BNF for Children 2011-2012

526 11.6 Treatment of glaucoma BNFC 2011–201211 EyeBetoptic c (Alcon) AOphthalmic solution (= eye drops), betaxolol (ashydrochloride) 0.5%, net price 5 mL = £1.90Excipients include benzalkonium chloride, disodium edetateOphthalmic suspension (= eye drops), betaxolol (ashydrochloride) 0.25%, net price 5 mL = £2.66Excipients include benzalkonium chloride, disodium edetateUnit dose eye drop suspension, betaxolol (ashydrochloride) 0.25%, net price 50 0.25 mL =£13.77CARTEOLOL HYDROCHLORIDECautions see notes aboveContra-indications see notes aboveSide-effects see notes aboveLicensed use not licensed for use in childrenIndication and doseSee notes aboveApply twice dailyTeoptic c (Spectrum Thea) AEye drops, carteolol hydrochloride 1%, net price 5 mL= £7.60; 2%, 5 mL = £8.40Excipients include benzalkonium chlorideLEVOBUNOLOL HYDROCHLORIDECautions see notes aboveContra-indications see notes aboveSide-effects see notes above; anterior uveitis occasionallyreportedLicensed use not licensed for use in childrenIndication and doseSee notes aboveApply once or twice dailyLevobunolol (Non-proprietary) AEye drops, levobunolol hydrochloride 0.5%. Net price5 mL = £3.05Excipients may include benzalkonium chloride, disodium edetate, sodiummetabisulphiteBetagan c (Allergan) AEye drops, levobunolol hydrochloride 0.5%, polyvinylalcohol (Liquifilm c ) 1.4%. Net price 5-mL = £1.85Excipients include benzalkonium chloride, disodium edetate, sodiummetabisulphiteUnit dose eye drops, levobunolol hydrochloride0.5%, polyvinyl alcohol (Liquifilm c ) 1.4%. Net price30 0.4 mL = £9.98Excipients include disodium edetateTIMOLOL MALEATECautions see notes aboveContra-indications see notes aboveSide-effects see notes aboveLicensed use not licensed for use in childrenIndication and doseSee notes aboveApply twice daily; long-acting preparations, seeunder preparations belowTimolol (Non-proprietary) AEye drops, timolol (as maleate) 0.25%, net price 5 mL= £1.56; 0.5%, 5 mL = £1.56Timoptol c (MSD) AEye drops, in Ocumeter c metered-dose unit, timolol(as maleate) 0.25%, net price 5 mL = £3.12; 0.5%,5 mL = £3.12Excipients include benzalkonium chlorideUnit dose eye drops, timolol (as maleate) 0.25%, netprice 30 0.2 mL = £8.45; 0.5%, 30 0.2 mL = £9.65Once-daily preparationsNyogel c (Novartis) AEye gel (= eye drops), timolol (as maleate) 0.1%, netprice 5 g = £2.85Excipients include benzalkonium chlorideDoseChild 12–18 years apply once daily in the morningTimoptol c -LA (MSD) AOphthalmic gel-forming solution (= eye drops),timolol (as maleate) 0.25%, net price 2.5 mL = £3.12;0.5%, 2.5 mL = £3.12Excipients include benzododecinium bromideDoseApply eye drops once dailyWith dorzolamideSee under DorzolamideProstaglandin analoguesThe prostaglandin analogues latanoprost, and travoprost,and the synthetic prostamide, bimatoprost,increase uveoscleral outflow and subsequently reduceintra-ocular pressure. They are used to reduce intraocularpressure. Only latanoprost is licensed for use inchildren; for prescribing information, see BNF section11.6. Children receiving prostaglandin analogues shouldbe managed by a specialist and monitored for anychanges to eye coloration since an increase in thebrown pigment in the iris can occur; particular care isrequired in those with mixed coloured irides and thosereceiving treatment to one eye only.SympathomimeticsApraclonidine (section 11.8.2) is an alpha 2 -adrenoceptoragonist. Eye drops containing apraclonidine0.5% are used for a short period to delay laser treatmentor surgery for glaucoma in patients not adequatelycontrolled by another drug; eye drops containing 1%are used for control of intra-ocular pressure after anteriorsegment laser surgery.Brimonidine is an alpha 2 -adrenoceptor agonist thatreduces intra-ocular pressure; it is contra-indicated inneonates and children under 2 years (risk of severesystemic side-effects), and should be used with cautionin children 2–12 years (increased risk of drowsiness).Carbonic anhydrase inhibitors andsystemic drugsThe carbonic anhydrase inhibitors, acetazolamide,brinzolamide, and dorzolamide, reduce intra-ocularpressure by reducing aqueous humour production. Systemicuse of acetazolamide also produces weak diuresis.