Timolol

(tye' moe lole)

PCaution when 

used during lactation : Caution when used during pregnancy

LCaution when used during lactation : Caution when used during lactation

Molecule Info

| See TERMINOLOGY & ABBREVIATIONS |

Indication & Dosage

Oral route
Hypertension
Adult: As maleate: 10 mg daily in 1-2 divided doses, increase according to response every 7 or more days. Maintenance: 10-40 mg/day in single or 2 divided doses. Max: 60 mg/day. Doses >30 mg should be given in 2 divided doses.
Renal impairment: Dose reduction may be needed. 
Hepatic impairment: Dose reduction may be needed. 

Prophylaxis of migraine
Adult: As maleate: 10-20 mg daily in 1-2 divided doses. Max: 30 mg daily.
Renal impairment: Dose reduction may be needed. 
Hepatic impairment: Dose reduction may be needed. 

Angina pectoris
Adult: As maleate: 5 mg bid, increase in steps of 10 mg every 3 or more days. Max: 60 mg/day in 2 divided doses.
Renal impairment: Dose reduction may be needed. 
Hepatic impairment: Dose reduction may be needed. 

Post myocardial infarction
Adult: As maleate: Initial: 5 mg bid for 2 days, starting within 1-4 wk after MI, increase to 10 mg bid if no adverse effects are observed.
Renal impairment: Dose reduction may be needed. 
Hepatic impairment: Dose reduction may be needed. 
Ophthalmic route
Open-angle glaucoma
Adult: Eye drop solution: Initially, instill 1 drop of 0.25% solution bid into the affected eye, may increase to 1 drop 0.5% solution bid if there is inadequate response; decrease to 1 drop daily if controlled. Do not exceed 1 drop bid of 0.5% solution. Gel-forming eyedrop: Instill 1 drop of 0.25% or 0.5% preparation in affected eyes once daily.

Ocular hypertension
Adult: Eye drop solution: Initially, instill 1 drop of 0.25% solution bid into the affected eye, may increase to 1 drop 0.5% solution bid if there is inadequate response; decrease to 1 drop daily if controlled. Do not exceed 1 drop bid of 0.5% solution. Gel-forming eyedrop: Instill 1 drop of 0.25% or 0.5% preparation in affected eyes once daily.

Administration

May be taken with or without food. May be taken w/ meals, milk or antacids to minimise GI discomfort.

Overdosage

Symptomatic bradycardia, hypotension, bronchospasm and acute heart failure. Gastric lavage followed by symptomatic and supportive treatment.

Contraindications

Present or history of bronchial asthma, severe COPD, sinus bradycardia, 2nd and 3rd degree heart block, sick sinus syndrome, overt heart failure, cardiogenic shock, severe peripheral vascular disease/Raynaud's disease), Prinzmetal angina, untreated pheochromocytoma, metabolic acidosis, hypotension.

Special Precautions

Due to systemic absorption of ophthalmic preparations, adverse reactions associated with systemic administration of β-blockers may occur. Abrupt withdrawal of beta-blocker may cause exacerbation of angina, and myocardial infarctions have occurred in some cases. Patients on long-term treatment should discontinue medication gradually over a period of 1-2 wk. May mask signs and symptoms of hypoglycaemia, hyperthyroidism. Abrupt withdrawal may precipitate thyroid storm in patients suspected of developing thyrotoxicosis. Ophthalmic Timolol should not be used alone for treatment of angle-closure glaucoma. β-blocker therapy may increase sensitivity towards allergen in patients with history of atrophy or severe anaphylaxis reactions. May rarely increase muscle weakness in some patients with myasthenia gravis. Caution in patients undergoing major surgery; cerebrovascular insufficiency, heart failure, renal or hepatic impairment, pregnancy and lactation. Safety and efficacy have not been established in paediatric patients.

Adverse Drug Reactions

Fatigue, headache, coldness of extremities, paraesthesia, GI symptoms, dyspnoea, skin rash, alopecia, dry mouth, bradycardia. Ophthalmic use: Burning, stinging, blurred vision, ocular irritation, decreased corneal sensitivity, visual disturbances, diplopia, ptosis, cystoid macular oedema, pseudopemphigoid, choroidal detachment following filtration surgery. Adverse reactions associated with systemic administration of β-blocker may occur with ophthalmic use.
Potentially Fatal: Heart failure, intensification of heart block, bronchospasm, respiratory failure.

