Betaxolol

For additional information see Beta-blockers (eye)

For drug interactions see Beta-blockers

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This drug has been discontinued.

Mode of action

Mode of action from Beta-blockers

Reduce aqueous humour production, probably by blockade of beta receptors on the ciliary epithelium.

Indications

Glaucoma

Ocular hypertension

Indications from Beta-blockers

Glaucoma

Ocular hypertension

Precautions

Precautions from Beta-blockers

Treatment with a systemic beta-blocker—reduces intraocular pressure (but less than with a topical beta-blocker). Adding a topical beta-blocker further reduces intraocular pressure (but this may be less effective than using an alternative class of topical agent). Risk of systemic adverse effects is increased.

Treatment with drugs that cause bradycardia—may further decrease heart rate; monitor cardiac function. Avoid combination with verapamil (unless under specialist supervision).

Cardiovascular

As topical beta-blockers are absorbed systemically, consider potential for cardiovascular effects (see Precautions in Beta-blockers). Topical beta-blockers are contraindicated in bradyarrhythmia, second? or third-degree atrioventricular block or uncontrolled heart failure.

Respiratory

As topical beta-blockers may precipitate bronchospasm, they are generally contraindicated in asthma. However, betaxolol (which is beta1 selective) may be used with caution if required.

They may be used with caution in COPD; betaxolol may be preferred.

Surgery

Theoretical increased risk of bradycardia and hypotension during surgery.

Elderly

Systemic adverse effects are more common, eg hypotension (may cause falls).

Pregnancy

May be used. Monitor fetus for possible adverse effects, eg bradycardia.

Breastfeeding

Considered safe to use. Although adverse effects are unlikely, consider monitoring the infant.

Adverse effects

Adverse effects from Beta-blockers

The most important adverse effects are systemic.

Common (>1%)

stinging on instillation (especially betaxolol solution), bradycardia, blurred vision

Infrequent (0.1–1%)

decreased corneal sensation, hypotension, fainting, fatigue, confusion, hallucinations, bronchospasm

Dosage – Betaxolol

□□, 1 eye drop twice daily.

Practice points

? betaxolol 0.25% suspension (which may be available through the SAS, see Drug availability in Australia) is as effective as betaxolol 0.5% solution; use of suspension reduces local stinging, which may help compliance

Practice points from Beta-blockers

? to reduce systemic effects, advise patients to close their eyes and apply punctal occlusion after administration, see Counselling

Products

Search for Betaxolol on the PBS

? eye drop, 0.5% (solution), 5 mL, Betoptic, Betoquin, PBS

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Mometasone (intranasal)

For additional information see Corticosteroids (intranasal)

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Mode of action

Mode of action from Corticosteroids

Produce local anti-inflammatory effects, decrease capillary permeability and mucus production, and produce vasoconstriction in the nasal mucosa.

Indications

Allergic rhinitis

Acute rhinosinusitis

Nasal polyps

Indications from Corticosteroids

Allergic rhinitis

Rhinosinusitis

Nasal polyps

Precautions

Precautions from Corticosteroids

Severe nasal infection—contraindicated.

Bleeding disorders—intranasal corticosteroids may cause nose bleeding.

Recent nasal surgery or trauma—intranasal corticosteroids may delay healing.

Pregnancy

Generally considered safe to use; budesonide, fluticasone or mometasone is preferred for first-trimester use due to greater experience.

Breastfeeding

Safe to use.

Adverse effects

Adverse effects from Corticosteroids

Systemic adverse effects are rare with nasal products used at recommended doses.

Common (>1%)

nasal stinging, itching, nose bleed, sneezing, sore throat, dry mouth, cough

Rare (<>

nasal septal perforation, glaucoma, cataract, allergic reactions (urticaria, angioedema, bronchospasm, rash)

Dosage – Mometasone

Allergic rhinitis

□□, child >12 years, initially 2 sprays into each nostril once daily, reduce to 1 spray into each nostril once daily when symptoms controlled.

2–12 years, 1 spray into each nostril once daily.

Rhinosinusitis

□□, child >12 years, 2 sprays into each nostril twice daily.

Nasal polyps

□□, initially 2 sprays into each nostril once daily; may be increased to 2 sprays into each nostril twice daily if necessary.

Practice points

Practice points from Corticosteroids

? all intranasal corticosteroids have similar efficacy and onset of action, with optimum effect after several days of regular use

? effective on an as-needed basis; some symptoms of allergic rhinitis may start to improve within hours of intranasal administration

? patients transferred from oral to intranasal corticosteroids may have impaired adrenal function; intranasal corticosteroids have little systemic effect, see also Adrenal suppression

Products

? nasal spray, 50 mcg/dose, 65 doses, 140 doses, 280 doses, Nasonex Aqueous

? nasal spray, 50 mcg/dose, 65 doses, 140 doses, Azonaire, Nasonex Allergy Aqueous

? nasal spray, 50 mcg/dose, 140 doses, Sensease, Telnasal

Mometasone combinations

Olopatadine with mometasone

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Prednisolone (eye)

For additional information see Corticosteroids (eye)

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Mode of action

Mode of action from Corticosteroids

Corticosteroids regulate gene expression resulting in local anti-inflammatory and immunosuppressive effects.

Indications

Selected allergic and inflammatory conditions of conjunctiva and cornea

Precautions

Precautions from Corticosteroids

History of, or risk factors for, glaucoma—increased risk of ocular hypertension due to corticosteroids; monitor intraocular pressure carefully.

Treatment with ocular NSAIDs—may increase risk of healing problems as both ocular corticosteroids and ocular NSAIDs may delay healing.

Ocular infection

Corticosteroids suppress the immune system and can increase the risk and severity of infections; their anti-inflammatory effects can also mask signs of infection. Ocular corticosteroids are contraindicated in most ocular infections, particularly in herpes simplex epithelial keratitis, fungal keratitis and untreated infections. They may be used in conjunction with anti-infectives in some specific infections with close supervision by, or after discussion with, an ophthalmologist.

Children

Children are at increased risk of ocular hypertension and cataract. They may also be at increased risk of adrenal suppression with intensive or long-term use of ocular corticosteroids.

Pregnancy

Safe to use.

Breastfeeding

Safe to use.

Adverse effects

Adverse effects from Corticosteroids

Do not use without close supervision by, or discussion with, an ophthalmologist: their serious adverse effects can threaten vision.

Common (>1%)

ocular hypertension (below), ocular infection, delayed corneal healing, rebound inflammation (after stopping treatment abruptly)

Rare (<>

posterior subcapsular cataracts (may be common with long-term use), adrenal suppression (with intensive or long-term use)

Ocular hypertension

Risk depends on the individual as well as the drug’s dose, duration of treatment and anti-inflammatory efficacy. Increased intraocular pressure is usually rever

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