Topical β-blocker Pregnancy: US labelling: there are no adequate and well-controlled studies in pregnant women; levobunolol hydrochloride ophthalmic solution should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Fetotoxicity (greater number of resorption sites) was seen in rabbits at 200 and 700 times the recommended glaucoma dose; no fetotoxic or teratogenic effects were seen in rats at up to 1,800 times the human dose.

Levobunolol hydrochloride

Brand names: Betagan

Levobunolol is a non-selective beta-adrenoceptor blocker used as eye drops to lower intraocular pressure in open-angle glaucoma and ocular hypertension.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One to two drops of levobunolol hydrochloride ophthalmic solution 0.5% in the affected eye(s)

Route: Topical ocular (ophthalmic solution 0.5%)

Frequency: Once a day (recommended starting dose); in patients with more severe or uncontrolled glaucoma it can be administered twice a day

Max: Dosages above one drop of the 0.5% solution twice a day are not generally more effective

No UK SPC (eMC) record was retrieved in this bundle — the regimen below is from US labelling and must be verified against UK labelling. As with any new medication, careful monitoring of patients is advised. If the patient's IOP is not at a satisfactory level on this regimen, concomitant therapy with other ophthalmic IOP-lowering agents can be instituted. Patients should not typically use two or more topical ophthalmic beta-adrenergic blocking agents simultaneously. Paediatric use: safety and effectiveness in paediatric patients have not been established. Geriatric use: no overall differences in safety or effectiveness have been observed between elderly and younger patients. No renal or hepatic dose adjustment is stated in the fetched sections. Dose quote — US label DOSAGE AND ADMINISTRATION: 'The recommended starting dose is one to two drops of levobunolol hydrochloride ophthalmic solution, 0.5% in the affected eye(s) once a day. In patients with more severe or uncontrolled glaucoma, levobunolol hydrochloride ophthalmic solution, 0.5% can be administered twice a day.'

Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Bronchial asthma, or a history of bronchial asthma, or severe chronic obstructive pulmonary disease
Sinus bradycardia
Second and third degree atrioventricular block
Overt cardiac failure; cardiogenic shock
Hypersensitivity to any component of these products

Side effects

Transient ocular burning and stinging — in up to 1 in 3 patients
Blepharoconjunctivitis — in up to 1 in 20 patients
Decreases in heart rate and blood pressure
Reported rarely: iridocyclitis, headache, transient ataxia, dizziness, lethargy, urticaria, pruritus; decreased corneal sensitivity in a small number of patients
Class effects reported with levobunolol or ophthalmic use of other beta-blockers: bradycardia, arrhythmia, hypotension, syncope, heart block, congestive heart failure, cardiac arrest, cerebral vascular accident/ischaemia; nausea, diarrhoea; depression, confusion, increased signs and symptoms of myasthenia gravis

Interactions

Other topical ophthalmic beta-adrenergic blocking agents — patients should not typically use two or more simultaneously (US label, Dosage and Administration)
No dedicated interactions section was present in the fetched bundle (no UK SPC §4.5) — clinician to source

Clinical monograph

How it works

By blocking beta-adrenergic receptors in the ciliary body it reduces aqueous humour production, thereby lowering intraocular pressure.

Prescribing in practice

Systemic absorption can produce beta-blockade, so it is contraindicated in patients with asthma, a history of obstructive airways disease, significant bradycardia, heart block or uncontrolled heart failure.
Use with caution alongside systemic beta-blockers or other drugs affecting heart rate and conduction, and in patients with diabetes as it may mask signs of hypoglycaemia.
Nasolacrimal occlusion or gentle eyelid closure after instillation reduces systemic absorption.

Monitoring

Monitor intraocular pressure to assess response and remain alert clinically to systemic beta-blocker effects such as bradycardia or bronchospasm.

Counselling the patient

Press gently on the inner corner of the eye for a short time after instilling to limit drug reaching the rest of the body.
Report breathlessness, wheeze, a slow or irregular pulse, or unusual tiredness, and tell other clinicians you use this drop.

Evidence & guidelines

Topical beta-blockers are an established option for lowering intraocular pressure in glaucoma, as reflected in NICE glaucoma guidance (NG81).

Reference: Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways