Carteolol (Ophthalmic)

As a non-selective beta blocker, Carteolol is used to alleviate pressure within the eye associated with com/health/coma/">glaucoma.

Overview

Carteolol, which is often marketed under the names Cartol, Ocupress, Arteolol, Calte, Elecbloc, Glauteolol, Poenglaucol, Mikelan and Singlauc, is a non-selective beta blocker which has been proven to be effective in the treatment of ocular conditions such as glaucoma. In addition to its properties as a beta blocker, it has also been found to function as a serotonin 5-HT1A and 5-HT1B receptor agonist.

It is administered in the form of ophthalmic drops containing the medicine, and this helps to relieve ocular hypertension (high pressure in the eyes) associated with glaucoma. Carteolol can be used on its own to combat symptoms of high eye pressure, or in conjunction with a prostaglandin.

When applied topically, this medicine has the action of reducing elevated intraocular pressure, whether it is associated with glaucoma or not, making it suitable for other forms of high eye pressure. Elevated intraocular pressure is a huge risk factor in the genesis of visual field loss associated with optic nerve damage. By using this drug, patients help to reduce pressure within the eye without causing any changes to the pupil size, which some cholinergic agents are known to do.

Carteolol functions to reduce eye pressure by causing a decrease in the production of aqueous humor, initiated by the non-selective Beta1 and Beta2 blockage of adrenergic receptors.

Conditions treated

  • Glaucoma
  • Elevated intraocular pressure

Type of medicine

  • Beta blocker

Side effects

Along with the desired effects, Carteolol use can also result in a number of different unwanted side effects. The most common side effects experienced by patients who undergo treatment with Carteolol include blurred vision, confusion, chest pain or discomfort, shortness of breath, dizziness or feeling faint after suddenly getting up from a prone position, slow or irregular heartbeat, unusual weakness or tiredness and/or sweating.

As the patient continues to undergo treatment with Carteolol as prescribed, the aforementioned side effects should begin to lessen over time. If any side effects persist or get worse as treatment continues, the patient is advised to follow this up with their doctor as soon as possible. In some instances, a healthcare professional may be able to advise ways to combat unpleasant side effects using natural or over the counter remedies.

The majority of patients will only experience minimal side effects while using Carteolol, if they experience any adverse effects whatsoever. Because the drug is designed to treat potentially serious conditions, most healthcare professionals agree that the benefits of using this medicine outweigh the risks associated with mild discomfort as a result of side effects encountered for the duration of its use.

Other side effects associated with drug, but reported rarely (albeit often enough to warrant mentioning) include the following: decrease urination levels, rash, rapid or pounding pulse, difficulty seeing at night, dilated veins in the neck, disturbed color perception, seizures extreme tiredness, severe numbness, stuffy or runny nose, slurred speech, seeing halos around lights, hoarseness, an inability to speak, irritation, itching, wheezing, tunnel vision, unusual feeling in the eyes, discoloration of the whites of the eye, and/or drainage from the eye. Patients who experience any of these side effects should seek medical advice.

Because Carteolol can potentially affect vision, as well as potentially causing confusion, patients are advised to refrain from driving or operating heavy machinery until it has been observed that they are safe to do while undergoing treatment with this medicine without putting themselves or other road users at risk.

Dosage

As with all medicines, it is incredibly important for patients to take Carteolol only as directed by a qualified physician. This means that patients should refrain from taking any more of the drug than advised - both in terms of frequency and dose size. In addition to this, patients should understand that, if a doctor recommends that they discontinue treatment, they should cease using Carteolol immediately, despite the fact that they may have a remaining supply of eye drops or topical ointment.

Adults and children suffering from intraocular pressure should administer 1 drop in the affected eye (or eyes) once every day, preferably in the evening time. If the patient is using more than one ophthalmic medication at the same time, each of these medicines should be administered at least five minutes apart to avoid the potential for the medications to mix. If intraocular pressure fails to return to a normal level, combined therapy with miotics such as pilocarbine along with epinephrine may be prescribed, along with a systemically administered carbonic anhydrase inhibitor like acetazolamide.

Adults and children suffering from glaucoma should administer only one drop in the affected eye once per day. If the patient fails to respond effectively to treatment with Carteolol alone, combined therapy with miotics such as pilocarbine along with epinephrine or dipivefrin may be prescribed, along with systemically administered carbonic anhydrase inhibitors like acetazolamide - as is the case with those suffering from intraocular pressure.

