Betoptic (betaxolol hydrochloride ophthalmic solution) is a topical beta-adrenergic blocking agent specifically formulated for the management of chronic open-angle glaucoma and ocular hypertension. As a cardioselective beta-1 blocker, it effectively reduces elevated intraocular pressure (IOP)—a primary risk factor for glaucomatous visual field loss—with a favorable systemic side effect profile compared to non-selective agents. Its mechanism of action decreases aqueous humor production, offering consistent 24-hour IOP control. Clinically trusted for decades, Betoptic provides ophthalmologists with a reliable therapeutic option for long-term glaucoma management, particularly in patients with concomitant pulmonary or cardiovascular conditions where non-selective beta-blockers may be contraindicated.

Features

• Active ingredient: Betaxolol hydrochloride 0.5%
• Pharmacologic class: Cardioselective beta-1 adrenergic receptor antagonist
• Formulation: Sterile, isotonic, buffered ophthalmic solution
• pH: Approximately 6.0–7.0 to minimize ocular irritation
• Preservative: Benzalkonium chloride 0.01%
• Available in: 2.5 mL, 5 mL, and 10 mL dropper bottles
• Storage: Room temperature (15°–30°C/59°–86°F)

Benefits

• Provides effective reduction of intraocular pressure, slowing glaucoma progression
• Cardioselective action minimizes risk of bronchospasm in susceptible patients
• Maintains ocular perfusion pressure, potentially offering neuroprotective benefits
• Well-tolerated with minimal systemic absorption when used properly
• Convenient twice-daily dosing supports patient adherence
• Compatible with other glaucoma medications for combination therapy

Common use

Betoptic is primarily indicated for the chronic management of elevated intraocular pressure in patients with open-angle glaucoma and ocular hypertension. It may be used as monotherapy or as part of a combination regimen with other intraocular pressure-lowering medications such as prostaglandin analogs, carbonic anhydrase inhibitors, or miotics. The medication is particularly valuable in patients with reactive airway disease or mild cardiovascular conditions where non-selective beta-blockers would be problematic. Off-label uses may include some cases of angle-closure glaucoma following iridotomy, though this requires specialist supervision.

Dosage and direction

The recommended dosage is one drop of Betoptic 0.5% in the affected eye(s) twice daily. Administration should be approximately 12 hours apart to maintain consistent therapeutic levels. Patients should be instructed to wash hands thoroughly before use, avoid touching the dropper tip to any surface to prevent contamination, and gently press the lacrimal sac at the medial canthus for 1–2 minutes after instillation to minimize systemic absorption. If using other ophthalmic medications, allow at least 5–10 minutes between applications, with Betoptic typically administered first among beta-blocker medications.

Precautions

Patients should be monitored for both ocular and systemic effects during therapy. Regular intraocular pressure measurements and visual field testing are essential to evaluate therapeutic response. Use with caution in patients with diabetes mellitus, as beta-blockers may mask signs and symptoms of acute hypoglycemia. Those with a history of severe cardiac disease, including heart failure or conduction abnormalities, require careful cardiovascular assessment before and during treatment. Contact lens wearers should remove lenses before instillation and wait at least 15 minutes before reinsertion due to benzalkonium chloride content.

Contraindications

Betoptic is contraindicated in patients with hypersensitivity to any component of the formulation, including benzalkonium chloride. Absolute contraindications include sinus bradycardia, greater than first-degree atrioventricular block, cardiogenic shock, overt cardiac failure, and bronchial asthma or severe chronic obstructive pulmonary disease. Relative contraindications include history of anaphylaxis to beta-blockers, myasthenia gravis, Raynaud’s phenomenon, and depression. Not recommended for use in children under 18 years due to limited safety data.

Possible side effects

Ocular effects: Transient burning/stinging upon instillation (15–25% of patients), conjunctival hyperemia, photophobia, dry eyes, itching, foreign body sensation, blurred vision, punctate keratitis, and rarely corneal hypoesthesia.

Systemic effects: Although uncommon due to limited systemic absorption, potential effects include bradycardia, hypotension, heart failure exacerbation, bronchospasm (particularly in predisposed patients), dizziness, headache, depression, insomnia, and gastrointestinal disturbances. Severe but rare systemic reactions include syncope, heart block, and exacerbation of myasthenia gravis.

Drug interaction

Concurrent use with oral beta-adrenergic blocking agents may produce additive systemic effects. Caution is advised with calcium channel blockers, digoxin, or antiarrhythmics due to potential additive effects on cardiac conduction. Concurrent use with catecholamine-depleting drugs (e.g., reserpine) may produce additive hypotensive or bradycardic effects. Epinephrine-containing preparations may cause mydriasis. Betoptic may antagonize the effects of beta-adrenergic agonists used for bronchospasm. Additive intraocular pressure-lowering effects may occur with other glaucoma medications.

Missed dose

If a dose is missed, it should be administered as soon as possible. However, if it is nearly time for the next scheduled dose, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed administration. Consistent adherence is important for maintaining stable intraocular pressure control, so patients should be educated about establishing a routine and using reminder systems if necessary.

Overdose

Ocular overdose may result in enhanced local effects such as significant conjunctival hyperemia, discomfort, or blurred vision. Systemic overdose, while rare with proper ocular administration, may manifest as bradycardia, hypotension, bronchospasm, acute heart failure, or hypoglycemia. Treatment is supportive and symptomatic. For significant systemic effects, intravenous atropine may be administered for bradycardia, beta-adrenergic agonists for bronchospasm, and appropriate cardiac support for hypotension or heart failure. Hemodialysis is not effective for betaxolol removal.

Storage

Store at controlled room temperature between 15°–30°C (59°–86°F). Protect from light and excessive heat. Keep the bottle tightly closed when not in use. Do not freeze. Discard any unused solution 28 days after opening the bottle to prevent contamination and degradation of the solution. Keep out of reach of children and pets. Do not use if the solution changes color or becomes cloudy.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions should be made by a qualified healthcare professional based on individual patient circumstances. The prescribing physician should be consulted for complete information regarding indications, dosage, warnings, and precautions. Patients should not alter or discontinue medication without medical supervision. While every effort has been made to ensure accuracy, medical knowledge is constantly evolving, and newer information may supersede details presented here.

Reviews

Clinical studies demonstrate Betoptic’s efficacy in reducing intraocular pressure by approximately 20–25% from baseline with twice-daily administration. Long-term studies show maintained efficacy over 24+ months of treatment with good patient tolerance. Ophthalmologists frequently note its value in patients with respiratory comorbidities where non-selective beta-blockers are contraindicated. Some clinicians report better ocular comfort compared to other beta-blocker eye drops. The cardioselective properties are particularly appreciated in elderly patients with cardiovascular risk factors. However, some specialists note that newer agents may provide greater pressure reduction in severe glaucoma, making Betoptic more suitable for mild to moderate cases or as part of combination therapy.