Ocular Hypertension and Glaucoma
In ophthalmology, topical levobunolol hydrochloride is used to reduce elevated IOP in various conditions, including chronic open-angle glaucoma and ocular hypertension. Reduction in IOP may reduce or prevent glaucomatous visual field loss or optic nerve damage and obviate surgery.
Levobunolol may be used alone or in conjunction wth a topical miotic (e.g., pilocarpine), topical dipivefrin, topical epinephrine, and/or a systemic carbonic anhydrase inhibitor. When used in conjunction with these agents, levobunolol may have an additive IOP-lowering effect. If levobunolol is used to reduce IOP in patients with angle-closure glaucoma, the drug should not be used alone but rather in combination with a topical miotic since levobunolol has little or no effect on pupil size.
Like timolol, levobunolol reduces elevated IOP in patients with chronic open-angle glaucoma without producing the miosis and/or ciliary spasm that are associated with miotic agents. In addition, use of levobunolol in patients with central lenticular opacities can avoid the visual impairment caused by a constricted pupil. When administered twice daily, usual dosages of levobunolol appear to be as effective as usual dosages of timolol in reducing IOP in patients with chronic open-angle glaucoma or ocular hypertension, and like timolol, ophthalmic levobunolol has been associated with adverse systemic pulmonary and cardiovascular effects. Increased airway resistance can occur following topical application of levobunolol to the eye. The drug should be used with caution in patients with diminished pulmonary function, and is contraindicated in patients with asthma or a history of asthma and in patients with severe chronic obstructive pulmonary disease.
(See Cautions: Precautions and Contraindications.)
During prolonged therapy with topical levobunolol, the effect in reducing IOP is generally well maintained, but tolerance has been reported in some patients. In long-term studies in patients receiving levobunolol for up to 2 years, the reduction in mean IOP was maintained following initial stabilization with the drug.