Usual Adult Dose for Intraocular Hypertension

Gel-forming Solution: 1 drop of 0.25% or 0.5% solution instilled in the affected eye(s) once a day

• Maximum dose: 1 drop of 0.5% solution once a day

Long-acting solution: 1 drop of 0.5% solution instilled in the affected eye(s) once a day in the morning

Ophthalmic Solution:

• Initial dose: 1 drop of 0.25% solution instilled in the affected eye(s) 2 times a day
• Titration: If the clinical response is inadequate, the dose may be increased to 1 drop of 0.5% solution instilled in the affected eye(s) 2 times a day
• Maintenance dose: 1 drop of 0.25% solution once a day to 1 drop of 0.5% solution 2 times a day
• Maximum dose: 1 drop of 0.5% solution 2 times a day

Comments:

• Ophthalmic Solution: If the intraocular pressure is maintained at satisfactory levels, the dosage schedule may be changed to one drop once a day in the affected eye(s).
• If intraocular pressure is still not at a satisfactory level on this regimen, concomitant therapy with pilocarpine and other miotics, and/or epinephrine, and/or systemically administered carbonic anhydrase inhibitors, such as acetazolamide, can be initiated.
• When additional ophthalmic medications are used, an interval of at least 5 (topical solutions) to 10 (gel-forming solutions) minutes between each application is recommended.
• Preservative-free formulations should be used in patients who are sensitive to preservatives (e.g., benzalkonium chloride), or when use of preservative-free formulations are advisable.
• The concomitant use of 2 topical beta-adrenergic blocking agents is not recommended.
• Intraocular pressure should be reassessed approximately 4 weeks after starting treatment.

Use: Treatment of elevated intraocular pressure in patients with ocular hypertension or open-angle glaucoma

Usual Adult Dose for Glaucoma (Open Angle)

Gel-forming Solution: 1 drop of 0.25% or 0.5% solution instilled in the affected eye(s) once a day

• Maximum dose: 1 drop of 0.5% solution once a day

Long-acting solution: 1 drop of 0.5% solution instilled in the affected eye(s) once a day in the morning

Ophthalmic Solution:

• Initial dose: 1 drop of 0.25% solution instilled in the affected eye(s) 2 times a day
• Titration: If the clinical response is inadequate, the dose may be increased to 1 drop of 0.5% solution instilled in the affected eye(s) 2 times a day
• Maintenance dose: 1 drop of 0.25% solution once a day to 1 drop of 0.5% solution 2 times a day
• Maximum dose: 1 drop of 0.5% solution 2 times a day

Comments:

• Ophthalmic Solution: If the intraocular pressure is maintained at satisfactory levels, the dosage schedule may be changed to one drop once a day in the affected eye(s).
• If intraocular pressure is still not at a satisfactory level on this regimen, concomitant therapy with pilocarpine and other miotics, and/or epinephrine, and/or systemically administered carbonic anhydrase inhibitors, such as acetazolamide, can be initiated.
• When additional ophthalmic medications are used, an interval of at least 5 (topical solutions) to 10 (gel-forming solutions) minutes between each application is recommended.
• Preservative-free formulations should be used in patients who are sensitive to preservatives (e.g., benzalkonium chloride), or when use of preservative-free formulations are advisable.
• The concomitant use of 2 topical beta-adrenergic blocking agents is not recommended.
• Intraocular pressure should be reassessed approximately 4 weeks after starting treatment.

Use: Treatment of elevated intraocular pressure in patients with ocular hypertension or open-angle glaucoma

Usual Pediatric Dose for Intraocular Hypertension

2 years and older:
Gel-forming Solution: 1 drop of 0.25% or 0.5% solution instilled in the affected eye(s) once a day

• Maximum dose: 1 drop of 0.5% solution once a day

Ophthalmic Solution:

• Initial dose: 1 drop of 0.25% solution instilled in the affected eye(s) 2 times a day
• Titration: If the clinical response is inadequate, the dose may be increased to 1 drop of 0.5% solution instilled in the affected eye(s) 2 times a day
• Maintenance dose: 1 drop of 0.25% solution once a day to 1 drop of 0.5% solution 2 times a day
• Maximum dose: 1 drop of 0.5% solution 2 times a day

Comments:

• If the intraocular pressure is maintained at satisfactory levels, the dosage schedule for ophthalmic solutions may be changed to one drop once a day in the affected eye(s).
• If intraocular pressure is still not at a satisfactory level on this regimen, concomitant therapy with pilocarpine and other miotics, and/or epinephrine, and/or systemically administered carbonic anhydrase inhibitors, such as acetazolamide, can be initiated.
• When additional ophthalmic medications are used, an interval of at least 5 (topical solutions) to 10 (gel-forming solutions) minutes between each application is recommended.
• Preservative-free formulations should be used in patients who are sensitive to preservatives (e.g., benzalkonium chloride), or when use of preservative-free formulations are advisable.
• The concomitant use of 2 topical beta-adrenergic blocking agents is not recommended.
• Intraocular pressure should be reassessed approximately 4 weeks after starting treatment.

