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CARDIOVASCULAR SYSTEM › BETA BLOCKING AGENTS › BETA BLOCKING AGENTS › Beta blocking agents, non-selective
timolol
C07AA06
Forms & Strengths
- Ophthalmic solution: 0.25%, 0.5%
- Ophthalmic gel-forming solution: 0.25%, 0.5%
- Oral tablet: 5 mg, 10 mg, 20 mg
Adult Dosing
- Open-angle glaucoma / ocular hypertension (ophthalmic solution): 1 drop of 0.25% or 0.5% in affected eye(s) twice daily
- Open-angle glaucoma / ocular hypertension (gel-forming solution): 1 drop of 0.25% or 0.5% in affected eye(s) once daily
- Hypertension (oral): Initial 10 mg twice daily, maintenance 20-60 mg/day in divided doses
- Migraine prophylaxis (oral): Initial 10 mg twice daily, maintenance up to 30 mg/day
Pediatric Dosing
- Glaucoma (ophthalmic): 1 drop of 0.25% solution into affected eye(s) once daily; may increase to twice daily if clinical response is inadequate
- Safety and efficacy of oral formulations not established in pediatric patients
Indications
- Treatment of elevated intraocular pressure in ocular hypertension or open-angle glaucoma
- Management of hypertension (oral)
- Prophylaxis of common migraine headaches (oral)
Mechanism of Action
- Non-selective beta-adrenergic receptor blocker (beta-1 and beta-2)
- Reduces aqueous humor production and slightly increases outflow facility in the eye
- Decreases heart rate, cardiac output, and blood pressure when administered systemically
Contraindications
- Bronchial asthma or history of bronchial asthma
- Severe chronic obstructive pulmonary disease
- Sinus bradycardia
- Second- or third-degree atrioventricular block
- Overt cardiac failure
- Cardiogenic shock
- Hypersensitivity to timolol maleate
Adverse Reactions
- Ocular burning, stinging, or irritation upon instillation
- Blurred vision and dry eyes
- Bradycardia, hypotension, and syncope (systemic absorption)
- Bronchospasm and dyspnea
- Fatigue, depression, and headache
- Masking of hypoglycemia symptoms in diabetes mellitus
Drug Interactions
- Systemic beta-blockers: May result in additive systemic beta-blocking effects
- Calcium channel antagonists (e.g., verapamil, diltiazem): Increased risk of atrioventricular conduction disturbances and left ventricular failure
- Catecholamine-depleting drugs (e.g., reserpine): Potential additive hypotensive and bradycardic effects
- CYP2D6 inhibitors (e.g., quinidine, fluoxetine): May increase systemic exposure of timolol
- Digitalis glycosides: Concomitant use may prolong AV conduction time
Curated Content: Needs Vetting Before Put to Clinical Use