
Distal edema, hypotension. Depression. Hypoglycemia may be masked in insulin dependent diabetes mellitus. Betablocking
agents have been associated with nocturnal hypotension, which may be a risk factor in progression of glaucomatous
optic nerve damage 52 .
Ocular (uncommon): Epithelial keratopathy, slight reduction in corneal sensitivity.
Beta-1 selective: Better tolerated in most patients sensitive to non-selective agents.
Ch. 3 - 12 EGS