Bradyarrhythmias secondary to topical levobunolol hydrochloride solution

• Published in: Clinical interventions in aging Vol. 9; pp. 1741 - 1745
• Main Authors: Lin, Lianjun, Wang, Yuchuan, Chen, Yan, Liu, Meilin
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2014; Taylor & Francis Ltd; Dove Press; Dove Medical Press
• Subjects: Adrenergic beta-Antagonists - administration & dosage; Adrenergic beta-Antagonists - adverse effects; Aged, 80 and over; Bradycardia; Bradycardia - chemically induced; Bradycardia - diagnosis; Cardiac arrhythmia; Cardiovascular disease; Care and treatment; Case Report; Case reports; Case studies; Complications and side effects; Diagnosis; Drug therapy; Electrocardiography; Electrocardiography, Ambulatory - drug effects; Frailty; Geriatrics; Glaucoma; Heart rate; Heart Rate - drug effects; Humans; Levobunolol; Levobunolol - administration & dosage; Levobunolol - adverse effects; levobunolol hydrochloride; Male; Ocular Hypertension - drug therapy; Older people; Ophthalmic Solutions; Risk factors; Sinus Arrest, Cardiac - chemically induced; Sinus Arrest, Cardiac - diagnosis; Sinuses; the elderly; topical beta-blocker; topical ß-blocker; China; topical β-blocker; bradycardia; the elderly; glaucoma
• ISSN: 1178-1998; 1176-9092; 1178-1998
• DOI: 10.2147/CIA.S69420

An 88-year-old man was admitted with fatigue, dizziness, and heart palpitations. Both the electrocardiogram and Holter confirmed the existence of sinus bradycardia and sinus arrest. One hour prior to the onset of symptoms, he received levobunolol hydrochloride solution topically. The levobunolol hydrochloride solution was discontinued and the bradycardia resolved. He was diagnosed as having intermittent sinus bradycardia and sinus arrest, induced by topical β-blocker therapy. Levobunolol hydrochloride solution is an effective therapy for ocular hypertension, probably by reducing aqueous fluid production. However, it can induce cardiac side effects such as bradyarrhythmia and should be used with caution in elderly patients or patients with cardiac disease.