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Betaxolol
Clinical data
Trade names	Kerlone
AHFS/Drugs.com	Monograph
MedlinePlus	a609023
Pregnancy; category	AU: C; ;
Routes of; administration	By mouth, ocular
ATC code	C07AB05 (WHO) S01ED02 (WHO);
Legal status
Legal status	In general: ℞ (Prescription only);
Pharmacokinetic data
Bioavailability	89%
Metabolism	Liver
Elimination half-life	14–22 hours
Excretion	Kidney (20%)
Identifiers
	IUPAC name (RS)-1-{4-[2-(cyclopropylmethoxy)ethyl]-; phenoxy}-3-(isopropylamino)propan-2-ol;
CAS Number	63659-18-7 ;
PubChem CID	2369;
IUPHAR/BPS	549;
DrugBank	DB00195 ;
ChemSpider	2279 ;
UNII	O0ZR1R6RZ2;
KEGG	D07526 ;
ChEBI	CHEBI:3082 ;
ChEMBL	ChEMBL423 ;
CompTox Dashboard (EPA)	DTXSID2022674 ;
ECHA InfoCard	100.113.058
Chemical and physical data
Formula	C18H29NO3
Molar mass	307.434 g·mol−1
3D model (JSmol)	Interactive image;
Chirality	Racemic mixture
	SMILES O(CCc1ccc(OCC(O)CNC(C)C)cc1)CC2CC2;
	InChI InChI=1S/C18H29NO3/c1-14(2)19-11-17(20)13-22-18-7-5-15(6-8-18)9-10-21-12-16-3-4-16/h5-8,14,16-17,19-20H,3-4,9-13H2,1-2H3 ; Key:NWIUTZDMDHAVTP-UHFFFAOYSA-N ;
	(verify)

Betaxolol is a selective beta₁ receptor blocker used in the treatment of hypertension and angina.^[1] It is also a adrenergic blocker with no partial agonist action and minimal membrane stabilizing activity.^[2] Being selective for beta₁ receptors, it typically has fewer systemic side effects 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.

It was patented in 1975 and approved for medical use in 1983.^[3]

Medical uses

Hypertension

Betaxolol is most commonly ingested orally alone or with other medications for the management of essential hypertension.^[4] 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.^[5]^[6]

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 cells and the optic nerve.^[7]

Furthermore, betaxolol is additionally able to protect retinal neurones following topical application from excitotoxicity or ischemia-reperfusion, providing a neuroprotective effect. This is thought to be attributed to its capacity to attenuate neuronal calcium and sodium influx.^[8] Betaxolol is also an effective treatment for Intraocular pressure^[9]

Paronychia

One study showed that topical betaxolol can be used in treating relapsed paronychia.^[10]

Contraindications

Hypersensitivity to the drug
Patients with sinus bradycardia, heart block greater than first degree, cardiogenic shock, and overt cardiac failure

Side effects

The adverse side-effects of betaxolol can be categorized into local and systemic effects.^[7] The local effects include:

transient irritation (20-40% of patients)
burning
pruritus, or general itching
punctate keratitis
blurry vision^[11]

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 congestive heart failure
mental effects such as depression, disorientation, vertigo, sleepwalking, rhinitis
dysuria
metabolic side effects such as an increase in LDL cholesterol levels
can mask the symptoms of hypoglycemia diabetic patients

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.

References

^ Buckley MM, Goa KL, Clissold SP (July 1990). "Ocular betaxolol. A review of its pharmacological properties, and therapeutic efficacy in glaucoma and ocular hypertension". Drugs. 40 (1): 75–90. doi:10.2165/00003495-199040010-00005. PMID 2202584. S2CID 46962082.
^ "Google Scholar". scholar.google.com. Retrieved 2023-12-26.
^ Fischer J, Ganellin CR (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 461. ISBN 9783527607495.
^ Tajran J, Goyal A (2023). "Betaxolol". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 32491793. Retrieved 2023-12-26.
^ "Betaxolol". MedlinePlus Drug Information. U.S. National Library of Medicine. Retrieved 2023-01-12.
^ "Betaxolol: MedlinePlus Drug Information". medlineplus.gov. Retrieved 2023-12-26.
^ ^a ^b Tajran J, Goyal A (2022). "Betaxolol". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 32491793. Retrieved 2023-01-12.
^ Wood JP, Schmidt KG, Melena J, Chidlow G, Allmeier H, Osborne NN (April 2003). "The beta-adrenoceptor antagonists metipranolol and timolol are retinal neuroprotectants: comparison with betaxolol". Experimental Eye Research. 76 (4): 505–516. doi:10.1016/s0014-4835(02)00335-4. PMID 12634114.
^ Goldberg I, Goldberg H (February 1995). "Betaxolol eye drops. A clinical trial of safety and efficacy". Australian and New Zealand Journal of Ophthalmology. 23 (1): 17–24. doi:10.1111/j.1442-9071.1995.tb01640.x. PMID 7619450.
^ Yen CF, Hsu CK, Lu CW (June 2018). "Topical betaxolol for treating relapsing paronychia with pyogenic granuloma-like lesions induced by epidermal growth factor receptor inhibitors". Journal of the American Academy of Dermatology. 78 (6): e143 – e144. doi:10.1016/j.jaad.2018.01.015. PMID 29339238. S2CID 39861588.
^ Buckley MM, Goa KL, Clissold SP (July 1990). "Ocular betaxolol. A review of its pharmacological properties, and therapeutic efficacy in glaucoma and ocular hypertension". Drugs. 40 (1): 75–90. doi:10.2165/00003495-199040010-00005. PMID 2202584. S2CID 46962082.