Use: Treatment of elevated intraocular pressure in patients with ocular hypertension or open-angle glaucoma

Usual Pediatric Dose for Glaucoma (Open Angle)

2 years and older:
Gel-forming Solution: 1 drop of 0.25% or 0.5% solution instilled in the affected eye(s) once a day

• Maximum dose: 1 drop of 0.5% solution once a day

Ophthalmic Solution:

• Initial dose: 1 drop of 0.25% solution instilled in the affected eye(s) 2 times a day
• Titration: If the clinical response is inadequate, the dose may be increased to 1 drop of 0.5% solution instilled in the affected eye(s) 2 times a day
• Maintenance dose: 1 drop of 0.25% solution once a day to 1 drop of 0.5% solution 2 times a day
• Maximum dose: 1 drop of 0.5% solution 2 times a day

Comments:

• If the intraocular pressure is maintained at satisfactory levels, the dosage schedule for ophthalmic solutions may be changed to one drop once a day in the affected eye(s).
• If intraocular pressure is still not at a satisfactory level on this regimen, concomitant therapy with pilocarpine and other miotics, and/or epinephrine, and/or systemically administered carbonic anhydrase inhibitors, such as acetazolamide, can be initiated.
• When additional ophthalmic medications are used, an interval of at least 5 (topical solutions) to 10 (gel-forming solutions) minutes between each application is recommended.
• Preservative-free formulations should be used in patients who are sensitive to preservatives (e.g., benzalkonium chloride), or when use of preservative-free formulations are advisable.
• The concomitant use of 2 topical beta-adrenergic blocking agents is not recommended.
• Intraocular pressure should be reassessed approximately 4 weeks after starting treatment.

Use: Treatment of elevated intraocular pressure in patients with ocular hypertension or open-angle glaucoma

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

First sign/symptom of cardiac failure: Treatment should be discontinued.

Signs/symptoms suggesting decreased cerebral blood flow: Alternative agents should be considered.

Patients undergoing elective surgery:

• Some experts recommend gradual withdrawal of beta-blockers.
• If use is necessary during surgery, effects of this drug may be reversed with adrenergic agonists.

Precautions

CONTRAINDICATIONS:

• Hypersensitivity to the active component or to any of the ingredients
• Patients with bronchial asthma/history of bronchial asthma, or severe chronic obstructive pulmonary disease
• Patients with cardiogenic shock, overt heart failure, second-/third-degree atrioventricular block, or sinus bradycardia

Safety and efficacy of some ophthalmic solutions and gel-forming solutions have not been established in patients younger than 2 years, while safety and efficacy of other ophthalmic solutions have not been established in pediatric patients. The manufacturer product information should be consulted for further details.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• Patients should be instructed to wash their hands before use and avoid allowing the tip of the bottle to touch the eye or surrounding structures.
• Systemic absorption of drugs from ophthalmic solutions may be minimized by pressure on the tear-duct immediately after application. The eyes should be kept closed for as long as possible (e.g., 3 to 5 minutes).
• Eye drop: Soft contact lenses should not be used during instillation of the drug; lenses may be inserted at least 15 minutes after instillation.
• Gel-forming solution: Prior to instillation, patients should invert the closed container and shake once before each use.

Storage requirements:

• Opened bottles containing preservatives should be discarded after 28 days.
• Protect from light; do not freeze.

General:

• If patients are using more than 1 ophthalmic formulation concurrently, at least 5 minutes should elapse between administration of the ophthalmic solution and additional formulation(s); at least 10 minutes should elapse between administration of gel-forming solutions and additional ophthalmic formulation(s).
• Transient blurred vision may occur after instillation, and could last from 30 second to 5 minutes.

Monitoring:

• CARDIOVASCULAR: Heart rate in patients with or a history of severe cardiac disease
• OCULAR: Regular corneal and intraocular pressure examinations

Patient advice:

• Inform patients that this drug may cause blurred vision, dizziness, fatigue, and/or visual disturbances, and they should avoid driving or operating machinery if these side effects occur.
• Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.