To administer Carteolol eye drops, patients should:

  • Wash their hands prior to using the drops.
  • Tilt their head back prior to pulling the lower lid of the affected eye downwards.
  • Hold the bottle of drops upside down, as close to the eye as possible. However, patients should try to avoid touching the eye when doing this.
  • Apply just enough pressure to the bottle of Carteolol drops to release a drop into the eye. Patients are advised to use no more than one drop, as advised by the manufacturer. Increased dosage will not alleviate symptoms any further, but may increase the possibility of side effects.
  • Close the eye after the drop has been administered, for a minute or two, while pressing gently on the side of the nose where the corner of the eye meets the nose. This will help to prevent the drop from draining into the nose or throat, keeping the solution in the eye.
  • Repeat the process in the other eye if the doctor has advised treatment for glaucoma in both eyes.
  • Replace the cap on the bottle and store it in a safe place.

When administering Carteolol, patients should take great care to avoid touching the dropper tip on any surface to avoid contamination. In the event of excess solution dripping onto the skin, patients should be instructed to clean the skin with warm or tepid water. To lessen the potential for systemic absorption, patients should apply pressure to the tear duct immediately after they have administered Carteolol.

Patients are advised against administering double doses. If a patient misses a dose, they should take the missed dose as soon as possible, unless it is nearly time to take the following dose. In this instance, patients should administer the following dose as normal and continue with treatment as standard from thereon in.

Incidences of overdose using this medication are rare. However, patients who experience symptoms of overdose (fast heartbeat, difficulty breathing, loss of co-ordination) after using Carteolol or any other medication should contact their local poison control center on 1800-222-1222 or visit their nearest emergency department immediately.

Interactions

All medicines can potentially interact with other drugs or chemicals in the body. These interactions can potentially affect the way in which one or both medicines function, and can lead to medicines becoming ineffective. Sometimes, interactions can even result in potentially harmful side effects occurring.

For these reasons, it is important that patients keep a detailed list of all the medications they are currently taking. This includes over the counter medicines, herbal supplements, and multivitamin compounds. Patients should provide their doctor with this list so that any potentially harmful interactions can be recognized and ruled out prior to the administration of a treatment.

Below is a list of medications known to interact negatively with Carteolol. Patients who are currently undergoing treatment with any of these drugs should inform their doctor before taking the first dose of this medicine:

  • albuterol
  • albuterol / ipratropium
  • aminophylline
  • aminophylline / amobarbital / ephedrine
  • aminophylline / ephedrine / guaifenesin / phenobarbital
  • aminophylline / ephedrine / phenobarbital / potassium iodide
  • aminophylline / guaifenesin
  • arformoterol
  • articaine / epinephrine
  • bitolterol
  • budesonide / formoterol
  • bupivacaine / epinephrine
  • chlorothiazide / methyldopa
  • chlorpheniramine / epinephrine
  • diltiazem
  • diltiazem / enalapril
  • dyphylline
  • dyphylline / ephedrine / guaifenesin / phenobarbital
  • dyphylline / guaifenesin
  • ephedrine / guaifenesin / theophylline
  • ephedrine / hydroxyzine / theophylline
  • ephedrine / phenobarbital / potassium iodide / theophylline
  • ephedrine / phenobarbital / theophylline
  • epinephrine
  • epinephrine / etidocaine
  • epinephrine / lidocaine
  • epinephrine / prilocaine
  • fluticasone / salmeterol
  • fluticasone / umeclidinium / vilanterol
  • fluticasone / vilanterol
  • formoterol
  • formoterol / glycopyrrolate
  • formoterol / mometasone
  • glycopyrrolate / indacaterol
  • guaifenesin / oxtriphylline
  • guaifenesin / theophylline
  • hydrochlorothiazide / methyldopa
  • indacaterol
  • isoetharine
  • levalbuterol
  • metaproterenol
  • methacholine
  • methyldopa
  • olodaterol
  • olodaterol / tiotropium
  • oxtriphylline
  • pirbuterol
  • potassium iodide / theophylline
  • racepinephrine
  • ritodrine
  • salmeterol
  • terbutaline
  • theophylline
  • trandolapril / verapamil
  • umeclidinium / vilanterol
  • verapamil

Patients are advised to also inform their doctor or healthcare provider if they are taking any substances in a recreational capacity that might affect their condition. This is because alcohol and other substances can affect blood pressure, which, in turn, can affect the level of intraocular pressure, rendering treatment with Carteolol ineffective or not as effective as it could be.

