Betaxolol: Difference between revisions

{{Short description|Chemical compound}}

{{cs1 config|name-list-style=vanc|display-authors=6}}

{{Infobox drug

| verifiedrevid = 459977756

| image = Betaxolol structure.svg

| chirality = [[Racemic mixture]]

| image2 = Betaxolol ball-and-stick.png

| width = 250px

| pregnancy_category =

| routes_of_administration = [[Oral administration|By mouth]], [[human eye|ocular]]

| metabolism = [[Liver]]

| excretion = [[Kidney]] (20%)

| CAS_number_Ref = {{cascite|correct|??}}

| C=18 | H=29 | N=1 | O=3

| SMILES = O(CCc1ccc(OCC(O)CNC(C)C)cc1)CC2CC2

<!-- Definition and medical uses -->

'''Betaxolol''' is a selective [[beta blocker|beta₁ receptor blocker]] used in the treatment of [[hypertension]] and [[angina]].<ref>{{cite journal | vauthors = Buckley MM, Goa KL, Clissold SP | title = Ocular betaxolol. A review of its pharmacological properties, and therapeutic efficacy in glaucoma and ocular hypertension | journal = Drugs | volume = 40 | issue = 1 | pages = 75–90 | date = July 1990 | pmid = 2202584 | doi = 10.2165/00003495-199040010-00005 | s2cid = 46962082 }}</ref> It is also a [[Adrenergic antagonist|adrenergic]] blocker with no partial agonist action and minimal membrane stabilizing activity.<ref>{{Cite web |title=Google Scholar |url=https://scholar.google.com/scholar?q=%22Betaxolol%22#d=gs_qabs&t=1703552255390&u=#p=8zHRlC92iIoJ |access-date=2023-12-26 |website=scholar.google.com}}</ref> Being selective for beta₁ receptors, it typically has fewer systemic [[adverse drug reaction|side effect]]s than non-selective beta-blockers, for example, not causing [[bronchospasm]] (mediated by beta₂ receptors) as [[timolol]] may. Betaxolol also shows greater affinity for beta₁ receptors than [[metoprolol]]. In addition to its effect on the heart, betaxolol reduces the pressure within the eye ([[intraocular pressure]]). This effect is thought to be caused by reducing the production of the liquid (which is called the [[aqueous humor]]) within the eye. The precise mechanism of this effect is not known. The reduction in intraocular pressure reduces the risk of damage to the [[optic nerve]] and loss of vision in patients with elevated intraocular pressure due to [[glaucoma]].

<!-- Society and culture -->

It was patented in 1975 and approved for medical use in 1983.<ref>{{cite book | vauthors = Fischer J, Ganellin CR |title=Analogue-based Drug Discovery |date=2006 |publisher=John Wiley & Sons |isbn=9783527607495 |page=461 |url=https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA461 |language=en}}</ref>

==Medical uses==

=== Hypertension ===

Betaxolol is most commonly ingested orally alone or with other medications for the management of [[essential hypertension]].<ref>{{cite book | vauthors = Tajran J, Goyal A | chapter = Betaxolol |date=2023 |chapter-url=http://www.ncbi.nlm.nih.gov/books/NBK557870/ | title = StatPearls |access-date=2023-12-26 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32491793 }}</ref> It is a cardioselective beta blocker, targeting beta-1 adrenergic receptors found in the cardiac muscle. Blood pressure is decreased by the mechanism of blood vessels relaxing and improving the flow of blood.<ref>{{Cite web |title=Betaxolol | work = MedlinePlus Drug Information |url=https://medlineplus.gov/druginfo/meds/a609023.html |access-date=2023-01-12 | publisher = U.S. National Library of Medicine |language=en}}</ref><ref>{{Cite web |title=Betaxolol: MedlinePlus Drug Information |url=https://medlineplus.gov/druginfo/meds/a609023.html |access-date=2023-12-26 |website=medlineplus.gov |language=en}}</ref>

=== Glaucoma ===

Ophthalmic betaxolol is an available treatment for [[primary open angle glaucoma]] (POAG) and optical hypertension. Betaxolol effectively prevents the increase of intracellular calcium, which leads to increased production of the aqueous humor. In the context of open angle glaucoma, increased aqueous humor produced by ciliary bodies increases intraocular pressure, causing degeneration of [[retinal ganglion cell]]s and the optic nerve.<ref name = "Tajran_2022">{{cite book | vauthors = Tajran J, Goyal A | chapter = Betaxolol |date=2022 | chapter-url= http://www.ncbi.nlm.nih.gov/books/NBK557870/ | title = StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32491793 |access-date=2023-01-12 }}</ref>

