· High blood pressure.

· Prophylaxis of stress angina attacks.

The usual dosage is 1 tablet 20 mg daily in one, taken only in the two indications.

Dosage in patients with renal insufficiency

The dosage should be adjusted, and in the state of renal function: up to a creatinine clearance of 20 ml per minute it is not necessary to change the dosage. However, clinical monitoring is recommended from the beginning of treatment to the equilibration of blood levels (4 days on average).
In patients with renal insufficiency, severe (creatinine clearance
Such an association should be made only under close clinical and electrocardiographic supervision, particularly in the elderly or at the beginning of treatment.

+; Amiodarone

Disorders of contractility, automatism and conduction (suppression of sympathetic compensatory mechanisms).

Associations that are the subject of precautions for use

Halogenated volatile anesthetics

Reduction of Cardiovascular Compensation Reactions by Beta-blockers (beta-adrenergic inhibition can be lifted during beta-stimulant intervention)
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As a general rule, do not stop beta-blocking therapy and, in any event, avoid abrupt stop. Inform the anesthesiologist of this treatment.

(Class Ia (quinidine, hydroquinidine, disopyramide) and class III (amiodarone, dofetilide, ibutilide, sotalol), certain neuroleptics, phenothiazinics (chlorpromazine, cyamemazine, levomepromazine, (Pimozide) and other medicinal products (cisapride, diphenemil, erythromycin IV, halofantrine, mizolastin, moxifloxacin, pentamidine, spiramycin IV, vincamine), benzamides (aminosulpride, sulpiride, tiapride), butyrophenones (droperidol, haloperidol) IV.

Increased risk of rhythm disorders, including ventricular torsades de pointes (hypokalaemia is a contributing factor)

Clinical and electrocardiographic monitoring.

+; Propafenone

Disorders of contractility, automatism and conduction (suppression of sympathetic compensatory mechanisms).

Clinical and electrocardiographic monitoring.

+; Baclofen

Increase in antihypertensive effect

Blood Pressure Monitoring and Dosage Adjustment of the Antihypertensive Medication If Needed

+, Insulin, sulphonylureas (see section Caveats and precautions for use)

All beta-blockers may mask certain symptoms of hypoglycemia, palpitations and tachycardia.
Prevent the patient and strengthen, especially at the beginning of treatment, self-monitoring, blood.

Anti-cholinesterases (ambenomium, donepezil, galantamine, neostigmine, pyridostigmine, rivastigmine, tacrine)
Risk of excessive bradycardia (addition, bradycardiac effects).

Clinical monitoring, regular.

+ Central antihypertensive drugs (clonidine, apraclonidine, alphamethyldopa, guanfacine, moxonidine, rilmenidine)

Significant increase in arterial pressure in the event of abrupt cessation of treatment with the central antihypertensive drug

Avoid abrupt cessation of treatment by the central antihypertensive drug

Clinical Surveillance.
+ Lidocaine by IV route

Increased plasma lidocaine levels with possible increase in neurological and cardiac adverse effects (decreased hepatic clearance of lidocaine).

Clinical monitoring, electrocardiographic and, optionally, control of plasma lidocaine concentrations, during combination and after discontinuation of the beta-blocker. Adjustment if necessary of the dosage of lidocaine.

Associations to be taken into account

+ NSAIDs (general route) including inhibitors, selective cox-2

Reduction of the effect, antihypertensive (inhibition of vasodilating prostaglandins, NSAIDs and hydrosodic retention with NSAIDs, pyrazole)

+; Calcium antagonists (dihydropyridines)

Hypotension, cardiac failure, in patients with latent or non-latent cardiac insufficiency, controlled. The beta-blocker can also minimize the reflex sympathetic reaction involved, in case of excessive hemodynamic repercussion

+ Antidepressants imipraminic, neuroleptic

Antihypertensive effect and risk of increased orthostatic hypotension (additive effect)

+; Mefloquine

Risk of bradycardia (addition of effects, bradycardia).
+, Dipyridamole (lane IV)

Increased effect, antihypertensive.

+, Alpha-blockers with urological focus (alfuzosin, doxazosin, prazosin, tamsulosin, terazosin)
Increase in hypotensive effect. Risk of increased orthostatic hypotension.

+ Amifostine

Increased effect, antihypertensive.

Without object.

In case of bradycardia or excessive blood pressure decrease, the administration

· Atropine, 1 to 2 mg I.V.

· Of glucagon in the dose of 1 mg renewable

Followed by, if necessary, isoprenaline 25 μg in slow injection or dobutamine 2.5 to 10 μg / Kg / min.
In the event of cardiac decompensation in the newborn mother treated with beta-blockers

· Glucagon based on 0.3 mg / kg

· Intensive care hospitalization

· Isoprenaline and dobutamine: generally high dosages and prolonged treatment require specialized surveillance.

Pregnancy

Teratogenicity

In the animal, no teratogenic action has been demonstrated. In the human species, no teratogenic effects have been reported, and to date, and the results of controlled prospective studies have not reported malformations at birth.

Neo-natal aspect

In babies' newborn babies, the beta-blocking action persists several days after birth: if this remanence can be of no clinical consequence, it is possible that a cardiac failure may occur, requiring hospitalization in care (See Overdose section), avoiding filling solutes (risk of OAP), otherwise, bradycardia, respiratory distress, hypoglycemia have been reported. Therefore, careful monitoring of the newborn (heart rate and blood glucose during the first 3 to 5 days of life) is recommended in specialized settings.
Breastfeeding

Betaxolol is excreted in milk. The risk of hypoglycaemia and bradycardia has not been evaluated: accordingly and by precaution, breast-feeding is not recommended during the treatment period.

At the clinical level

Most frequently reported

· Asthenia

· Cooling the ends

· Bradycardia, severe if necessary

· Digestive disorders (gastralgia, nausea, vomiting)

· Impotence

· Insomnia.

Much more, rarely

· Deceleration of atrioventricular conduction or intensification of an existing atrioventricular block

· Heart failure

· Blood pressure drop

· Bronchospasm

· Hypoglycemia

· Raynaud's syndrome

· Aggravation of an existing intermittent claudication

· Various skin manifestations including rashes, psoriasiformes or exacerbation of psoriasis (see section 4.4).


· Dry Eye

· Nightmares.

Biologically speaking

In rare cases, the appearance of antinuclear antibodies accompanied only by exceptional clinical manifestations in the form of lupus syndrome and which led to discontinuation of treatment.

Reporting of suspected adverse reactions

The reporting of suspected adverse effects after authorization of the drug is important. It provides continuous monitoring of the benefit / risk ratio of the drug. Health professionals report any suspected adverse reactions via the national reporting system: National Agency for the Safety of Medicines and Health Products (Ansm) and network of Regional Pharmacovigilance Centers -
· Hypertension · Prophylaxis of stress angina attacks