Warnings

In addition to providing a doctor with a list of current medications, patients should also discuss their medical history, including any current health conditions. In some instances, Carteolol dosage may require adjustment to account for other conditions. In some instances, it may not be feasible for a patient with certain health conditions to undergo treatment with this medication at all.

Patients with a history of bronchial asthma or COPD should, in general, avoid treatment with ophthalmic beta blockers. This is because medications like Carteolol are systemically absorbed and can potentially produce clinically significant systemic effects, even when used as low or undetectable blood plasma levels. Beta blockers in the respiratory tract can adversely affect pulmonary function as a result of counteracting bronchodilation caused by the catecholamine stimulation of beta-2 receptors.

Manufacturers of ophthalmic beta blockers consider the use of these medicines to be contraindicated in patients who have cardiogenic shock. In cardiac tissues, beta blockers cause a reduction in chronotropic and inotropic activity, and this can cause depression of cardiac output and blood pressure in these patients.

Beta blockers can potentially be dangerous in patients suffering from overt congestive heart failure (CHF). This is because topically-applied beta blockers like Carteolol are systemically absorbed, and can potentially produce clinically significant effects even at relatively low or even undetectable levels. Sympathetic stimulation is thought to be important to maintain hemodynamic function in patients with CHF, and beta blockers can potentially cause heart failure to worsen. Great caution should, therefore, be taken by doctors when prescribing Carteolol to patients with CHF. It may be administered, however, if the patient is well-compensated with a course of diuretics, digitalis, and ACE inhibitor or nitrates. If cardiac failure develops or worsens, Carteolol use should be discontinued.

Patients with diabetes should proceed with caution when taking Carteolol. This is because beta blockers can potentially mask symptoms of hypoglycemia such as tachycardia, changes in blood pressure and/or tremors. In addition to this, beta blockers may also inhibit catecholamine-mediated glycogenolysis, creating the ideal conditions for insulin-induced hypoglycemia and potentially delaying the recovery of normal blood-glucose levels.

Hypothyroidism sufferers should be aware that some symptoms of the condition may be masked by the use of beta-blockers, including (but not limited to) tremor, heat intolerance, anxiety and tachycardia. However, the abrupt withdrawal of treatment with beta blockers in thyrotoxic patients can potentially exacerbate symptoms of hyperthyroidism or even cause a thyroid storm. Carteolol should, therefore, be administered with great caution in patients who are suspected of having hyperthyroidism. Cessation of treatment, if required, should take place over a gradual period of up to a fortnight. However, patients are advised against discontinuing treatment without first consulting with a doctor.

Storage

Carteolol should be stored in a cool and dry place, away from natural light and direct heat, and out of the sight and reach of children. Once a bottle of these drops has been opened, it can be used for a period of up to four weeks.

After four weeks, the solution should be discarded in a safe and hygienic manner, even if some of the solution remains. Replacing the bottle with a new one helps to prevent the risk of infection. Unwanted Carteolol solution should not be poured down the toilet or drain.

Summary

Carteolol is effective in the treatment of glaucoma and ocular hypertension and can be used as a standalone treatment or used in conjunction with prostaglandins and other beta blockers. It functions by increasing the drainage of excess fluid from within the eye, which ultimately results in lower pressure.

Before using this medicine, patients should tell their doctor if they have a history of heart disease or congestive heart failure, circulation problems, thyroid disorders or muscle disorders. This drug may not be suitable for certain patients suffering from asthma, severe chronic obstructive pulmonary disease, bronchitis or emphysema.

To get the best possible results from this medicine, patient and doctor should work together in order to ascertain the right dosage and frequency of treatment. Patients should be forthcoming about what medications they are currently taking, as well as any conditions they are currently suffering from, in order to avoid any potentially harmful interactions or contra-interactions.

When used correctly, Carteolol helps intraocular pressure to return to normal levels, allowing the patient to enjoy an improved quality of life.

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Last Reviewed:
December 24, 2017
Last Updated:
April 04, 2018
Content Source: