carteolol hydrochloride (redirected from Ocupress)

sympatholytic drugs 

Drugs that inhibit nerve impulses in the sympathetic nervous system. They may block the effect of alpha-adrenergic receptors (e.g. thymoxamine, which is used to reverse pupillary blockage caused by a mydriatic) or the effect of beta-adrenergic receptors, called beta-blockers (e.g. betaxolol which block beta 1 receptors; timolol maleate, levobunolol, metipranolol and carteolol which block beta 1 and beta 2 receptors). Beta-blockers are used in the treatment of glaucoma. Syn. adrenergic blocking agents. See alpha-adrenergic antagonist; betablocker.

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carteolol hydrochloride

Ocupress, Teoptic (UK)

Pharmacologic class: Beta-adrenergic blocker (nonselective)

Therapeutic class: Antianginal, antihypertensive

Pregnancy risk category C

Action

Blocks stimulation of cardiac beta₁-adrenergic receptor sites and pulmonary beta₂-adrenergic receptor sites. Shows intrinsic sympathomimetic activity, causing slowing of heart rate, decreased myocardial excitability, reduced cardiac output, and decreased renin release from kidney. Also reduces intraocular pressure.

Availability

Tablets: 2.5 mg, 5 mg

Ophthalmic solution: 1%

⊘Indications and dosages

➣ Hypertension

Adults: 2.5 mg P.O. daily, given alone or with diuretic; may be increased up to 10 mg daily. (Dosages above 10 mg may produce no further response or may decrease response.) Maintenance dosage is 2.5 to 5 mg P.O. daily.

➣ Open-angle glaucoma; ocular hypertension

Adults: One drop (1% solution) in affected eye(s) b.i.d.

Dosage adjustment

• Renal impairment
• Elderly patients

Off-label uses

• Angina pectoris

Contraindications

• Hypersensitivity to drug, its components, or beta-adrenergic blockers
• Uncompensated heart failure
• Pulmonary edema
• Cardiogenic shock, bradycardia, second- or third-degree atrioventricular block
• Bronchial asthma, severe obstructive pulmonary disease
• Overt heart failure (ophthalmic form only)

Precautions

Use cautiously in:
• renal or hepatic impairment, pulmonary disease, diabetes mellitus, hypoglycemia, thyrotoxicosis, hypotension, respiratory depression
• elderly patients
• pregnant or breastfeeding patients
• children.

Administration

• Give with or without food.
• Check apical pulse before giving. If it's slower than 60 beats/minute, withhold dose and call prescriber.
☞ Don't withdraw oral drug abruptly. Doing so may lead to withdrawal phenomenon (angina exacerbation, myocardial infarction, ventricular arrhythmias, and even death).

Route	Onset	Peak	Duration
P.O.	Variable	1-3 hr	24-48 hr
Ophthalmic	Unknown	Unknown	Unknown

Adverse reactions

CNS: fatigue, weakness, anxiety, depression, dizziness, insomnia, memory loss, nightmares, paresthesia, hallucinations, disorientation, slurred speech

CV: orthostatic hypotension, peripheral vasoconstriction, conduction disturbances, bradycardia, heart failure

EENT: decreased night vision and stinging (ophthalmic form), blurred vision, dry eyes, tinnitus, stuffy nose, nasal congestion, pharyngitis, laryngospasm

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dry mouth, anorexia

GU: dysuria, polyuria, nocturia, dark urine, erectile dysfunction, decreased libido, Peyronie's disease

Metabolic: hyperglycemia, hypoglycemia

Musculoskeletal: arthralgia, back or leg pain, muscle cramps

Respiratory: wheezing, bronchospasm, respiratory distress, pulmonary edema

Skin: pruritus, rash, sweating

Other: drug-induced lupuslike syndrome, anaphylaxis

Interactions

Drug-drug. Adrenergics: antagonism of carteolol effects

Allergen immunotherapy: increased risk of anaphylaxis

Amphetamines, ephedrine, epinephrine, norepinephrine, phenylephrine, pseudoephedrine: unopposed alpha-adrenergic stimulation, causing excessive hypertension and bradycardia

Antihypertensives, nitrates: additive hypotension

Clonidine: increased hypotension and bradycardia, exaggerated withdrawal phenomenon

Digoxin: additive bradycardia

Dobutamine, dopamine: decrease in beneficial cardiovascular effects

General anesthetics, I.V. phenytoin, verapamil: additive myocardial depression

Insulin, oral hypoglycemics: altered efficacy of these drugs

MAO inhibitors: hypertension

Nonsteroidal anti-inflammatory drugs: decreased antihypertensive effect

Thyroid preparations: decreased carteolol efficacy

Drug-diagnostic tests. Blood urea nitrogen, lipoproteins, potassium, triglycerides, uric acid: increased levels

Glucose or insulin tolerance test: test interference

Drug-behaviors. Acute alcohol ingestion: additive hypotension

Cocaine use: unopposed alpha-adrenergic stimulation, causing excessive hypertension and bradycardia

Sun exposure: photophobia

Patient monitoring

• Monitor vital signs (especially blood pressure) and ECG. Drug may alter cardiac output and cause ineffective airway clearance.
• Monitor for disorientation, agitation, visual disturbances, dizziness, ataxia and euphoria. Symptoms usually subside over several hours.
• Weigh patient daily and measure fluid intake and output to detect fluid retention.
• Evaluate renal function.
• Assess blood glucose level regularly if patient has diabetes mellitus.

Patient teaching

☞ Caution patient not to stop using oral drug abruptly, because doing so may cause serious reactions.
• Instruct patient to take last dose at bedtime.
☞ Instruct patient to report breathing problems immediately.
• Tell patient to report dizziness, confusion, depression, respiratory problems, or rash.
• Advise patient to move slowly when sitting up or standing to avoid dizziness or light-headedness from sudden blood pressure drop.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Inform male patient that drug may cause erectile dysfunction. Advise him to discuss this issue with prescriber.
• Teach patient proper use of eyedrops. Tell him to wash hands first, not to touch dropper tip to any surface, and not to use drops when contact lenses are in eyes.
• Inform patient that although eyedrops commonly cause stinging and blurred vision, he should notify prescriber if these symptoms are severe.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.