Furthermore, betaxolol is additionally able to protect retinal neurones following topical application from [[excitotoxicity]] or [[Ischemia-reperfusion injury|ischemia-reperfusion]], providing a neuroprotective effect. This is thought to be attributed to its capacity to attenuate neuronal calcium and sodium influx.<ref>{{cite journal | vauthors = Wood JP, Schmidt KG, Melena J, Chidlow G, Allmeier H, Osborne NN | title = The beta-adrenoceptor antagonists metipranolol and timolol are retinal neuroprotectants: comparison with betaxolol | journal = Experimental Eye Research | volume = 76 | issue = 4 | pages = 505–516 | date = April 2003 | pmid = 12634114 | doi = 10.1016/s0014-4835(02)00335-4 }}</ref> Betaxolol is also an effective treatment for [[Intraocular pressure]]<ref>{{cite journal | vauthors = Goldberg I, Goldberg H | title = Betaxolol eye drops. A clinical trial of safety and efficacy | journal = Australian and New Zealand Journal of Ophthalmology | volume = 23 | issue = 1 | pages = 17–24 | date = February 1995 | pmid = 7619450 | doi = 10.1111/j.1442-9071.1995.tb01640.x }}</ref><br>

=== Paronychia ===

One study showed that topical betaxolol can be used in treating relapsed [[paronychia]].<ref>{{cite journal | vauthors = Yen CF, Hsu CK, Lu CW | title = Topical betaxolol for treating relapsing paronychia with pyogenic granuloma-like lesions induced by epidermal growth factor receptor inhibitors | journal = Journal of the American Academy of Dermatology | volume = 78 | issue = 6 | pages = e143-e144 | date = June 2018 | pmid = 29339238 | doi = 10.1016/j.jaad.2018.01.015 | s2cid = 39861588 }}</ref>

* Patients with [[sinus bradycardia]], heart block greater than first degree, cardiogenic shock, and overt cardiac failure

== Side effects ==

{{Expand section|date=January 2019}}

The adverse side-effects of betaxolol can be categorized into local and systemic effects.<ref name = "Tajran_2022" /> The local effects include:

* transient irritation (20-40% of patients)

* burning

* [[pruritus]], or general itching

* [[punctate keratitis]]

* blurry vision<ref>{{cite journal | vauthors = Buckley MM, Goa KL, Clissold SP | title = Ocular betaxolol. A review of its pharmacological properties, and therapeutic efficacy in glaucoma and ocular hypertension | journal = Drugs | volume = 40 | issue = 1 | pages = 75–90 | date = July 1990 | pmid = 2202584 | doi = 10.2165/00003495-199040010-00005 | s2cid = 46962082 }}</ref>

Systemically, patients taking betaxolol might experience:

* [[bradycardia]]

* [[hypotension]]

* fatigue

* sexual impotence

* hair loss

* confusion

* headache

* dizziness

* [[bronchospasm]] at higher doses

* cardiac problems such as [[arrhythmia]], [[bundle branch block]], [[myocardial infarction]], [[sinus arrest]], and [[Heart failure|congestive heart failure]]

* mental effects such as [[Depression (mood)|depression]], [[disorientation]], [[vertigo]], [[sleepwalking]], [[rhinitis]]

* [[dysuria]]

* metabolic side effects such as an increase in [[Low-density lipoprotein|LDL cholesterol]] levels

* can mask the symptoms of [[hypoglycemia]] [[Diabetes|diabetic]] patients

{{See also|Beta blocker}}

==History==

Betaxolol was approved by the U.S. [[Food and Drug Administration]] (FDA) for ocular use as a 0.5% solution (Betoptic) in 1985 and as a 0.25% solution (Betoptic S) in 1989.

==Society and culture==

===Brand names===

Brand names include Betoptic, Betoptic S, Lokren, Kerlone.

== See also ==

* [[Levobetaxolol]]

* [[Cicloprolol]]

== References ==

{{Reflist}}

== External links ==

* [https://web.archive.org/web/20071020131717/http://products.sanofi-aventis.us/kerlone/kerlone.pdf Kerlone prescribing information]

{{Beta blockers}}

{{Adrenergic receptor modulators}}

[[Category:Cyclopropanes]]

[[Category:N-isopropyl-phenoxypropanolamines]]

[[Category:Ophthalmology drugs]]