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Cardioselective Beta-1 Blocker — Glaucoma Pregnancy: UK SPC section 4.6: there are no data on the effects of Betaxolol Eye Drops on human fertility. There are no adequate data for the use of betaxolol in pregnant women; 'Betaxolol should not be used during pregnancy unless clearly necessary.' To reduce systemic absorption, see section 4.2 (nasolacrimal occlusion). Epidemiological studies have not revealed malformative effects but show a risk for intra-uterine growth retardation when beta-blockers are administered by the oral route. Signs and symptoms of beta-blockade (e.g. bradycardia, hypotension, respiratory distress and hypoglycaemia) have been observed in the neonate when beta-blockers have been administered until delivery; if the product is administered until delivery, the neonate should be carefully monitored during the first days of life. Lactation: beta-blockers are excreted in breast milk, with the potential to cause serious undesirable effects in the infant; however, at therapeutic doses of betaxolol in eye drops it is not likely that sufficient amounts would be present in breast milk to produce clinical symptoms of beta-blockade in the infant.

Betaxolol 0.5% Eye Drops

Brand names: Betoptic, Betoptic S

Betaxolol 0.5% eye drops are a topical cardioselective (beta-1 selective) beta-blocker used to lower intraocular pressure in ocular hypertension and chronic open-angle glaucoma.

Adult dose

Dose: Reduction of elevated intraocular pressure in ocular hypertension and chronic open angle glaucoma: one drop instilled into the affected eye(s) twice daily (adults, including the elderly)
Route: Topical ophthalmic (eye drops, solution) - for ocular use only
Frequency: Twice daily
SOURCE SCOPE: UK SPC for Betoptic 0.5% w/v Eye Drops Solution (eMC product 14098), section 4.2, verbatim: 'Adults (including the elderly) The usual dose is one drop to be instilled into the affected eye(s) twice daily.' This card covers the 0.5% solution only; any other Betoptic strength or formulation (including the Betoptic S brand also named on this page) is not covered by this source. NO MAXIMUM DOSE is printed in the SPC, so none is given. CHILDREN, verbatim: 'Betoptic is not recommended for use in children.' REDUCING SYSTEMIC ABSORPTION, verbatim: 'When using nasolacrimal occlusion or closing the eyelids for 2 minutes, the systemic absorption is reduced. This may result in a decrease in systemic side effects and an increase in local activity.' ANGLE-CLOSURE GLAUCOMA (section 4.4): betaxolol has no effect on the pupil, so 'Betoptic should be used with a miotic to reduce elevated intraocular pressure in angle-closure glaucoma.' OTHER TOPICAL BETA-BLOCKERS (section 4.4): 'The use of two topical beta-adrenergic blocking agents is not recommended.' CONTACT LENSES (section 4.4): the product contains benzalkonium chloride, which may be absorbed by soft contact lenses; patients must remove lenses before instillation and wait 15 minutes before reinsertion. After the cap is removed, if the tamper evident snap collar is loose, remove it before using the product.

Dose adjustments

Renal

No renal dose adjustment is stated in the UK SPC sections retrieved (section 4.2 gives one adult regimen only).

Hepatic

No hepatic dose adjustment is stated in the UK SPC sections retrieved (section 4.2 gives one adult regimen only).

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients
  • Reactive airway disease including severe bronchial asthma or a history of severe bronchial asthma, severe chronic obstructive pulmonary disease
  • Sinus bradycardia, sick sinus syndrome, sino-atrial block, second or third degree atrioventricular block not controlled with pace-maker
  • Overt cardiac failure, cardiogenic shock

