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Acute pulmonary edema associated with ocular metipranolol use
1Robert C. Byrd Health Sciences Center, School of Pharmacy, West Virginia University, Morgantown 26506, USA.
The Annals of Pharmacotherapy
|April 1, 1995
Summary
Ocular metipranolol, a nonselective beta-blocker, may cause pulmonary edema. This case highlights the need for caution when prescribing beta-blocker eyedrops, even in patients without prior heart conditions.
Area of Science:
- Ophthalmology
- Cardiology
- Pharmacology
Background:
- Ocular beta-blockers are frequently prescribed for glaucoma.
- Nonselective beta-blockers, like metipranolol, can have systemic effects.
- Cardiogenic pulmonary edema is a serious condition affecting heart function.
Observation:
- A 72-year-old woman developed cardiogenic pulmonary edema shortly after using metipranolol eyedrops.
- Symptoms recurred upon accidental re-administration of metipranolol.
- Switching to betaxolol eyedrops resolved the pulmonary edema.
Findings:
- This is the first reported case linking metipranolol eyedrops to pulmonary edema.
- A temporal association suggests metipranolol as the causative agent.
- Potential mechanisms include negative inotropic/chronotropic effects or drug accumulation due to lipid solubility or metabolic deficiency.
Implications:
- Ocular beta-blockers require careful use in patients with contraindications to beta-blockade.
- Prudent use is advised even in patients without a history of heart failure.
- This case underscores the importance of considering systemic drug effects from topical ocular medications.