ACUTE PULMONARY-EDEMA ASSOCIATED WITH OCULAR METIPRANOLOL USE

OBJECTIVE: To report a case of pulmonary edema associated with the use of ocular metipranolol, a nonselective beta-blocker. CASE SUMMARY: A 72-year-old woman with no history of pulmonary or cardiac disease pres ented to the emergency room with signs and symptoms consistent with ca rdiogenic pulmonary edema. The patient had used metipranolol eyedrops approximately 1 hour before becoming symptomatic. When rechallenged in advertently while hospitalized, the patient again became symptomatic. The patient's metipranolol eyedrops then were substituted with betaxol ol eyedrops. She continued to be free of symptoms of pulmonary edema a t subsequent clinic visits 1, 4, and 6 weeks following discharge. DISC USSION: This is the first reported case of pulmonary edema associated with metipranolol. There was a reasonable temporal association between use of the eyedrops and the onset of symptoms. Beta-blockers may caus e cardiogenic pulmonary edema secondary to their negative inotropic an d negative chronotropic effects. The drug's lipid solubility or a defi ciency in the enzyme responsible for its metabolism may have allowed t he drug to accumulate to a critical concentration over the 6-week peri od of use. CONCLUSIONS: Ocular beta-blockers must be used with caution in patients with relative contraindications to beta-blockade. This ca se illustrates that these agents must be used prudently even in patien ts with no history of symptomatic congestive heart failure.