Levobunolol belongs to the class of medications known as beta-blockers. Levobunolol is used to control intraocular (eye) pressure in people with chronic open-angle Glaucoma or mild-to-moderate ocular hypertension (increased pressure within the eye).

Your doctor may have suggested Ratio Levobunolol for conditions other than those listed in these drug information articles. As well, some forms of Ratio Levobunolol may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking Ratio Levobunolol, speak to your doctor. Do not stop taking Ratio Levobunolol without consulting your doctor.

Do not give Ratio Levobunolol to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take Ratio Levobunolol if their doctor has not prescribed it.

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The recommended dose of levobunolol eye drops is 1 drop of levobunolol 0.5% once or twice a day in the affected eye(s). Doses greater than 1 drop twice daily have not been found to be any more effective.

Ask your doctor or pharmacist to show you the correct way to instill the eye drops. Ratio Levobunolol is for external use only. Do not touch the dropper tip to any surface, since this may contaminate the solution. Protect the medication from light and excessive heat. Discard any unused solution after the end of the treatment period.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important to use Ratio Levobunolol regularly and exactly as prescribed by your doctor. If you miss a dose, use it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Ratio Levobunolol at room temperature, protect it and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes Ratio Levobunolol. If you are concerned about side effects, discuss the risks and benefits of Ratio Levobunolol with your doctor.

The following side effects have been reported by at least 1% of people taking Ratio Levobunolol. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• blurred vision (temporary)
• crusting of eyelashes
• decreased night vision
• dizziness or light headedness when rising from a lying or sitting position
• dry eyes
• feeling like you have something in your eye
• headache
• increased sensitivity of eye to light
• itching, stinging, burning, or watering of eye or other eye irritation
• nausea
• stinging of eye or other eye irritation (when medication is applied)
• tiredness

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• blurred vision or other change in vision
• droopy upper eyelid
• eye pain
• fainting
• fast, slow or irregular heartbeat
• itchiness
• seeing "double"
• shortness of breath or difficulty breathing
• signs of Depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
• signs of heart problems (e.g., fast, irregular heartbeat or pulse, chest pain, sudden weight gain, difficulty breathing, leg swelling)
• swelling, irritation, or inflammation of eye or eyelid

Stop taking the medication and seek immediate medical attention if any of the following occur:

• confusion
• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking Ratio Levobunolol.

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0.5%
Each mL of sterile ophthalmic solution contains 5 mg of levobunolol (0.5%). Nonmedicinal ingredients: benzalkonium chloride 0.004% (as preservative), edetate disodium, polyvinyl alcohol (Liquifilm), potassium phosphate monobasic, sodium chloride, sodium metabisulfite, sodium phosphate dibasic, and sodium hydroxide or hydrochloric acid to adjust pH. Bottles should protected from light and excessive heat.

Do not take Ratio Levobunolol if you:

• are allergic to levobunolol or any ingredients of Ratio Levobunolol
• have Asthma or a history of asthma or severe COPD (Chronic Obstructive Pulmonary Disease) (e.g., chronic Bronchitis or emphysema)
• have certain abnormal heart rhythms associated with slowing down of the heart rate
• have overt heart failure
• suffer from cardiogenic shock

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There may be an interaction between levobunolol and any of the following:

• alpha/beta agonists (e.g., Epinephrine, norepinephrine)
• Amiodarone
• beta-adrenergic blockers (e.g., atenolol, Propranolol, Sotalol)
• beta 2-agonists (e.g., salbutamol, formoterol, terbutaline)
• calcium channel blockers (e.g., Diltiazem, Nifedipine, Verapamil)
• Ceritinib
• Clonidine
• Digoxin
• Donepezil
• Dronedarone
• ergot alkaloids (e.g., Dihydroergotamine, ergonovine,  ergotamine, methylergonovine)
• Fentanyl
• Fingolimod
• Galantamine
• grass pollen allergen extract
• Guanfacine
• Ivabradine
• Lacosamide
• Lanreotide
• lidocaine
• methyldopa
• Octreotide
• Pasireotide
• Propafenone
• Regorafenib
• Rivastigmine
• Tizanidine
• theophyllines (e.g., Aminophylline, Oxtriphylline, Theophylline)
• Tofacitinib

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Ratio Levobunolol. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Ratio Levobunolol.

Allergies: Ratio Levobunolol should be used with caution by anyone with a known allergy to other beta-blockers (e.g., Metoprolol, Atenolol).

Medical conditions: Ratio Levobunolol belongs to the family of medications known as beta-blockers. Although levobunolol is given as an eye drop, small amounts may be absorbed into the bloodstream. For this reason, it should not be used by anyone who must avoid internal use of beta-blockers. This includes those with abnormally low heart rate, certain abnormal heart rhythms, uncontrolled Congestive Heart Failure, asthma, or severe chronic obstructive pulmonary disease.

Sulfites: This product contains sodium metabisulfite, a sulfite that may cause allergic-type reactions, including Anaphylaxis (severe allergic reaction), in certain susceptible people. Sulfite sensitivity is seen more frequently in those with asthma.

Pregnancy: Ratio Levobunolol has not been studied for use by pregnant women. It should be used during pregnancy only if the potential benefits outweigh the potential risks.

Breast-feeding: It is not known if levobunolol passes into breast milk. Related medications have been shown to pass into breast milk. Talk to your doctor about breast-feeding while using levobunolol.

Children: The safety and effectiveness of Ratio Levobunolol have not been established for use by children.

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