Levobunolol hydrochloride

How it works

By blocking beta-adrenergic receptors in the ciliary body it reduces aqueous humour production, thereby lowering intraocular pressure.

Prescribing in practice

• Systemic absorption can produce beta-blockade, so it is contraindicated in patients with asthma, a history of obstructive airways disease, significant bradycardia, heart block or uncontrolled heart failure.
• Use with caution alongside systemic beta-blockers or other drugs affecting heart rate and conduction, and in patients with diabetes as it may mask signs of hypoglycaemia.
• Nasolacrimal occlusion or gentle eyelid closure after instillation reduces systemic absorption.

Monitoring

Monitor intraocular pressure to assess response and remain alert clinically to systemic beta-blocker effects such as bradycardia or bronchospasm.

Counselling the patient

• Press gently on the inner corner of the eye for a short time after instilling to limit drug reaching the rest of the body.
• Report breathlessness, wheeze, a slow or irregular pulse, or unusual tiredness, and tell other clinicians you use this drop.

Evidence & guidelines

Topical beta-blockers are an established option for lowering intraocular pressure in glaucoma, as reflected in NICE glaucoma guidance (NG81).