Beta-blocker eyedrops (timolol, betaxolol, levobunolol, carteolol, metipranolol) are used to reduce intraocular pressure in glaucoma. They may be used alone, or in combination with other pressure-lowering preparations.

Dosage regimen

* Beta-blockers are usually used once in the morning or twice daily.

Patient knowledge

* Does the patient understand the need for their medication? As patients can not directly see or feel any benefit from glaucoma medication, concordance may be an issue. Ensure they understand the need for regular dosing, and the consequences of compliance failure.

* Is the patient using more than one type of eye product? If so, ensure they know to leave at least ten minutes between the application of different types to prevent the second drops washing out the first.

Is the medicine working?

* Check the patient can apply the medication correctly. Elderly patients and those with musculoskeletal conditions may find it difficult to aim or squeeze a small container of eye drops or ointment. These patients may benefit from combination products, which cut the number of applications per day, and compliance aids such as eye drop dispensers.

* It is important to counsel in the regular and correct use of their medication to maximize the effectiveness of treatment. If medication is not working, patient should go back to their GP as another glaucoma eye drops may be added to their current medication.

Side effects

* Common side effects of beta-blockers include stinging, burning, pain and itching.

Monitoring

* Beta-blockers are contraindicated in patients with bradycardia, uncontrolled heart failure and asthma.

* Patients should be reminded of the need for regular intraocular pressure checks.

Lifestyle

* Double-check whether patients are taking any OTC medication. Look out for hayfever and travel sickness products as sedating antihistamines have significant antimuscarinic activity and should be avoided in glaucoma patients.

* All eye products should be discarded 28 days after opening.

* Remind patients to order their repeat prescription on time to prevent them running out.

* Patients on more than one eye medication may be confused about what to take when. Pointing out distinguishing features, such as bottle colour, may help.

Ken P.K Wan, community pharmacist, Clacton-on-Sea, Essex