Which medications in the drug class Beta-adrenergic blockers are used in the treatment of Primary Open-Angle Glaucoma (POAG)?

Updated: Mar 16, 2020
  • Author: Kristin Schmid Biggerstaff, MD; Chief Editor: Inci Irak Dersu, MD, MPH  more...
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Beta-adrenergic blockers

Topical beta-adrenergic receptor antagonists decrease aqueous humor production by the ciliary body. Adverse effects are due to systemic absorption of the drug, decreased cardiac output, and bronchoconstriction. In susceptible patients, this may cause bronchospasm, bradycardia, heart block, or hypotension. The patient's pulse rate and blood pressure also should be monitored if symptoms emerge after initiation of treatment. Patients may be instructed to perform punctal occlusion after administering the drops to reduce systemic absorption. Depression or anxiety may be experienced in some patients, and sexual dysfunction may be initiated or exacerbated. Ocular adverse effects may include blurred vision, eye ache, and corneal anesthesia.

Levobunolol (Betagan)

Nonselective beta-adrenergic blocking agents that lower IOP by reducing aqueous humor production.

Timolol (Timoptic XE, Istalol, Betimol)

Nonselective agents that may reduce elevated and normal IOP, with or without glaucoma, by reducing production of aqueous humor.

The brands Timoptic XE and Istalol are both administered once daily. However, Timoptic XE is a gel-forming solution, while Istalol is an aqueous solution.

Carteolol ophthalmic

Blocks beta1- and beta2-receptors and has mild intrinsic sympathomimetic activity (ISA), with possibly fewer cardiac and lipid profile adverse effects.

Betaxolol ophthalmic (Betoptic S)

Beta1-selective adrenergic antagonist, with possibly less pulmonary effects than nonselective agents. IOP-lowering effect is slightly less than nonselective beta-blockers.

Metipranolol hydrochloride

Beta-adrenergic blocker that has little or no intrinsic sympathomimetic effects and membrane stabilizing activity. Has little local anesthetic activity. Reduces intraocular pressure by reducing production of aqueous humor.

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