Carteolol (ophthalmic)

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Carteolol (ophthalmic)
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sheng Shi, M.D. [2], Rabin Bista, M.B.B.S. [3]

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Overview

Carteolol (ophthalmic) is a beta-Adrenergic Blocker that is FDA approved for the treatment of chronic open-angle glaucoma and intraocular hypertension. Common adverse reactions include angina, asthenia, dizziness, headache, insomnia, blurred vision, burning sensation in eye, conjunctival edema, conjunctival hyperemia, epiphora, and eye irritation.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Chronic open-angle Glaucoma and Intraocular Hypertension

  • Dosing information
  • Usual dosage: one drop bid in the affected eye.

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Carteolol in adult patients.

Non–Guideline-Supported Use

Chronic Angina pectoris

  • Dosing information
  • 20- 40 mg PO qd [1]
  • 15 mg/day [2]

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

FDA Package Insert for Carteolol contains no information regarding FDA-labeled indications and dosage information for children.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Carteolol in pediatric patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Carteolol in pediatric patients.

Contraindications

Ocupress Ophthalmic Solution is contraindicated in those individuals with bronchial asthma or with a history of bronchial asthma, or severe chronic obstructive pulmonary disease (see WARNINGS); sinus bradycardia; second- and third-degree atrioventricular block; overt cardiac failure (see WARNINGS); cardiogenic shock; or hypersensitivity to any component of this product.

Warnings

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

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

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.

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.

PRECAUTIONS

General

Use with caution in patients with known diminished pulmonary function.

Information to the Patient

  • For topical use only. To prevent contaminating the dropper tip and solution, care should be taken not to touch the eyelids or surrounding areas with the dropper tip of the bottle. Keep bottle tightly closed when not in use. Protect from light.

Risk from Anaphylactic Reaction

  • While taking beta-blockers, patients with a history of atopy or a history of severe anaphylactic reaction to a variety of allergens may be more reactive to repeated accidental, diagnostic, or therapeutic challenge with such allergens. Such patients may be unresponsive to the usual doses of epinephrine used to treat anaphylactic reactions.

Muscle Weakness

  • Beta-adrenergic blockade has been reported to potentiate muscle weakness consistent with certain myasthenic symptoms (e.g., diplopia, ptosis and generalized weakness).

Adverse Reactions

Clinical Trials Experience

The following adverse reactions have been reported in clinical trials with Ocupress Ophthalmic Solution:

Ocular

Systemic

  • The following additional adverse reactions have been reported with ophthalmic use of beta1 and beta2 (nonselective) adrenergic receptor blocking agents:

Body As a Whole: Headache

Cardiovascular: Arrhythmia, syncope, heart block, cerebral vascular accident, cerebral ischemia, congestive heart failure, palpitation (see WARNINGS).

Digestive: Nausea

Psychiatric: Depression

Skin: Hypersensitivity, including localized and generalized rash

Respiratory: Bronchospasm (predominantly in patients with pre-existing bronchospastic disease), respiratory failure

Endocrine: Masked symptoms of hypoglycemia in insulin-dependent diabetics

Special Senses: Signs and symptoms of keratitis, blepharoptosis, visual disturbances including refractive changes (due to withdrawal of miotic therapy in some cases), diplopia, ptosis.

  • Other reactions associated with the oral use of nonselective adrenergic receptor blocking agents should be considered potential effects with ophthalmic use of these agents.

Postmarketing Experience

There is limited information regarding Carteolol (ophthalmic) Postmarketing Experience in the drug label.

Drug Interactions

  • Ocupress should be used with caution in patients who are receiving a beta-adrenergic blocking agent orally, because of the potential for additive effects on systemic beta-blockade.

Close observation of the patient is recommended when a beta-blocker is administered to patients receiving catecholamine-depleting drugs such as reserpine, because of possible additive effects and the production of hypotension and/or marked bradycardia, which may produce vertigo, syncope, or postural hypotension.

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): C

  • Carteolol hydrochloride increased resorptions and decreased fetal weights in rabbits and rats at maternally toxic doses approximately 1052 and 5264 times the maximum recommended human oral dose (10 mg/70 kg/day), respectively. A dose-related increase in wavy ribs was noted in the developing rat fetus when pregnant females received daily doses of approximately 212 times the maximum recommended human oral dose. No such effects were noted in pregnant mice subjected to up to 1052 times the maximum recommended human oral dose. There are no adequate and well-controlled studies in pregnant women. Ocupress (carteolol hydrochloride) should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.


Pregnancy Category (AUS): There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Carteolol (ophthalmic) in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Carteolol (ophthalmic) during labor and delivery.

Nursing Mothers

  • It is not known whether this drug is excreted in human milk, although in animal studies carteolol has been shown to be excreted in breast milk. Caution should be exercised when Ocupress is administered to nursing mothers.

Pediatric Use

Safety and effectiveness in pediatric patients have not been established.

Geriatic Use

There is no FDA guidance on the use of Carteolol (ophthalmic) in geriatric settings.

Gender

There is no FDA guidance on the use of Carteolol (ophthalmic) with respect to specific gender populations.

Race

There is no FDA guidance on the use of Carteolol (ophthalmic) with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Carteolol (ophthalmic) in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Carteolol (ophthalmic) in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Carteolol (ophthalmic) in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Carteolol (ophthalmic) in patients who are immunocompromised.

