Betoptic-S (Betaxolol 0.25%)

Systemic absorption: Topical dosing produces the same reactions as systemic beta-blockade, including death from bronchospasm in patients with asthma and death from cardiac failure reported with ophthalmic beta-blockers.

Cardiac failure: Minor effect on heart rate and blood pressure in clinical studies, but use caution with a history of cardiac failure or heart block and discontinue at the first signs of failure.

Bronchospasm and pulmonary distress: Asthmatic attacks and pulmonary distress have been reported during betaxolol treatment; rechallenge of some such patients did not adversely affect pulmonary function test results, but adverse pulmonary effects in patients sensitive to beta-adrenergic receptor inhibitors cannot be ruled out. Caution with excessive restriction of pulmonary function.

Diabetes mellitus: Masks the signs and symptoms of acute hypoglycemia; caution in labile diabetes and in patients on insulin or oral hypoglycemics.

Thyrotoxicosis: Masks tachycardia and other signs of hyperthyroidism; abrupt withdrawal may precipitate thyroid storm.

Muscle weakness: May potentiate myasthenic symptoms including diplopia, ptosis, and generalized weakness.

Surgical anesthesia: Impairs beta-mediated reflex cardiac response; protracted severe hypotension and difficulty restarting the heartbeat have been reported, so consider gradual withdrawal before elective surgery.

Atopy and anaphylaxis: Patients with atopy or prior severe anaphylaxis may be more reactive on repeat allergen challenge and unresponsive to usual epinephrine doses.

Angle-closure glaucoma: Little or no effect on the pupil, so it should not be used alone when the immediate objective is reopening the angle.

Vascular insufficiency: Consider alternative therapy if reduced cerebral blood flow or Raynaud's phenomenon develops after starting treatment.