Carteolol Ophthalmic

Name: Carteolol Ophthalmic

Commonly used brand name(s)

In the U.S.

  • Ocupress

Available Dosage Forms:

  • Solution

Therapeutic Class: Antiglaucoma

Pharmacologic Class: Beta-Adrenergic Blocker, Nonselective

Before Using carteolol

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For carteolol, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to carteolol or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of carteolol in the pediatric population. Safety and efficacy have not been established .

Geriatric

No information is available on the relationship of age to the effects of carteolol in geriatric patients. However, elderly patients are more likely to have age-related heart problems, which may require caution in patients receiving carteolol .

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking carteolol, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using carteolol with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Clonidine
  • Crizotinib
  • Diltiazem
  • Dronedarone
  • Epinephrine
  • Fenoldopam
  • Fingolimod
  • Indacaterol
  • Lacosamide
  • Oxymetazoline
  • Rivastigmine
  • Verapamil

Using carteolol with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acarbose
  • Aceclofenac
  • Acemetacin
  • Acetyldigoxin
  • Albiglutide
  • Alfuzosin
  • Alogliptin
  • Amiodarone
  • Amtolmetin Guacil
  • Arbutamine
  • Aspirin
  • Bromfenac
  • Bufexamac
  • Bunazosin
  • Canagliflozin
  • Celecoxib
  • Chlorpropamide
  • Choline Salicylate
  • Clonixin
  • Dapagliflozin
  • Deslanoside
  • Dexibuprofen
  • Dexketoprofen
  • Diclofenac
  • Diflunisal
  • Digitoxin
  • Digoxin
  • Dipyrone
  • Doxazosin
  • Droxicam
  • Dulaglutide
  • Empagliflozin
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Exenatide
  • Felbinac
  • Fenoprofen
  • Fepradinol
  • Feprazone
  • Floctafenine
  • Flufenamic Acid
  • Flurbiprofen
  • Glimepiride
  • Glipizide
  • Glyburide
  • Ibuprofen
  • Indomethacin
  • Insulin Aspart, Recombinant
  • Insulin Degludec
  • Insulin Detemir
  • Insulin Glargine, Recombinant
  • Insulin Glulisine
  • Insulin Human Inhaled
  • Insulin Human Isophane (NPH)
  • Insulin Human Regular
  • Insulin Lispro, Recombinant
  • Ketoprofen
  • Ketorolac
  • Linagliptin
  • Liraglutide
  • Lixisenatide
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Metformin
  • Metildigoxin
  • Mibefradil
  • Miglitol
  • Morniflumate
  • Moxisylyte
  • Nabumetone
  • Naproxen
  • Nateglinide
  • Nepafenac
  • Niflumic Acid
  • Nimesulide
  • Nimesulide Beta Cyclodextrin
  • Oxaprozin
  • Oxyphenbutazone
  • Parecoxib
  • Phenoxybenzamine
  • Phentolamine
  • Phenylbutazone
  • Piketoprofen
  • Pioglitazone
  • Piroxicam
  • Pramlintide
  • Pranoprofen
  • Prazosin
  • Proglumetacin
  • Propyphenazone
  • Proquazone
  • Repaglinide
  • Rifapentine
  • Rofecoxib
  • Rosiglitazone
  • Salicylic Acid
  • Salsalate
  • Saxagliptin
  • Sitagliptin
  • Sodium Salicylate
  • St John's Wort
  • Sulindac
  • Tamsulosin
  • Tenoxicam
  • Terazosin
  • Tiaprofenic Acid
  • Tolazamide
  • Tolbutamide
  • Tolfenamic Acid
  • Tolmetin
  • Trimazosin
  • Urapidil
  • Valdecoxib
  • Vildagliptin

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of carteolol. Make sure you tell your doctor if you have any other medical problems, especially:

  • Asthma or
  • Bradycardia (slow heartbeat) or
  • Chronic obstructive pulmonary disease (COPD), severe or
  • Heart block or
  • Heart failure—Should not use in patients with these conditions .
  • Diabetes or
  • Hyperthyroidism (overactive thyroid) or
  • Hypoglycemia (low blood sugar)—May cover up some of the signs and symptoms of these diseases, such as a fast heartbeat .
  • Lung disease—Use with caution. May cause difficulty with breathing in patients with this condition .
  • Myasthenia gravis—May worsen symptoms of this condition, such as muscle weakness .

If OVERDOSE is suspected

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

How do I store and/or throw out Carteolol?

  • Store in an upright position at room temperature.
  • Protect from light.
  • Store in a dry place. Do not store in a bathroom.
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Check with your pharmacist about how to throw out unused drugs.

Dosing Geriatric

Refer to adult dosing.

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).

What should I discuss with my healthcare provider before using carteolol ophthalmic?

Do not use this medication if you are allergic to carteolol, or if you have:

  • asthma, or severe chronic obstructive pulmonary disease (COPD);

  • slow heartbeats; or

  • a heart condition called "AV block."

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use this medication:

  • breathing problems such as bronchitis or emphysema;

  • a history of heart disease or congestive heart failure;

  • diabetes;

  • history of stroke, blood clot, or circulation problems;

  • a thyroid disorder; or

  • a muscle disorder such as myasthenia gravis.

FDA pregnancy category C. It is not known whether carteolol ophthalmic is harmful to an unborn baby. Before using this medication, tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether carteolol passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

For Healthcare Professionals

Applies to carteolol ophthalmic: ophthalmic solution

General

The most commonly reported side effects were transient eye irritation, burning, tearing, conjunctival hyperemia, and edema.[Ref]

Ocular

Very common (10% or more): Transient eye irritation (25%), burning (25%), tearing (25%), conjunctival hyperemia (25%), edema (25%)
Frequency not reported: Blurred/cloudy vision, photophobia, decreased night vision, ptosis, ocular signs (including blepharoconjunctivitis, abnormal corneal staining, corneal sensitivity), keratitis, blepharoptosis, visual disturbances including refractive changes (due to withdrawal of miotic therapy in some cases), diplopia, sensation of foreign body, conjunctivitis, choroidal detachment following filtration surgery, dry eyes, corneal erosion[Ref]

Cardiovascular

Frequency not reported: Bradycardia, palpitations, arrhythmia, syncope, heart block, cerebral vascular accident, cerebral ischemia, congestive heart failure, chest pain, atrioventricular block, cardiac arrest, cardiac failure, hypotension, Raynaud's phenomenon, cold hands and feet[Ref]

Hypersensitivity

Frequency not reported: Angioedema, urticaria, localized and generalized rash, pruritus, anaphylactic reaction[Ref]

Dermatologic

Frequency not reported: Alopecia, psoriasiform rash or exacerbation of psoriasis[Ref]

Respiratory

Frequency not reported: Dyspnea, sinusitis, bronchospasm (predominantly in patients with pre-existing bronchospastic disease), respiratory failure, cough[Ref]

Nervous system

Frequency not reported: Headache, dizziness, taste perversion, memory loss, syncope, increases in signs and symptoms of myasthenia gravis, paresthesia, dysgeusia[Ref]

Psychiatric

Frequency not reported: Insomnia, depression, nightmares[Ref]

Gastrointestinal

Frequency not reported: Nausea, diarrhea, dry mouth, abdominal pain, vomiting, dyspepsia[Ref]

Genitourinary

Frequency not reported: Sexual dysfunction, decreased libido[Ref]

Metabolic

Frequency not reported: Hypoglycemia, masked symptoms of hypoglycemia in insulin-dependent diabetics[Ref]

Musculoskeletal

Frequency not reported: Myalgia[Ref]

Other

Frequency not reported: Asthenia, malaise, discomfort, edema, fatigue[Ref]

Some side effects of carteolol ophthalmic may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

Carteolol ophthalmic Pregnancy Warnings

This drug should be used during pregnancy only if the benefit outweighs the risk to the fetus. US FDA pregnancy category: C Comments: -A risk for intra uterine growth retardation has been shown when beta-blockers are administered orally. -Signs and symptoms of beta blockade (e.g., bradycardia, hypotension, respiratory distress and hypoglycemia) have been reported in neonates when beta-blockers have been administered until delivery. -Neonates should be monitored during the first days of life.

Animal studies have revealed increased resorptions and decreased fetal weights. There are no adequate and well-controlled studies in pregnant women. US FDA pregnancy category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

(web3)