Ocupress

Carteolol is a beta-blocker that reduces pressure inside the eye.

Carteolol ophthalmic (for the eyes) is used to treat open-angle glaucoma and other causes of high pressure inside the eye.

Carteolol ophthalmic may also be used for other purposes not listed in this medication guide.

Do not use this medication if you are allergic to carteolol, or if you have asthma, or severe chronic obstructive pulmonary disease (COPD), or a heart condition called "AV block."

Before using this medication, tell your doctor if you have breathing problems such as bronchitis or emphysema, a history of heart disease or congestive heart failure, diabetes, history of stroke, blood clot, or circulation problems, a thyroid disorder, or a muscle disorder such as myasthenia gravis.

Do not allow the dropper to touch any surface, including the eyes or hands. If the dropper becomes contaminated it could cause an infection in your eye, which can lead to vision loss or serious damage to the eye.

Carteolol ophthalmic is sometimes given together with other eye medications to treat glaucoma. Do not use any other eye medication unless your doctor has prescribed it for you. If you use another eye medication, use it at least 10 minutes before or after using carteolol ophthalmic. Do not use the medications at the same time.

Carteolol ophthalmic can cause blurred vision. Be careful if you drive or do anything that requires you to be able to see clearly.

Do not use this medication while you are wearing contact lenses. Carteolol ophthalmic may contain a preservative that can be absorbed by soft contact lenses. Wait at least 15 minutes after using carteolol before putting your contact lenses in.

Do not use this medication if you are allergic to carteolol, or if you have:

• asthma, or severe chronic obstructive pulmonary disease (COPD);
• slow heartbeats; or
• a heart condition called "AV block."

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use this medication:

• breathing problems such as bronchitis or emphysema;
• a history of heart disease or congestive heart failure;
• diabetes;
• history of stroke, blood clot, or circulation problems;
• a thyroid disorder; or
• a muscle disorder such as myasthenia gravis.

FDA pregnancy category C. It is not known whether carteolol ophthalmic is harmful to an unborn baby. Before using this medication, tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether carteolol passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Dosage Forms & Strengths

ophthalmic solution

• 1%

Chronic Open-Angle Glaucoma & Intraocular Hypertension

Instill 1 gtt in affected eye(s) BID

Not recommended

Ocupress is part of the drug class:

• Beta blocking agents, non selective

Do not use this medication if you are allergic to carteolol, or if you have:

• asthma, or severe chronic obstructive pulmonary disease (COPD);

• slow heartbeats; or

• a heart condition called "AV block."

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use this medication:

• breathing problems such as bronchitis or emphysema;

• a history of heart disease or congestive heart failure;

• diabetes;

• history of stroke, blood clot, or circulation problems;

• a thyroid disorder; or

• a muscle disorder such as myasthenia gravis.

FDA pregnancy category C. It is not known whether carteolol ophthalmic is harmful to an unborn baby. Before using this medication, tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether carteolol passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Use carteolol ophthalmic exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the instructions on your prescription label.

Wash your hands before using the eye drops.

Do not use this medication while you are wearing contact lenses. Carteolol ophthalmic may contain a preservative that can be absorbed by soft contact lenses. Wait at least 15 minutes after using carteolol before putting your contact lenses in.

To apply the eye drops:

• Tilt your head back slightly and pull down your lower eyelid. Hold the dropper above the eye with the dropper tip down. Look up and away from the dropper as you squeeze out a drop, then close your eye.

• Gently press your finger to the inside corner of the eye (near your nose) for about 1 minute to keep the liquid from draining into your tear duct. If you use more than one drop in the same eye, wait about 5 minutes before putting in the next drop.

• Do not allow the dropper tip to touch any surface, including the eyes or hands. If the dropper becomes contaminated it could cause an infection in your eye, which can lead to vision loss or serious damage to the eye.

Do not use the eye drops if the liquid has changed colors or has particles in it. Call your doctor for a new prescription.

Tell your doctor right away if you have any eye injury or infection. If you have any type of surgery, including eye surgery, tell the surgeon ahead of time that you are using carteolol ophthalmic. You may need to stop using the medicine for a short time.

Store this medication at room temperature away from moisture, heat, and light. Keep the bottle tightly closed when not in use.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using this medication and call your doctor at once if you have any of these serious side effects:

• severe swelling, itching, burning, redness, pain, or discomfort in or around your eye;

• drainage, crusting, or oozing of your eyes or eyelids;

• bronchospasm (wheezing, chest tightness, trouble breathing);

• slow heart rate, weak pulse, fainting, slow breathing (breathing may stop);

• fast or pounding heartbeats;

• feeling short of breath, even with mild exertion; or

• swelling, rapid weight gain.

