they are attempting Carteolol (Ophthalmic) Overview Side Effects Dosage Professional Interactions More Pregnancy Warnings Breastfeeding Warnings User Reviews Pricing & Coupons Pronunciation (KAR tee oh lole) Index Terms Carteolol Hydrochloride Dosage Forms Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Solution, Ophthalmic, as hydrochloride: Generic: 1% (5 mL, 10 mL, 15 mL) Slideshow Easy On The Eye - 8 Tips for Maintaining Good Eyesight Pharmacologic Category Ophthalmic Agent, Antiglaucoma Pharmacology Blocks both beta 1 - and beta 2 -adrenergic receptors and reduces intraocular pressure by reducing aqueous humor production or possibly increases the outflow of aqueous humor Absorption ~25% of ophthalmic dose is absorbed systemically (Chrisp 1992) Metabolism Hepatic via CYP2D6 (Henness 2007) Excretion Urine (Henness 2007) Time to Peak Plasma 0.25 hours (Henness 2007) Half-Life Elimination ~5 hours (urinary elimination); 13.8 hours (terminal) (Henness 2007) Use: Labeled Indications Elevated intraocular pressure: Treatment of elevated intraocular pressure (IOP) in patients with chronic open-angle glaucoma and intraocular hypertension. Contraindications Hypersensitivity to carteolol or any component of the formulation; sinus bradycardia; second- or third-degree atrioventricular block; cardiogenic shock; bronchial asthma or history of; severe chronic obstructive pulmonary disease (COPD); overt cardiac failure Documentation of allergenic cross-reactivity for Ophthalmic Beta-Adrenergic Blocking Agents is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty. Dosing: Adult Elevated intraocular pressure: Ophthalmic: Instill 1 drop in affected eye(s) twice daily Dosing: Geriatric Refer to adult dosing. Dosing: Renal Impairment There are no dosage adjustments provided in the manufacturer s labeling. Dosing: Hepatic Impairment There are no dosage adjustments provided in the manufacturer s labeling. Administration For topical ophthalmic use only. Wash hands before use. To avoid contamination, do not touch dropper tip to eyelids or other surfaces when placing drops in eyes. Remove contact lenses prior to administration; wait 15 minutes before reinserting if using products containing benzalkonium chloride. Storage Store at 15 C to 25 C (59 F to 77 F). Protect from light. Drug Interactions Acetylcholinesterase Inhibitors: May enhance the bradycardic effect of Beta-Blockers. Monitor therapy Alpha-/Beta-Agonists (Direct-Acting): Beta-Blockers may enhance the vasopressor effect of Alpha-/Beta-Agonists (Direct-Acting). Epinephrine used as a local anesthetic for dental procedures will not likely cause clinically relevant problems. Some beta-adrenoceptor mediated effects of Alpha-/Beta-Agonists (Direct-Acting), including anti-anaphylactic effects of epinephrine, may be diminished by Beta-Blockers. Management: Cardioselective beta-blockers and lower doses of epinephrine may confer a more limited risk. Patients who may require acute subcutaneous epinephrine (e.g., bee sting kits) should probably avoid beta blockers. Consider therapy modification Alpha1-Blockers: Beta-Blockers may enhance the orthostatic hypotensive effect of Alpha1-Blockers. The risk associated with ophthalmic products is probably less than systemic products. Monitor therapy Alpha2-Agonists: May enhance the AV-blocking effect of Beta-Blockers. Sinus node dysfunction may also be enhanced. Beta-Blockers may enhance the rebound hypertensive effect of Alpha2-Agonists. This effect can occur when the Alpha2-Agonist is abruptly withdrawn. Management: Closely monitor heart rate during treatment with a beta blocker and clonidine. Withdraw beta blockers several days before clonidine withdrawal when possible, and monitor blood pressure closely. Recommendations for other alpha2-agonists are unavailable. Exceptions: Apraclonidine. Consider therapy modification Amiodarone: May enhance the bradycardic effect of Beta-Blockers. Possibly to the point of cardiac arrest. Amiodarone may increase the serum concentration of Beta-Blockers. Monitor therapy Antipsychotic