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| Clinical data | |
|---|---|
| Trade names | AKBeta, Betagan, Vistagan, others |
| AHFS/Drugs.com | Monograph |
| MedlinePlus | a686011 |
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| Routes of administration | Topical eye drop |
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| Pharmacokinetic data | |
| Bioavailability | 7.5% (rabbit eye) |
| Metabolites | dihydrolevobunolol (equally active) |
| Onset of action | ≤ 1 hour |
| Eliminationhalf-life | 6 hours[2] |
| Duration of action | up to 16 hours |
| Excretion | mostlyrenal |
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| Chemical and physical data | |
| Formula | C17H25NO3 |
| Molar mass | 291.391 g·mol−1 |
| 3D model (JSmol) | |
| Melting point | 209 to 211 °C (408 to 412 °F) (hydrochloride) |
| Solubility in water | soluble (hydrochloride) |
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Levobunolol (trade namesAKBeta,Betagan,Vistagan, among others) is a non-selectivebeta blocker. It is usedtopically in the form of eye drops to manageocular hypertension (high pressure in the eye) and open-angleglaucoma.[3]
Like other non-selective beta blockers, levobunolol is contraindicated in patients with airway diseases such asasthma and severechronic obstructive pulmonary disease (COPD), as well as heart problems such assinus bradycardia, second- or third-degreeatrioventricular block,sick sinus syndrome, andcardiogenic shock.[3][4] Combination withMAO-A inhibitors is also contraindicated because it could cause a dangerous rise in blood pressure.[2]
Levobunolol is not useful for the treatment of closed-angle glaucoma.[2]
The most common side effect is eye irritation felt as stinging or burning, which occurs in up to a third of patients.Blepharoconjunctivitis occurs in up to 5% of patients. Rarer adverse effects includekeratitis,edema and increasedlacrimation.[3][4] Allergies are rare, but seem to be more common than under the related drugtimolol.[2]
If the substance reaches thenasal mucosa via thetear duct, it can be absorbed into the bloodstream and cause systemic side effects. These includeorthostatic hypotension (low blood pressure) and other effects on the heart and circulatory system, breathing problems in people with asthma, and skin symptoms such as itching and aggravation ofpsoriasis.[2]
Even in the form of eye drops, levebunolol may cause hypotension when combined withalpha blockers,calcium channel blockers,tricyclic antidepressants, and other drugs that lower blood pressure. It can also cause severehypertension (high blood pressure) when combined withsympathomimetic drugs or MAO-A inhibitors,bradycardia (low heart rate) when combined withantiarrhythmics ormefloquine, andhypoglycemia (low blood sugar) when combined withantidiabetic drugs such asinsulin.[2]
Levobunolol is a non-cardioselective beta blocker, that is, it blocksbeta-1 receptors as well asbeta-2 receptors. The latter type dominates in theciliary body, where it controlsaqueous humour production. Blocking this type of receptor reduces aqueous humour production, loweringintraocular pressure. The substance has no relevantmembrane stabilizing effect orintrinsic sympathomimetic activity. Like other beta blockers, and unlike the anti-glaucoma medicationpilocarpine, levobunolol has no effect onaccommodation andpupil size.[3][5]
The substance quickly penetrates thecornea and reaches the aqueous humour. It is reduced to dihydrolevobunolol, which is equally active, in the eye's tissues. The drug starts to lower intraocular pressure within an hour, reaches its maximum effect after two to six hours, and remains effective for up to 16 hours. It has anelimination half-life of six hours and is mainly excreted via the kidney.[2][3]
Levobunolol is the pure L-enantiomer of bunolol and has more than 60 times the pharmacological activity of D-bunolol.[3] It is used as thehydrochloride, which melts at 209 to 211 °C (408 to 412 °F) and is soluble in water andmethanol and slightly soluble inethanol.[2]
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