Drug Interactions

Hypotensive action may be reduced by NSAIDs. Increased hypotensive effect of other antihypertensives, general anaesthetics, catecholamine-depleting drugs e.g. reserpine. Use with methoxyflurane may cause cardiac depression. Decreased response to sympathomimetics. Increased β-blockade activity with CYP2D6 inhibitors e.g. quinidine. Increased risk of AV prolongation with diltiazem, verapamil and digoxin. May exacerbate rebound hypertension following abrupt discontinuance of clonidine in patients receiving a concomitant beta-blocker. Potential additive effects of β-blockade in patients receiving both oral and ophthalmic β-blockers. Concomitant use of 2 ophthalmic β-blockers is not recommended.

Pregnancy Category

ROUTE : OPHTH

Category C: Either studies in animals have revealed adverse effects on the foetus and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

ROUTE : PO

Category C: D in 2nd & 3rd trimesters. Either studies in animals have revealed adverse effects on the foetus and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Storage

Ophthalmic: Store at 15-30°C . Avoid freezing and protect light. Oral: Store at 15-30°C .

Pharmacology

Timolol is a non-selective β-adrenergic receptor blocker. It does not have significant intrinsic sympathomimetic activity, direct myocardial depressant activity or local anaesthetic activity. Exact mechanism of ocular hypotensive effect is unclear, but it is thought to be related to reduction of aqueous humor formation. Beta-blockade also causes lowering of blood pressure.
Onset: Ophthalmic: About 30 min.
Absorption: Oral: Rapid and almost completely absorbed; plasma concentration peaks in 1-2 hr. Ophthalmic: Part of the dose is absorbed systemically.
Distribution: Not extensively protein-bound. Crosses the placenta and distributed into breast milk.
Metabolism: Undergo first-pass metabolism and partially metabolised in the liver. Plasma half-life: 4hr.
Excretion: Excreted in urine as metabolites and unchanged drug.

mph Class

Beta-Blockers / Antiglaucoma Preparations

ATC Classification

S01ED01 - timolol; Belongs to the class of beta blocking agents used in the treatment of glaucoma and miosis. 
C07AA06 - timolol; Belongs to the class of non-selective beta-blocking agents. Used in the treatment of cardiovascular diseases.

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Brand/Product Info


Total Products : 13             
Brand Name Manufacturer/Marketer Composition Dosage Form Pack Size & Price
ARISTOMOL Aristopharma Ltd. Timolol maleate 0.5% Eye Drop 5ml: 70.00 MRP
ASINOL Asiatic Laboratories Ltd. Timolol maleate 0.5% Eye Drop 5ml: 67.00 MRP
INRAMOL Eye Drop Beximco Pharmaceuticals Ltd Timolol 0.5% Eye Drop 5 ml: 70.00 MRP
INTRAMOL Beximco Pharmaceuticals Ltd Timolol Maleate BP equivalent to Timolol 5mg/ml Eye Drops 5ml: 70.00 MRP
LOTENSIN ACI Ltd. Timolol maleate 0.5% Eye Drop 5ml: 67.25 MRP
NYOLOL Novartis (Bangladesh) Ltd. Timolol maleate ophthalmic gel 0.1% Gel 5gm gel: 249.00 MRP
OCUPRES Popular Pharmaceuticals Ltd. Timolol maleate 0.5% Eye Drop 5ml: 70.26 MRP
TIMOCARE Drop Healthcare Pharmacuticals Ltd. Timolol Maleate BP equivalent to Timolol 5mg/ml Eye Drops 5ml: 70.00 MRP
TIMODROP Reman Drug Laboratories Ltd. Timolol maleate 0.25% & 0.5% Eye Drop 5ml each: 50.00 & 75.00 MRP
TIMOLAT IBN SINA Pharmaceutical Industry Ltd. Timolol maleate 0.5% Eye Drop 5ml: 75.00 IP
TIMOLOL OSL Opso Saline Ltd. Timolol maleate 0.25% & 0.5% Eye Drop 5ml each: 43.16 & 62.99 MRP
TIMOMIN Nipa Pharmaceuticals Ltd. Timolol maleate 0.5% Eye Drop 5ml: 70.00 MRP
TIMOPRESS 0.5 Incepta Pharmaceuticals Limited Timolol Maleate BP equivalent to Timolol 5mg/ml Eye Drops 5ml: 70.00 MRP

Gen. MedInfo

Why is this medication prescribed?