Less serious side effects may include:

• mild burning, stinging, itching, or watering of your eyes;

• blurred or cloudy vision;

• mildly swollen or puffy eyes;

• increased sensitivity of your eyes to light;

• trouble seeing at night;

• droopy eyelids;

• headache, dizziness, depression ;

• muscle weakness;

• sleep problems (insomnia);

• stuffy nose; or

• nausea, altered sense of taste.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Before using carteolol ophthalmic, tell your doctor if you are using any of the following drugs:

• oral carteolol (Blocadren);

• digoxin (digitalis, Lanoxin);

• reserpine;

• insulin or diabetes medications you take by mouth;

• any other beta-blocker such as atenolol (Tenormin), bisoprolol (Zebeta), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), timolol (Blocadren), and others;

• a calcium channel blocker such as amlodipine (Norvasc), diltiazem (Tiazac, Cartia, Cardizem), felodipine (Plendil), nifedipine (Nifedical, Procardia, Adalat), verapamil (Calan, Covera, Isoptin, Verelan); or

• medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), haloperidol (Haldol), mesoridazine (Serentil), or thioridazine (Mellaril).

This list is not complete and there may be other drugs that can interact with carteolol ophthalmic. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Carteolol HCl is a nonselective beta-adrenergic blocking agent with associated intrinsic sympathomimetic activity and without significant membrane-stabilizing activity.

Ocupress (carteolol HCl) reduces normal and elevated intraocular pressure (IOP) whether or not accompanied by glaucoma. The exact mechanism of the ocular hypotensive effect of beta-blockers has not been definitely demonstrated.

In general, beta-adrenergic blockers reduce cardiac output in patients in good and poor cardiovascular health. In patients with severe impairment of myocardial function, beta-blockers may inhibit the sympathetic stimulation necessary to maintain adequate cardiac function. Beta-adrenergic blockers may also increase airway resistance in the bronchi and bronchioles due to unopposed parasympathetic activity.

Given topically twice daily in controlled domestic clinical trials ranging from 1.5 to 3 months, Ocupress produced a median percent reduction of IOP 22% to 25%. No significant effects were noted on corneal sensitivity, tear secretion, or pupil size.

Ocupress Ophthalmic Solution has not been detected in plasma following ocular instillation. However, as with other topically applied ophthalmic preparations, Ocupress may be absorbed systemically. The same adverse reactions found with systemic administration of beta-adrenergic blocking agents may occur with topical administration. For example, severe respiratory reactions and cardiac reactions, including death due to bronchospasm in patients with asthma, and rarely death in association with cardiac failure, have been reported with topical application of beta-adrenergic blocking agents (see CONTRAINDICATIONS).

Cardiac Failure

Sympathetic stimulation may be essential for support of the circulation in individuals with diminished myocardial contractility, and its inhibition by beta-adrenergic receptor blockade may precipitate more severe failure.

In Patients Without a History of Cardiac Failure

Continued depression of the myocardium with beta-blocking agents over a period of time can, in some cases, lead to cardiac failure. At the first sign or symptom of cardiac failure, Ocupress should be discontinued.

Non-allergic Bronchospasm

In patients with non-allergic bronchospasm or with a history of non-allergic bronchospasm (e.g., chronic bronchitis, emphysema), Ocupress should be administered with caution since it may block bronchodilation produced by endogenous and exogenous catecholamine stimulation of beta2 receptors.

Major Surgery

The necessity or desirability of withdrawal of beta-adrenergic blocking agents prior to major surgery is controversial. Beta-adrenergic receptor blockade impairs the ability of the heart to respond to beta-adrenergically mediated reflex stimuli. This may augment the risk of general anesthesia in surgical procedures. Some patients receiving beta-adrenergic receptor blocking agents have been subject to protracted severe hypotension during anesthesia. For these reasons, in patients undergoing elective surgery, gradual withdrawal of beta-adrenergic receptor blocking agents may be appropriate.

If necessary during surgery, the effects of beta-adrenergic blocking agents may be reversed by sufficient doses of such agonists as isoproterenol, dopamine, dobutamine or levarterenol (see OVERDOSAGE).

Diabetes Mellitus

Beta-adrenergic blocking agents should be administered with caution in patients subject to spontaneous hypoglycemia or to diabetic patients (especially those with labile diabetes) who are receiving insulin or oral hypoglycemic agents. Beta-adrenergic receptor blocking agents may mask the signs and symptoms of acute hypoglycemia.

Thyrotoxicosis

Beta-adrenergic blocking agents may mask certain clinical signs (e.g., tachycardia) of hyperthyroidism. Patients suspected of developing thyrotoxicosis should be managed carefully to avoid abrupt withdrawal of beta-adrenergic blocking agents which might precipitate a thyroid storm.

The usual dose is one drop of Ocupress Ophthalmic Solution, 1%, in the affected eye(s) twice a day.

If the patient’s IOP is not at a satisfactory level on this regimen, concomitant therapy with pilocarpine and other miotics, and/or epinephrine or dipivefrin, and/or systemically administered carbonic anhydrase inhibitors, such as acetazolamide, can be instituted.