Systemic adverse effects of ophthalmic beta-blockers.

OBJECTIVE: To review published clinical information on the systemic adverse effects of ophthalmic beta-blockers for the purpose of developing a pilot contraindication/warning system for active prescriptions in the Veterans Affairs dispensing database. DATA SOURCES: Articles were identified by searching MEDLINE (1966-October 2000) and International Pharmaceutical Abstracts (1970-October 2000). STUDY SELECTION AND DATA EXTRACTION: Article relevance was determined by review of titles, abstracts, and key words. DATA SYNTHESIS: The preponderance of the evidence suggests that ophthalmic beta-blockers may be associated with bronchospasm and adverse cardiovascular effects including bradycardia. Depression and other central nervous system effects are reported less commonly. Data are inadequate to suggest that ophthalmic beta-blocker use is routinely associated with adverse metabolic effects. CONCLUSIONS: The strongest level of evidence (grade A1) supports a contraindication for use of ophthalmic beta-blockers for respiratory disease, with a moderate level of evidence (grade B1) for cardiovascular disease. Data are insufficient to support or refute contraindications for other disease states. The search technique and classification scheme described in this article provide a methodology for evaluating, grading, and applying evidence on potential adverse effects of drug therapy.

Cardiac dysrhythmia with the use of clonidine in explosive disorder.

Clonidine has been used in the management of hypertension in adults with few cases of cardiac dysrhythmia reported. These appear to occur most frequently in association with preexisting cardiac disease or toxic concentrations of the drug. We observed a case of clonidine-induced bradycardia and irregular firing of the sinoatrial node in a child who does not have cardiac disease given low doses of the drug in the treatment of intermittent explosive disorder.