Side effects

  • Very common: ocular discomfort (the most common adverse reaction in clinical trials, occurring in 12.0% of patients)
  • Common: headache; vision blurred; lacrimation increased
  • Uncommon: punctate keratitis, keratitis, conjunctivitis, blepharitis, visual impairment, photophobia, eye pain, dry eye, asthenopia, blepharospasm, eye pruritus, eye discharge, eyelid margin crusting, eye inflammation, eye irritation, conjunctival disorder, conjunctival oedema, ocular hyperaemia; bradycardia, tachycardia; asthma, dyspnoea, rhinitis; nausea
  • Rare: anxiety, insomnia, depression; syncope; cataract, decreased corneal sensitivity, erythema of eyelid; hypotension; cough, rhinorrhoea; dysgeusia; dermatitis, rash, alopecia; libido decreased
  • Frequency unknown: hypersensitivity; dizziness; arrhythmia; asthenia
  • Systemic beta-blockade: 'Like other topically applied ophthalmic drugs, betaxolol is absorbed into the systemic circulation. This may cause similar undesirable effects as seen with systemic beta-blocking agents.' Additional reactions seen with ophthalmic beta-blockers (frequency unknown) include systemic allergic reactions (angioedema, urticaria, localised and generalised rash, pruritus, anaphylactic reaction), hypoglycaemia, nightmares, memory loss, hallucinations, psychoses, confusion, cerebrovascular accident and cerebral ischaemia
  • Note: section 4.8 in the source bundle is cut off at the source-fetch limit part-way through the class-effect table, so this list is not complete - consult the full SPC

Interactions

  • No specific drug interaction studies have been performed with betaxolol (SPC section 4.5)
  • Potential for additive hypotension and/or marked bradycardia when ophthalmic beta-blockers are given with oral calcium channel blockers, beta-adrenergic blocking agents, anti-arrhythmics (including amiodarone), digitalis glycosides, parasympathomimetics and guanethidine - close observation recommended
  • Beta-blockers can decrease the response to adrenaline used to treat anaphylactic reactions - special caution in patients with a history of atopy or anaphylaxis
  • Caution with concomitant adrenergic psychotropic drugs
  • Systemic beta-blocker already in use: the effect on intra-ocular pressure or the known effects of systemic beta-blockade may be potentiated - observe the response closely; use of two topical beta-adrenergic blocking agents is not recommended (section 4.4)
  • Note: section 4.5 in the source bundle is cut off at the source-fetch limit (mid-sentence on mydriasis with adrenaline), so this list is not complete - consult the full SPC

Monitoring

  • Cardiovascular disease (e.g. coronary heart disease, Prinzmetal's angina, cardiac failure) and hypotension: therapy should be critically assessed; patients should be watched for signs of deterioration and of adverse reactions
  • First degree heart block: beta-blockers should only be given with caution because of the negative effect on conduction time
  • Respiratory status: caution in mild/moderate bronchial asthma (or history of it) and mild/moderate COPD; respiratory reactions, including death due to bronchospasm in asthma, have been reported with some ophthalmic beta-blockers
  • Spontaneous hypoglycaemia or labile diabetes: beta-blockers may mask the signs and symptoms of acute hypoglycaemia; they may also mask the signs of hyperthyroidism - caution if thyrotoxicosis is suspected
  • Muscle weakness: beta-adrenergic blocking agents have been reported to potentiate muscle weakness consistent with certain myasthenic symptoms (diplopia, ptosis, generalised weakness)
  • Ocular surface: ophthalmic beta-blockers may induce dryness of the eyes; caution in corneal diseases, Sicca syndrome or similar tear film abnormalities; benzalkonium chloride - monitor patients in prolonged use
  • Surgical anaesthesia: ophthalmic beta-blockers may block systemic beta-agonist effects (e.g. of adrenaline) - inform the anaesthesiologist that the patient is receiving betaxolol
  • Choroidal detachment has been reported with aqueous suppressant therapy after filtration procedures
  • If given until delivery, the neonate should be carefully monitored during the first days of life (section 4.6)

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

  • Despite topical use and relative beta-1 selectivity, systemic absorption means it should be avoided in uncontrolled heart failure, marked bradycardia or heart block and used cautiously in reversible airways disease.
  • It can mask the adrenergic warning signs of hypoglycaemia in people with diabetes.
  • Apply pressure to the inner corner of the eye after instillation to limit systemic absorption.

Monitoring

Monitor intraocular pressure to confirm response and observe for systemic beta-blockade such as bradycardia or bronchospasm.

Counselling the patient

  • Report wheeze, breathlessness, a slow pulse or dizziness.
  • Brief stinging or blurred vision after drops is common and settles.
  • Remove contact lenses before instillation and wait before reinserting.

Evidence & guidelines

Betaxolol eye drops are an established topical therapy for open-angle glaucoma and ocular hypertension as reflected in current prescribing references.

Reference: NICE NG81 (Glaucoma 2022); SPC Betoptic; Betoptic S; EGS Guidelines for Glaucoma 4th Ed; 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).

Related

Curated clinical cross-links plus same-class fallbacks.

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