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Levobunolol ocular

Updated 2 Feb 2023 | Beta-blockers (in glaucoma)


Eye drops containing levobunolol hydrochloride (preservative containing and preservative-free).

Drugs List

  • BETAGAN 0.5% eye drops 0.4ml unit dose
  • levobunolol 0.5% eye drops
  • levobunolol 0.5% eye drops preservative-free 0.4ml unit dose
  • Therapeutic Indications


    Treatment of elevated intraocular pressure in chronic open-angle glaucoma
    Treatment of elevated intraocular pressure in ocular hypertension



    Instil 1 drop into the affected eye(s) once to twice daily.


    Children from birth to 18 years (unlicensed): Instil 1 drop into the affected eye(s) once to twice daily.

    Additional Dosage Information

    As full clinical response may take several weeks to occur, measure intraocular pressure four weeks after starting and then during ongoing therapy.

    If required, levobunolol may be used with other agents to lower intra-ocular pressure. The use of two topical beta-adrenergic blocking agents is not recommended.


    Cardiogenic shock
    History of asthma
    History of obstructive pulmonary disease
    Second degree atrioventricular block
    Severe chronic obstructive pulmonary disease
    Sinoatrial exit block
    Sinus bradycardia
    Third degree atrioventricular block
    Uncontrolled cardiac failure

    Precautions and Warnings

    Children under 18 years
    History of allergies including anaphylaxis
    Soft contact lenses
    Cardiac failure
    Cardiovascular disorder
    Chronic obstructive pulmonary disease
    Corneal disorder
    Diabetes mellitus
    First degree atrioventricular block
    Intermittent claudication
    Non-paced sinus node dysfunction
    Prinzmetal's angina
    Raynaud's syndrome
    Severe peripheral circulatory disorder
    Spontaneous hypoglycaemia

    Advise diabetic patients that hypoglycaemic symptoms may be reduced/altered
    Control cardiac failure before starting treatment
    Give concurrent miotic treatment if used to treat narrow angle glaucoma
    May mask symptoms of hyperthyroidism
    May unmask the symptoms of myasthenia gravis
    Advise ability to drive/operate machinery may be affected by side effects
    Advise patient blurred vision may affect ability to drive/operate machinery
    Contains benzalkonium chloride. Not to be used with soft contact lenses
    In combined therapy, administer eye products at least five minutes apart
    To reduce systemic absorption compress lacrimal sac during administration
    Assess intra-ocular pressure about 4 weeks after starting treatment
    Monitor patient with history of severe cardiac disease for signs of failure
    Monitor pulse rates in patients with potential for cardiac failure
    Beta blockers may reduce the response to adrenaline in anaphylaxis
    Contains phosphate: Risk of calcification in existing notable cornea damage
    Systemic absorption & adverse effects of systemic beta blockers may occur
    Consider gradual withdrawal of treatment prior to general anaesthesia
    Do not withdraw this drug suddenly
    Possibly withdraw treatment if dry eyes and/or skin rash occur
    Not licensed for use in children under 18 years
    Advise patient to avoid touching the eye/other surfaces with container tip
    If soft contact lenses worn,insert them 15 minutes after using eye drops

    Preserved formulations contain benzalkonium chloride.

    The CSM (CHM) has advised that beta blockers, even those with apparent cardioselectivity, should not be used in patients with asthma or a history of obstructive airways disease, unless no alternative treatment is available. In such cases the risk of inducing bronchospasm should be appreciated and appropriate precautions taken.

    Pregnancy and Lactation


    Levobunolol is contraindicated in pregnancy.

    The manufacturer notes that as there is no adequate data for the use of levobunolol eye drops in pregnant women, this medication should not be used during pregnancy unless clearly necessary.

    Studies involving the systemic use of beta blockers did not indicate malformative effects, but some pharmacological effects such as bradycardia have been observed in foetuses and neonates. Systemic use of some beta-blockers can cause intra-uterine growth retardation (IUGR) and reduced placental weight. In one case report, ophthalmic doses of a beta-blocker were seen to affect the foetal heart rate.

    If, after careful consideration of the risks involved, levobunolol eye drops are used during pregnancy, it is advisable to consider lacrimal sac compression and removal of any excess on the skin with a tissue.

    Any infant, exposed in utero to levobunolol eye drops should be monitored closely after birth for bradycardia and other symptoms.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Levobunolol is contraindicated in breastfeeding.

    Levobunolol is excreted into breast milk. If treatment is required during lactation, consideration should be given to whether the mother should stop breast feeding.

    If, after careful consideration of the risks involved, levobunolol eye drops are used during breastfeeding, it is advisable to consider lacrimal sac compression and removal of any excess on the skin with a tissue.

    Infants exposed to levobunolol via breast milk should be closely observed for lethargy, hypotension, bradycardia, apnoea and other signs or symptoms of beta blockade.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Abdominal pain
    Anterior uveitis
    Ataxia (transient)
    Atrioventricular block
    Blurred vision
    Burning and stinging of the eyes
    Cardiac arrest
    Cardiac failure
    Cerebral haematoma
    Cerebrovascular accident
    Choroidal detachment (following filtration surgery)
    Cold extremities
    Congestive cardiac failure
    Conjunctival irritation
    Contact dermatitis
    Corneal reflex decreased
    Decreased corneal sensitivity
    Dry eyes
    Dry mouth
    Exacerbation of intermittent claudication
    Exacerbation of myasthenia gravis
    Eye pain
    Eyelid oedema
    Eyelid pruritus
    Facial oedema
    Hypersensitivity reactions
    Impaired autonomic response to hypoglycaemia
    Increased allergic sensitivity
    Increased lacrimation
    Increased seriousness of anaphylactic reactions
    Induces asthma attacks
    Lichenoid keratosis
    Loss of iris pigmentation
    Memory loss
    Nasal discomfort
    Ocular discharge
    Ocular irritation
    Ocular oedema
    Ocular pruritus
    Psoriasis like symptoms
    Quincke's oedema
    Raynaud's phenomenon
    Reduced libido
    Respiratory failure
    Sexual dysfunction
    Skin exfoliation
    Sleep disturbances
    Throat irritation
    Ulcerative keratitis
    Upper abdominal pain
    Visual disturbances


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: September 2014.

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.

    Summary of Product Characteristics: Betagan eye drops 0.5%. Allegan Ltd. Revised September 2014.

    Summary of Product Characteristics: Betagan Unit Dose. Allergan Ltd. Revised September 2014.

    NICE Evidence Services Available at: Last accessed: 22 August 2017

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Levobunolol Last revised: Sept 07, 2013
    Last accessed: Sept 03, 2014

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