Cardioselective beta-blocker (eye drops + oral) Pregnancy: There are no adequate data in pregnant women; betaxolol should not be used during pregnancy unless clearly necessary (reduce systemic absorption by nasolacrimal occlusion). Epidemiological studies show a risk of intra-uterine growth retardation with oral beta-blockers, and neonatal beta-blockade (bradycardia, hypotension, respiratory distress, hypoglycaemia) has been observed when beta-blockers were given until delivery - monitor the neonate carefully during the first days of life. Beta-blockers are excreted in breast milk, but at therapeutic ophthalmic doses it is unlikely that sufficient amounts would be present to produce clinical beta-blockade in the infant.

Betaxolol

Brand names: Betoptic

Betaxolol is a cardioselective (beta-1 selective) beta-adrenoceptor blocker; in ophthalmology it is used topically to lower intraocular pressure in ocular hypertension and open-angle glaucoma.

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 drop of betaxolol 0.5% eye drops instilled into the affected eye(s)

Route: Topical ocular (eye drops, 0.5% w/v) - for ocular use only

Frequency: Twice a day

FORMULATION SCOPE: the SPC fetched is 'Betaxolol 0.5% Eye Drops' - the topical ophthalmic product for raised intraocular pressure. If this page is intended to cover systemic (oral) betaxolol for hypertension, that formulation is NOT in this bundle and must be sourced separately. eMC 4.2: adults (including the elderly) one drop twice a day. Children: no clinical studies have been performed to establish safety and efficacy, so the product is currently not recommended for use in children. Using nasolacrimal occlusion or closing the eyelids for 2 minutes reduces systemic absorption, which may decrease systemic side effects and increase local activity. Intraocular pressure should be reassessed approximately four weeks after starting treatment because the response may take a few weeks to stabilise. If necessary, concomitant treatment with miotics, adrenaline and/or carbonic anhydrase inhibitors can be instituted; allow an interval of at least 10 minutes between each ophthalmic application to prevent wash-out. The use of two topical beta-adrenergic agents is not recommended. Transfer from a single antiglaucoma agent: continue that agent and add one drop of betaxolol 0.5% in each affected eye twice daily; on the following day discontinue the previous agent completely and continue with betaxolol. When several antiglaucoma agents are in use, assess the patient individually and adjust one agent at a time at intervals of not less than one week. Patients should remove soft contact lenses before use. In angle-closure glaucoma betaxolol has no effect on the pupil, so it should be used together with a miotic. US labelling (openFDA, BETOPTIC S ophthalmic suspension 2.5 mg/mL, 0.25%): instil one drop in the affected eye(s) twice daily; shake well before using; administer other topical ophthalmic medicines at least 10 minutes before BETOPTIC S.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; 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

Sinus bradycardia, sick sinus syndrome, sino-atrial block
Cardiogenic shock
Overt cardiac failure
Second or third degree atrioventricular block not controlled with a pacemaker
Reactive airway disease including severe bronchial asthma or a history of severe bronchial asthma, and severe chronic obstructive pulmonary disease
Hypersensitivity to betaxolol, to any of the excipients or to other beta-blocking agents

Side effects

Ocular discomfort (very common - 12.0% of patients in clinical trials)
Vision blurred, increased lacrimation, headache (common)
Punctate keratitis, keratitis, conjunctivitis, blepharitis, photophobia, eye pain, dry eye, ocular hyperaemia (uncommon)
Bradycardia, tachycardia; asthma, dyspnoea, rhinitis (uncommon); arrhythmia (frequency unknown)
Rare: hypotension, syncope, anxiety, insomnia, depression, dermatitis, rash; systemic allergic reactions including angioedema and anaphylaxis, hypoglycaemia and increased signs of myasthenia gravis (frequency unknown)

Interactions

Systemic beta-blocking agents - the effect on intraocular pressure or the known effects of systemic beta-blockade may be potentiated; observe the patient closely (eMC 4.4; US 7.1 oral beta-adrenergic receptor inhibitors may have additive effects)
Catecholamine-depleting drugs (e.g. reserpine) - possible additive effects with hypotension and/or bradycardia, which may result in vertigo, syncope or postural hypotension (US 7.2)
Concomitant adrenergic psychotropic drugs - exercise caution (US 7.3)
Calcium antagonists, antiarrhythmics (including amiodarone) and digitalis - additive effects resulting in hypotension and/or marked bradycardia (US 7.4)

Clinical monograph

How it works

It blocks beta-adrenergic receptors in the ciliary body, reducing aqueous humour production and thereby lowering intraocular pressure.

Prescribing in practice

Even as eye drops it can be absorbed systemically, so avoid in uncontrolled heart failure, significant bradycardia or heart block, and use cautiously in asthma or COPD despite its relative beta-1 selectivity.
Topical beta-blockers can mask the adrenergic warning signs of hypoglycaemia in people with diabetes.
Press on the inner corner of the eye after instillation to reduce systemic absorption.

Monitoring

Monitor intraocular pressure for response and watch for systemic effects such as bradycardia or bronchospasm.

Counselling the patient

Report breathlessness, wheeze, a slow heartbeat or dizziness.
Transient stinging or blurred vision after instillation is common.
Do not stop suddenly without advice if you also have heart or blood pressure conditions.

Evidence & guidelines

Betaxolol is an established topical beta-blocker for glaucoma and ocular hypertension, with comparatively favourable respiratory tolerability among ocular beta-blockers.

Reference: NICE NG81; RCOphth; 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