timolol/dorzolamide (Rx)

Brand and Other Names:Cosopt, Cosopt PF
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

timolol/dorzolamide

ophthalmic solution

  • 0.5%/2%
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Open-Angle Glaucoma or Ocular Hypertension

Instill 1 gtt in affected eye(s) q12hr

Dosage Forms & Strengths

timolol/dorzolamide

ophthalmic solution

  • 0.5%/2%
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Open-Angle Glaucoma or Ocular Hypertension

<2 years

  • Contraindicated

>2 years

  • Instill 1 gtt in affected eye(s) q12hr
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Interactions

Interaction Checker

and timolol/dorzolamide

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Adverse Effects

            >10%

            Dorzolamide

            • Ocular burning, stinging, discomfort (33%)
            • Bitter taste (25%)
            • Superficial punctate keratitis (10-15%)
            • Ocular allergic reactions (10%)

            Frequency Not Defined

            Dorzolamide

            • Blurred vision
            • Ocular dryness
            • Photophobia
            • Ocular redness
            • Tearing
            • Stevens-Johnson syndrome
            • Toxic epidermal necrolysis

            Timolol

            • Arrythmia
            • Bradycardia
            • Syncope
            • Fatigue
            • Headache
            • Dyspnea
            • Bronchospasm
            • Chest pain
            • Edema
            • Paresthesia
            • Nausea
            • Rales
            • Depression
            • Decreased exercise tolerance
            • Raynaud's phenomenon  
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            Warnings

            Contraindications

            Age <2 years

            Hypersensitivity, asthma, severe COPD, sinus bradycardia, 2nd/3rd degree AV block (except in patients with artificial pacemaker), overt CHF, cardiogenic shock

            Cautions

            Dorzolamide (a sulfonamide) and, although administered topically, is absorbed systemically; same types of adverse reactions attributable to sulfonamides may occur with topical administration, including severe skin reactions

            Bacterial keratitis associated with use of multiple-dose containers of topical ophthalmic products, inadvertently contaminated by patients who, in most cases, had concurrent corneal disease or disruption of ocular epithelial surface

            Conjunctivitis reported with chronic administration (may resolve upon discontinuation of therapy)

            Sympathetic stimulation may be essential for support of circulation in diminished myocardial contractility; its inhibition by beta-adrenergic receptor blockade may precipitate more severe failure; in patients without history of cardiac failure continued depression of myocardium with beta-blocking agents over a period of time can, in some cases, lead to cardiac failure; discontinue therapy at first sign or symptom of cardiac failure

            Not for use as monotherapy in angle-closure glaucoma

            Use caution in diabetes, heart failure, psychiatric disease (may cause or exacerbate CNS depression), peripheral vascular disease

            Not for administration to patients with chronic obstructive pulmonary disease (e.g., chronic bronchitis, emphysema) of mild or moderate severity, bronchospastic disease, or a history of bronchospastic disease (other than bronchial asthma or a history of bronchial asthma, in which timiool is contraindicated)

            Patients may be unresponsive to usual doses of epinephrine used to treat anaphylactic reactions; patients with a history of atopy or a history of severe anaphylactic reactions to a variety of allergens may be more reactive to repeated accidental, diagnostic, or therapeutic challenge with such allergens Increase muscle weakness in some patients with myasthenia gravis or myasthenic symptoms reported

            Beta-adrenergic receptor blocking agents may mask signs and symptoms of acute hypoglycemia; administer with caution in patients subject to spontaneous hypoglycemia or to diabetic patients (especially those with labile diabetes) who are receiving insulin or oral hypoglycemic agents

            Beta-adrenergic blocking agents may mask certain clinical signs (e.g., tachycardia) of hyperthyroidism; manage carefully patients suspected of developing thyrotoxicosis to avoid abrupt withdrawal of beta-adrenergic blocking agents that might precipitate thyroid storm

            Not studied in patients with severe renal impairment (CrCl <30 mL/min); not recommended; dorzolamide and its metabolite are excreted predominantly by kidney

            Use with caution in hepatic impairment; not studed

            Patients receiving beta-adrenergic receptor blocking agents have experienced protracted severe hypotension during anesthesia; difficulty in restarting and maintaining heartbeat has also reported; gradual withdrawal of beta-adrenergic receptor blocking agents recommended; the effects of beta-adrenergic blocking agents may be reversed by sufficient doses of adrenergic agonists if necessary

            There is increased potential for developing corneal edema in patients with low endothelial cell counts; use caution

            Avoid concomitant administration with systemic beta-blockers or carbonic anhydrase inhibitors

            Use caution in patients taking calcium channel blockers, cardiac glycosides, or inhaled anesthetic agents

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Excreted in breast milk; not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Dorzolamide: Sulfonamide and carbonic anhydrase inhibitor; inhibition of carbonic anhydrase in ciliary processes of the eye decreases aqueous humor secretion, presumably by slowing the formation of bicarbonate ions with subsequent reduction in sodium and fluid transport

            Timolol: Nonselective beta-adrenergic receptor blocker; reduces IOP by reducing production of aqueous humor

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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