Joint Statement: Betoptic S Discontinuation

Betoptic S (betaxolol 0.25%) is being discontinued globally by Novartis. Existing Canadian supplies are expected to run out by the end of this year. There is no other marketed betaxolol eye drop in Canada.  Novartis has indicated that this is a global decision and will not be reversed. The discontinuation has already occurred elsewhere across the globe. We have created a small document for our colleagues in anticipation of this change. 

Betaxolol and Timolol provide similar efficacy in treating glaucoma.¹ However, timolol (a non-selective beta blocker) can adversely affect pulmonary function whereas betaxolol (a selective B-1 blocker) has less impact on pulmonary function.² Therefore, betaxolol has been recommended as the topical beta blocker of choice in patients with pulmonary disease (e.g. asthma, COPD). While betaxolol is not widely prescribed, it remains a part of glaucoma control for some patients.  

We hope providers will guide patients through this drug discontinuation. Alternative management strategies may include switching to another class of topical glaucoma medication (e.g. prostaglandin analogue, carbonic anhydrase inhibitor, alpha agonist) if no contraindication exists,³ increasing ocular availability while decreasing systemic absorption of other therapies by eyelid closure or nasolacrimal occlusion,⁴ laser trabeculoplasty,⁵ minimally invasive glaucoma surgery (MIGS) or minimally invasive bleb surgery (MIBS),⁶ or incisional glaucoma surgery.⁷ Patient needs and availability of treatment will be unique across the country. We thank you, the providers, for continuing to manage excellence in care for all Canadians. 

1. Stewart RH, Kimbrough RL, Ward RL. Betaxolol vs timolol. A six-month double-blind comparison. Arch Ophthalmol. 1986 Jan;104(1):46-8 

2. Schoene RB, Abuan T, Ward RL, Beasley CH. Effects of topical betaxolol, timolol, and placebo on pulmonary function in asthmatic bronchitis. Am J Ophthalmol. 1984 Jan;97(1):86-92 

3. Li T, Lindsley K, Rouse B, Hong H, Shi Q, Friedman DS, Wormald R, Dickersin K. Comparative Effectiveness of First-Line Medications for Primary Open-Angle Glaucoma: A Systematic Review and Network Meta-analysis. Ophthalmology. 2016 Jan;123(1):129-40 

4. Flach AJ. The importance of eyelid closure and nasolacrimal occlusion following the ocular instillation of topical glaucoma medications, and the need for the universal inclusion of one of these techniques in all patient treatments and clinical studies. Trans Am Ophthalmol Soc. 2008;106:138-45 

5. Li X, Wang W, Zhang X. Meta-analysis of selective laser trabeculoplasty versus topical medication in the treatment of open-angle glaucoma. BMC Ophthalmol. 2015 Aug 19;15:107 

6. Nichani P, Popovic MM, Schlenker MB, Park J, Ahmed IIK. Microinvasive glaucoma surgery: A review of 3476 eyes. Surv Ophthalmol. 2021 Sep-Oct;66(5):714-742 

7. Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL; Tube versus Trabeculectomy Study Group. Treatment outcomes in the Tube Versus Trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol. 2012 May;153(5):789-803.e2