carteolol hydrochloride

carteolol hydrochloride

Ocupress, Teoptic (UK)

Pharmacologic class: Beta-adrenergic blocker (nonselective)

Therapeutic class: Antianginal, anti-hypertensive

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

Ophthalmic solution: 1%

Indications and dosages

Open-angle glaucoma; ocular hypertension

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

Contraindications

• Hypersensitivity to drug or its components
• Other beta-adrenergic blockers
• Cardiogenic shock, bradycardia, second- or third-degree atrioventricular block
• Sinus bradycardia, bronchial asthma, severe obstructive pulmonary disease
• Overt heart failure

Precautions

Use cautiously in:
• pulmonary disease, diabetes mellitus, hypoglycemia, thyrotoxicosis, hypotension, respiratory depression, major surgery, history of bronchospasm
• angle-closure glaucoma
• pregnant or breastfeeding patients
• children.

Administration

• Be aware that if the patient's intraocular pressure isn't at a satisfactory level on prescribed regimen, concomitant therapy with pilocarpine and other miotics, or epinephrine or dipivefrin, or systemically administered carbonic anhydrase inhibitors such as acetazolamide may be instituted.

Adverse reactions

CNS: headache, 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, 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. Discontinue drug at first sign of heart failure.
• 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.
• Assess blood glucose level regularly if patient has diabetes mellitus.

Patient teaching

• 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.
• 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.

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.