Timolol

Should be taken with food.

Reactive airway diseases including current or history of bronchial asthma and severe COPD, sinus bradycardia, sick sinus syndrome, sino-atrial block, 2nd- or 3rd-degree atrioventricular (AV) block, overt heart failure, cardiogenic shock. Hypotension, uncontrolled heart failure, severe peripheral vascular disease (PVD) or Raynaud's disease, Prinzmetal's angina, metabolic acidosis (oral); untreated phaeochromocytoma (oral, 0.1% ophthalmic gel); corneal dystrophies (0.1% ophthalmic gel).

Patient with CV disease (e.g. coronary heart disease, 1st-degree AV block, compensated heart failure), mild to moderate COPD, current or history of bronchospastic disease (other than current or history of bronchial asthma); corneal diseases, history of atopy or severe anaphylaxis to various allergens; cerebrovascular disease or insufficiency, myasthenia gravis, diabetes mellitus especially labile diabetes, thyroid disease, psoriasis. Patients subject to spontaneous hypoglycaemia and those undergoing major surgery. Timolol may mask signs of hyperthyroidism (e.g. tachycardia) and acute hypoglycaemia. Ophthalmic: Patient with Prinzmetal's angina, hypotension, peripheral vascular disease, Raynaud's disease. If used for angle-closure glaucoma, timolol must be used with a miotic agent and not alone as it has little or no effect on pupillary constriction. Treatment recommendations may vary among individual products or between countries (refer to detailed product guidelines). Avoid abrupt withdrawal (particularly in patients with ischaemic heart disease). Renal and hepatic impairment (oral). Elderly. Pregnancy and lactation. Patient Counselling This drug may cause dizziness, fatigue, and visual disturbances (e.g. mild and transient blurred vision, ptosis, refractive changes); if affected do not drive or operate machinery. Ophthalmic: If another topical ophthalmic agent is to be used, separate the administration of the other product by at least 5-10 minutes. For 0.25% or 0.5% ophthalmic solution: Remove soft contact lenses prior to instillation of eye drops and wait at least 15 minutes before reinsertion. Monitoring Parameters Monitor blood pressure, heart rate, and apical and radial pulses periodically; intraocular pressure after approx 4 weeks of treatment (ophthalmic).

Significant: Exacerbation of angina and MI (following abrupt withdrawal), bradycardia, may precipitate or aggravate symptoms of arterial insufficiency (in patients with PVD and Raynaud's disease); induction or exacerbation of psoriasis, anaphylactic reactions; induction of dryness of eyes, choroidal detachment. Rarely, worsening of myasthenia gravis or myasthenic symptoms (e.g. diplopia, ptosis, generalised weakness). Cardiac disorders: Palpitation, chest pain. Ear and labyrinth disorders: Vertigo, tinnitus. Eye disorders: Ocular irritation (e.g. burning and stinging sensation, tearing, redness, itching), blurred vision, discharge, foreign body sensation, conjunctivitis, keratitis, diplopia, ptosis, refractive changes, corneal erosion. Gastrointestinal disorders: Dyspepsia, nausea, vomiting, dry mouth, diarrhoea, abdominal pain. General disorders and administration site conditions: Fatigue, asthenia. Immune system disorders: SLE. Metabolism and nutrition disorders: Hypoglycaemia, anorexia. Musculoskeletal and connective tissue disorders: Myalgia, arthralgia. Nervous system disorders: Headache, dizziness, somnolence, paraesthesia. Psychiatric disorders: Insomnia, depression, confusion, hallucination, memory loss, nightmare. Reproductive system and breast disorders: Decreased libido, impotence. Respiratory, thoracic and mediastinal disorders: Dyspnoea, cough. Skin and subcutaneous tissue disorders: Alopecia, rash, pruritus. Vascular disorders: Hypotension, syncope, peripheral coldness.
Potentially Fatal: Severe respiratory reactions, including those due to bronchospasm (particularly in asthma patients); severe cardiac reactions, including cardiac failure.

Additive blood pressure-lowering effect with other antihypertensive agents, TCAs, phenothiazines, and barbiturates. May increase the blood sugar-lowering effects of insulin and oral antidiabetic agents. May cause attenuated reflex tachycardia and increased risk of hypotension with anaesthetics. May cause additive effects and produce hypotension or marked bradycardia (resulting in vertigo, syncope, postural hypotension) with catecholamine-depleting drugs (e.g. reserpine, guanethidine). Hypotension may occur when given with dihydropyridine Ca channel blockers (e.g. nifedipine); AV conduction disturbances or left ventricular failure may occur with verapamil and diltiazem. May increase the AV conduction time with digitalis glycosides. NSAIDs may diminish the therapeutic effects of timolol. May increase the risk of bradycardia with antiarrhythmics including amiodarone. May result in potentiated systemic β-blockade (e.g. depression, decreased heart rate) with CYP2D6 inhibitors (e.g. quinidine, paroxetine, fluoxetine). Timolol may exacerbate the rebound hypertensive effect of clonidine when it is abruptly withdrawn. May increase the vasoconstricting effects of ergot preparations. Mydriasis may occur when ophthalmic timolol is given with epinephrine.

Antiglaucoma Preparations / Beta-Blockers

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