Ophthalmic timolol is used to treat glaucoma, a condition in which increased pressure in the eye can lead to gradual loss of vision. Timolol is in a class of medications called beta-blockers. It works by decreasing the pressure in the eye.

How should this medicine be used?

Ophthalmic timolol may come as a solution and an extended-release gel-forming solution . Timolol eye drops are usually instilled once or twice a day, at evenly spaced intervals, until pressure in the eye is controlled . Then it may be instilled once a day. Timolol gel-forming solution is usually instilled once a day. Follow the directions on your prescription label carefully, and ask doctor or pharmacist to explain any part you do not understand. Use timolol exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Timolol eye drops and gel-forming solution control glaucoma but do not cure it. Continue to use timolol even if you feel well. Do not stop using the medication without talking to your doctor.

To instill the eye drops or eye gel, follow these steps:

  • Wash your hands thoroughly with soap and water.
  • If you are using the gel-forming solution, invert the container and shake it once. Make sure that the end of the dropper is not chipped or cracked.
  • Avoid touching the dropper tip against your eye or anything else; eye drops and droppers must be kept clean.
  • While tilting your head back, pull down the lower lid of your eye with your index finger to form a pocket.
  • Hold the dropper with the other hand, as close to the eye as possible without touching it.
  • Brace the remaining fingers of that hand against your face.
  • If you are using the eye drops, gently squeeze the dropper so that a single drop falls into the pocket made by the lower eyelid. If you are using the gel-forming solution, check the directions that came with your medication to see whether you should push the bottom of the bottle so that a single drop falls out or press a specially marked area on the side of the bottle. If you are using the type of bottle that must be pushed from the bottom, be careful not to squeeze the sides of the bottle. Remove your index finger from the lower eyelid.
  • Close your eye for 2 to 3 minutes and tip your head down as though looking at the floor. Try not to blink or squeeze your eyelids.
  • Place a finger on the tear duct and apply gentle pressure.
  • Wipe any excess liquid from your face with a tissue.
  • If you are to use more than one drop in the same eye, wait at least 5 minutes before instilling the next drop.
  • Replace and tighten the cap on the dropper bottle. Do not wipe or rinse the dropper tip.
  • Wash your hands to remove any medication.

Other uses for this medicine

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before using timolol eye drops or gel-forming solution,

  • tell your doctor if you are allergic to timolol, beta blockers, or any other drugs.
  • tell your doctor what prescription and nonprescription medications you are taking, especially beta blockers such as atenolol, carteolol, esmolol, labetalol, metoprolol, nadolol, propranolol, sotalol, and timolol; quinidine, verapamil and vitamins.
  • if you are using another topical eye medication, instill it at least 10 minutes before or after you instill timolol eye drops or gel-forming solution.
  • tell your doctor if you have or have ever had thyroid, heart, or lung disease; congestive heart failure; myasthenia gravis; or diabetes.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using timolol, consult your doctor immediately.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are using timolol.
  • if you have eye surgery, an eye injury, or develop an eye infection while using timolol eye drops or gel-forming solution, ask your doctor if you can continue using the same container of timolol.
  • you should know that your vision may be blurred during your treatment with timolol gel-forming solution. Avoid rubbing your eyes even if your vision is blurred. Do not drive a car or operate machinery if you are unable to see clearly.
  • if you wear soft contact lenses, remove them before instilling timolol eye drops or gel-forming solution, and wait until 15 minutes after using timolol to put them back in.

What should I do if I forget a dose?

Instill the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not instill a double dose to make up for a missed one.

What side effects can this medication cause?

Timolol eye drops or gel-forming solution may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • eye irritation
  • double vision
  • headache
  • depression
  • dizziness
  • nausea

Some side effects can be serious. If you experience any of the following symptoms, stop using timolol and consult your doctor immediately:

  • slow or irregular heartbeat
  • difficulty breathing
  • sudden weight gain
  • swelling of the feet or lower legs
  • fainting

This medication may cause other side effects.  Consult your doctor if you have any unusual problems while taking this.

What other information should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to this medicine.

Do not let anyone else use your medication. If you still have symptoms and need further treatment, consult your doctor.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

 


This information is provided for reference only and not a replacement for and should only be used in conjunction with full consultation with a registered medical practitioner. It may not contain all the available information you require and cannot substitute professional medical care, nor does it take into account all individual circumstances. Although great effort has been made to ensure content accuracy, mph-bd shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise.