Pharmacologic class: Beta-adrenergic blocker (nonselective)
Therapeutic class: Antianginal, anti-hypertensive
Pregnancy risk category C
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.
Ophthalmic solution: 1%
Indications and dosages
➣ Open-angle glaucoma; ocular hypertension
Adults: One drop (1% solution) in affected eye(s) b.i.d.
• 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
Use cautiously in:
• pulmonary disease, diabetes mellitus, hypoglycemia, thyrotoxicosis, hypotension, respiratory depression, major surgery, history of bronchospasm
• angle-closure glaucoma
• pregnant or breastfeeding patients
• 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.
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
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
☞ 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.
• 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.