Administration and Monitoring

Administration

  • Oral

Monitoring

FDA Package Insert for Carteolol contains no information regarding drug monitoring.

IV Compatibility

There is limited information about the IV Compatibility

Overdosage

  • No specific information on emergency treatment of overdosage in humans is available. Should accidental ocular overdosage occur, flush eye(s) with water or normal saline. The most common effects expected with overdosage of a beta-adrenergic blocking agent are bradycardia, bronchospasm, congestive heart failure and hypotension.
  • In case of ingestion, treatment with Ocupress should be discontinued and gastric lavage considered. The patient should be closely observed and vital signs carefully monitored. The prolonged effects of carteolol must be considered when determining the duration of corrective therapy. On the basis of the pharmacologic profile, the following additional measures should be considered as appropriate:

Symptomatic Sinus Bradycardia or Heart Block: Administer atropine. If there is no response to vagal blockade, administer isoproterenol cautiously.

Bronchospasm: Administer a beta2-stimulating agent such as isoproterenol and/or a theophylline derivative.

Congestive Heart Failure: Administer diuretics and digitalis glycosides as necessary.

Hypotension: Administer vasopressors such as intravenous dopamine, epinephrine or norepinephrine bitartrate.

Pharmacology

Carteolol skeletal.png
1 : 1 mixture (racemate)Carteolol
Systematic (IUPAC) name
(RS)-5-[3-(tert-butylamino)-2-hydroxypropoxy]-3,4-dihydroquinolin-2(1H)-one
Identifiers
CAS number 51781-06-7
ATC code C07AA15 S01ED05 (WHO)
PubChem 2583
DrugBank DB00521
Chemical data
Formula C16H24N2O3 
Mol. mass 292.373 g/mol
SMILES eMolecules & PubChem
Pharmacokinetic data
Bioavailability 85%
Metabolism Hepatic, active with 8-hydrocarteolol
Half life 6–8 hours
Excretion Renal (50-70%)
Therapeutic considerations
Pregnancy cat.

C(US)

Legal status

Prescription only

Routes Eye drops

Mechanism of Action

  • 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.

Structure

  • Ocupress® (carteolol hydrochloride ophthalmic solution), 1%, is a nonselective beta-adrenoceptor blocking agent for ophthalmic use.
  • The chemical name for carteolol hydrochloride is (±)–5–[3–[(1,1–dimethylethyl) amino]–2 hydroxypropoxy]–3, 4–dihydro–2(1H)–quinolinone monohydrochloride. The structural formula is as follows:
Carteolol01.jpg
  • Each mL contains 10 mg carteolol HCl and the inactive ingredients – Benzalkonium chloride 0.05 mg (0.005%) as a preservative; sodium chloride; sodium phosphate, dibasic; sodium phosphate, monobasic; and water for injection, USP. The product has a pH of 6.2 to 7.2

Pharmacodynamics

FDA Package Insert for Carteolol contains no information regarding pharmacodynamics.

Pharmacokinetics

FDA Package Insert for Carteolol contains no information regarding pharmacokinetics.

Nonclinical Toxicology

  • Carteolol hydrochloride did not produce carcinogenic effects at doses up to 40 mg/kg/day in two-year oral rat and mouse studies. Tests of mutagenicity, including the Ames Test, recombinant (rec)-assay, in vivo cytogenetics and dominant lethal assay demonstrated no evidence for mutagenic potential. Fertility of male and female rats and male and female mice was unaffected by administration of carteolol hydrochloride dosages up to 150 mg/kg/day.

Clinical Studies

  • FDA Package Insert for Carteolol contains no information regarding clinical studies.

How Supplied

Carteolol Hydrochloride Ophthalmic Solution USP, 1% is supplied as a sterile ophthalmic solution in a plastic bottle with a controlled drop tip in the following sizes:

5 mL bottles - NDC 24208-367-05
10 mL bottles - NDC 24208-367-10
15 mL bottles - NDC 24208-367-15

Storage

  • Store between 15°- 25°C (59°-77°F). Protect from light.

DO NOT USE IF IMPRINTED NECKBAND IS NOT INTACT. KEEP OUT OF REACH OF CHILDREN

Images

Drug Images

Package and Label Display Panel

Carteolol label 01.jpg
This image of the FDA label is provided by the National Library of Medicine.
Carteolol panel 01.png
This image of the FDA label is provided by the National Library of Medicine.

Patient Counseling Information

  • For topical use only. To prevent contaminating the dropper tip and solution, care should be taken not to touch the eyelids or surrounding areas with the dropper tip of the bottle. Keep bottle tightly closed when not in use. Protect from light

Precautions with Alcohol

Alcohol-Carteolol interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

  • Cartrol
  • Ocupress

Look-Alike Drug Names

There is limited information about the Look-Alike Drug Names.

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  1. Luther RR, Maurath CJ, Klepper MJ, Peckinpaugh RO, Ringham GL (1986). "Carteolol treatment of essential hypertension: a long-term study of safety and efficacy". J Int Med Res. 14 (4): 175–84. PMID 3758467.
  2. Takase B, Hikita H, Uehata A, Satomura K, Kurita A, Nakamura H (1997). "Effect of carteolol on silent myocardial ischemia, variability in heart rate, and the pain-modulating system". Am Heart J. 134 (5 Pt 1): 945–54. PMID 9398108.

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