Agents (Phenothiazines): May enhance the hypotensive effect of Beta-Blockers. Beta-Blockers may decrease the metabolism of Antipsychotic Agents (Phenothiazines). Antipsychotic Agents (Phenothiazines) may decrease the metabolism of Beta-Blockers. Monitor therapy Barbiturates: May decrease the serum concentration of Beta-Blockers. Monitor therapy Beta2-Agonists: Beta-Blockers (Nonselective) may diminish the bronchodilatory effect of Beta2-Agonists. Avoid combination Bradycardia-Causing Agents: May enhance the bradycardic effect of other Bradycardia-Causing Agents. Monitor therapy Bretylium: May enhance the bradycardic effect of Bradycardia-Causing Agents. Bretylium may also enhance atrioventricular (AV) blockade in patients receiving AV blocking agents. Monitor therapy Bupivacaine: Beta-Blockers may increase the serum concentration of Bupivacaine. Monitor therapy Calcium Channel Blockers (Nondihydropyridine): May enhance the hypotensive effect of Beta-Blockers. Bradycardia and signs of heart failure have also been reported. Calcium Channel Blockers (Nondihydropyridine) may increase the serum concentration of Beta-Blockers. Exceptions: Bepridil. Monitor therapy Cardiac Glycosides: Beta-Blockers may enhance the bradycardic effect of Cardiac Glycosides. Monitor therapy Ceritinib: Bradycardia-Causing Agents may enhance the bradycardic effect of Ceritinib. Management: If this combination cannot be avoided, monitor patients for evidence of symptomatic bradycardia, and closely monitor blood pressure and heart rate during therapy. Avoid combination Cholinergic Agonists: Beta-Blockers may enhance the adverse/toxic effect of Cholinergic Agonists. Of particular concern are the potential for cardiac conduction abnormalities and bronchoconstriction. Management: Administer these agents in combination with caution, and monitor for conduction disturbances. Avoid methacholine with any beta blocker due to the potential for additive bronchoconstriction. Monitor therapy Dipyridamole: May enhance the bradycardic effect of Beta-Blockers. Monitor therapy Disopyramide: May enhance the bradycardic effect of Beta-Blockers. Beta-Blockers may enhance the negative inotropic effect of Disopyramide. Monitor therapy Dronedarone: May enhance the bradycardic effect of Beta-Blockers. Dronedarone may increase the serum concentration of Beta-Blockers. This likely applies only to those agents that are metabolized by CYP2D6. Management: Use lower initial beta-blocker doses; adequate tolerance of the combination, based on ECG findings, should be confirmed prior to any increase in beta-blocker dose. Consider therapy modification Ergot Derivatives: Beta-Blockers may enhance the vasoconstricting effect of Ergot Derivatives. Exceptions: Nicergoline. Consider therapy modification Fingolimod: Beta-Blockers may enhance the bradycardic effect of Fingolimod. Management: Avoid the concomitant use of fingolimod and beta-blockers if possible. If coadministration is necessary, patients should have overnight continuous ECG monitoring conducted after the first dose of fingolimod. Monitor patients for bradycardia. Consider therapy modification Floctafenine: May enhance the adverse/toxic effect of Beta-Blockers. Avoid combination Grass Pollen Allergen Extract (5 Grass Extract): Beta-Blockers may enhance the adverse/toxic effect of Grass Pollen Allergen Extract (5 Grass Extract). More specifically, Beta-Blockers may inhibit the ability to effectively treat severe allergic reactions to Grass Pollen Allergen Extract (5 Grass Extract) with epinephrine. Some other effects of epinephrine may be unaffected or even enhanced (e.g., vasoconstriction) during treatment with Beta-Blockers. Consider therapy modification Insulins: Beta-Blockers may enhance the hypoglycemic effect of Insulins. Monitor therapy Ivabradine: Bradycardia-Causing Agents may enhance the bradycardic effect of Ivabradine. Monitor therapy Lacosamide: Bradycardia-Causing Agents may enhance the AV-blocking effect of Lacosamide. Monitor therapy Lidocaine (Systemic): Beta-Blockers may increase the serum concentration of Lidocaine (Systemic). Monitor therapy Lidocaine (Topical): Beta-Blockers may increase the serum concentration of Lidocaine (Topical). Monitor therapy Mepivacaine: Beta-Blockers may increase the serum concentration of Mepivacaine. Monitor therapy Methacholine: Beta-Blockers may enhance the adverse/toxic effect of Methacholine. Avoid combination Methoxyflurane: May enhance the hypotensive effect of Beta-Blockers. Monitor therapy Midodrine: Beta-Blockers may enhance the bradycardic effect of Midodrine. Monitor therapy NIFEdipine: May enhance the hypotensive effect of Beta-Blockers. NIFEdipine may enhance the negative inotropic effect of Beta-Blockers. Monitor therapy Nonsteroidal Anti-Inflammatory Agents: May diminish the antihypertensive effect of Beta-Blockers. Monitor therapy Opioids (Anilidopiperidine): May enhance the bradycardic effect of Beta-Blockers. Opioids (Anilidopiperidine) may enhance the hypotensive effect of Beta-Blockers. Monitor therapy Regorafenib: May enhance the bradycardic effect of Beta-Blockers. Monitor therapy Reserpine: May enhance the hypotensive effect of Beta-Blockers. Monitor therapy Rivastigmine: May enhance the bradycardic effect of Beta-Blockers. Avoid combination Ruxolitinib: May enhance the bradycardic effect of Bradycardia-Causing Agents. Management: Ruxolitinib Canadian product labeling recommends avoiding use with bradycardia-causing agents to the extent possible. Monitor therapy Sulfonylureas: Beta-Blockers may enhance the hypoglycemic effect of Sulfonylureas. Cardioselective beta-blockers (eg, acebutolol, atenolol, metoprolol, and penbutolol) may be safer than nonselective beta-blockers. All beta-blockers appear to mask tachycardia as an initial symptom of hypoglycemia. Ophthalmic beta-blockers are probably associated with lower risk than systemic agents. Monitor therapy Terlipressin: May enhance the bradycardic effect of Bradycardia-Causing Agents. Monitor therapy Theophylline Derivatives: Beta-Blockers (Nonselective) may diminish the bronchodilatory effect of Theophylline Derivatives. Consider therapy modification Tofacitinib: May enhance the bradycardic effect of Bradycardia-Causing Agents. Monitor therapy Adverse Reactions >10%: Ocular: Conjunctival hyperemia 1% to 10%: Ocular: Anisocoria, corneal punctate keratitis, corneal staining, corneal sensitivity decreased, eye pain, vision disturbances Warnings/Precautions Concerns related to adverse events: Anaphylactic reactions: Use caution with history of atopy or a history of severe anaphylaxis to a variety of allergens; patients taking beta-blockers may become more sensitive to repeated challenges. Treatment of anaphylaxis (eg, epinephrine) in patients taking beta-blockers may be ineffective or promote undesirable effects. Choroidal detachment: Beta-blockade and/or other aqueous suppressive therapy have been associated with choroidal detachment following filtration procedures. Disease-related concerns: Diabetes: Use with caution in patients with diabetes mellitus (especially labile diabetes); may potentiate hypoglycemia and/or mask signs and symptoms. Heart failure (HF): Use with caution in patients with compensated heart failure and monitor for a worsening of the condition; may lead to heart failure in patients without a history of heart failure. Use is contraindicated in overt heart failure. In a scientific statement from the American Heart Association, carteolol has been determined to be an agent that may exacerbate underlying myocardial dysfunction (magnitude: major) (AHA [Page 2016]). Myasthenia gravis: Use with caution in patients with myasthenia gravis; may worsen disease or other myasthenic symptoms (diplopia, ptosis, and generalized weakness). Peripheral vascular disease and Raynaud disease: Can precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease (PVD) and Raynaud disease. Use with caution and monitor for progression of arterial obstruction. Respiratory disease: In general, patients with bronchospastic disease should not receive beta-blockers; if used at all, should be used cautiously with close monitoring. Severe respiratory reactions, including fatalities due to bronchospasm in patients with asthma, have been reported with ophthalmic use. Use is contraindicated in bronchial asthma or history of bronchial asthma and severe COPD. Thyroid disease: May mask signs of hyperthyroidism (eg, tachycardia). If thyrotoxicosis is suspected, carefully manage and monitor; abrupt withdrawal may exacerbate symptoms of hyperthyroidism or precipitate thyroid storm. Concurrent drug therapy issues: Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information Special populations: Contact lens wearers: Some products may contain benzalkonium chloride, which may be absorbed by soft contact lenses; remove lens prior to administration and wait 15 minutes before reinserting. Dosage form specific issues: Absorption: Systemic absorption of carteolol and adverse effects may occur with ophthalmic use, including respiratory and cardiovascular effects (eg, bradycardia and/or hypotension). Appropriate use: Should not be used alone in angle-closure glaucoma (has no effect on pupillary constriction). Multidose vials have been associated with development of bacterial keratitis; avoid contamination. Surgery: May block systemic effects of beta agonists (eg, epinephrine, norepinephrine); notify anesthesiologist if patient is receiving ophthalmic beta blocker therapy. Patients undergoing planned major surgery should be gradually tapered off therapy (if possible) prior to procedure. If necessary during surgery, effects of beta blocker therapy may be reversed by adrenergic agonists. Monitoring Parameters Intraocular pressure; monitor for systemic effect of beta-blockade with ophthalmic administration; blood pressure Pregnancy Risk Factor C Pregnancy Considerations Adverse events were observed in some animal reproduction studies. The same adverse effects observed with systemic administration of beta-blockers may occur following ophthalmic use of carteolol. If ophthalmic agents are needed for the treatment of glaucoma during pregnancy, the minimum effective dose should be used in combination with punctal occlusion to decrease potential exposure to the fetus (Johnson 2001; Salim 2014; Samples 1988). Patient Education Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?) Patient may experience burning or watery eyes. Have patient report immediately to prescriber vision changes, eye pain, severe eye irritation, bradycardia, severe dizziness, passing out, muscle weakness, shortness of breath, excessive weight gain, or swelling of arms or legs (HCAHPS). Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients. Next Interactions Print this page Add to My Med List More about carteolol ophthalmic Side Effects During Pregnancy or Breastfeeding Dosage Information Drug Interactions Pricing & Coupons En Español 0 Reviews Add your own review/rating Drug class: ophthalmic glaucoma agents Consumer resources Carteolol ophthalmic Carteolol (Ophthalmic) Carteolol Ophthalmic (Advanced Reading) Professional resources Carteolol (FDA) Other brands: Ocupress Related treatment guides Glaucoma, Open Angle Intraocular Hypertension} Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA WADA Class Anti-Doping Classification Carteolol ophthalmic Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first! Manufacturer Sandoz Inc. Drug Class Ophthalmic glaucoma agents Related Drugs ophthalmic glaucoma agents timolol ophthalmic , Lumigan , latanoprost ophthalmic , Travatan , brimonidine ophthalmic , Xalatan Glaucoma, Open Angle timolol ophthalmic , Lumigan , latanoprost ophthalmic , Travatan , brimonidine ophthalmic , Xalatan , epinephrine ophthalmic , Alphagan , dorzolamide ophthalmic , pilocarpine ophthalmic , Cosopt , Azopt , More... Intraocular Hypertension timolol ophthalmic , Lumigan , latanoprost ophthalmic , Travatan , brimonidine ophthalmic , Xalatan , Combigan , Alphagan , dorzolamide ophthalmic , pilocarpine ophthalmic , Cosopt , Azopt , More...} } listening to
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