timolol ophthalmic (Rx)

Brand and Other Names:Timoptic, Timoptic in Ocudose, more...Timoptic XE, Betimol, Istalol
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

ophthalmic solution

  • 0.25%
  • 0.5%

gel forming solution

  • 0.25%
  • 0.5%

Ocular Hypertension

1 gtt affected eye(s) q12hr 0.25%, if not effective increase 0.5% 1 gtt q12hr THEN

Decrease to 1 gtt/day if IOP controlled

XE formulation (0.25% or 0.5%): 1 gtt qDay

Ocular hypertension

<2 years

  • Safety and efficacy not established

≥2 years

  • 1 gtt affected eye(s) q12hr 0.25%, if not effective increase 0.5% 1 gtt q12hr THEN
  • Decrease to 1 gtt/day if IOP controlled
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Adverse Effects

>10%

Burning or stinging (38%)

>1%

Blurred vision (4-10%)

Cataract (4-10%)

Conjunctivitis (4-10%)

Decreased visual acuity (4-10%)

Headache (4-10%)

Hypertension (4-10%)

Infection (4-10%)

Itching (4-10%)

Frequency Not Defined

Ocular irritation

Blepharitis

Keratitis

Ocular pain

Discharge (e.g., crusting)

Foreign body sensation

Dry eyes

Eyelid erythema

Blepharoptosis

Decreased corneal sensitivity

Diplopia

Cystoid macular edema

Pseudopemphigoid

Choroidal detachment following filtration surgery

Epiphora

Photophobia

Conjunctival injection

Corneal fluorescein staining

Retinal vascular disorder

Ptosis

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Warnings

Contraindications

Hypersensitivity to any component of this product; bronchial asthma; history of bronchial asthma; severe chronic obstructive pulmonary disease; sinus bradycardia; second or third degree atrioventricular block; overt cardiac failure; cardiogenic shock

Cautions

Observe patients receiving topical timolol and a systemic ß-adrenergic blocking agent concomitantly for potential additive effects on IOP and/or systemic effects of ß-adrenergic blockade

Severe respiratory reactions and cardiac reactions, including death due to bronchospasm in patients with asthma, and rarely death in association with cardiac failure, reported following systemic or ophthalmic administration of timolol maleate

Sympathetic stimulation may be essential for support of the circulation in individuals with diminished myocardial contractility, and its inhibition of beta-adrenergic receptor blockade may precipitate more severe failure

In Patients Without a 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; at first sign or symptom of cardiac failure, therapy should be discontinued

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 timolol is contraindicated) should, in general, not receive beta-blockers

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

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

Because of potential effects of beta-adrenergic blocking agents on blood pressure and pulse, these agents should be used with caution in patients with cerebrovascular insufficiency; if signs or symptoms suggesting reduced cerebral blood flow develop following initiation of therapy, alternative therapy should be considered

There have been reports of bacterial keratitis associated with use of multiple-dose containers of topical ophthalmic products; these containers had been inadvertently contaminated by patients who, in most cases, had a concurrent corneal disease or a disruption of ocular epithelial surface

Choroidal detachment after filtration procedures has been reported with the administration of aqueous suppressant

In patients with angle-closure glaucoma, the immediate objective of treatment is to reopen the angle; this requires constricting the pupil; timolol maleate has little or no effect on the pupil; timolol should not be used alone in the treatment of angle-closure glaucoma

While taking beta-blockers, 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; such patients may be unresponsive to usual doses of epinephrine used to treat anaphylactic reactions

Beta-adrenergic blockade has been reported to potentiate muscle weakness consistent with certain myasthenic symptoms (e.g., diplopia, ptosis, and generalized weakness); timolol has been reported rarely to increase muscle weakness in some patients with myasthenia gravis or myasthenic symptoms

Remove contact lens prior to administration

Major surgery

  • Some authorities recommend gradual withdrawal of beta-adrenergic receptor blocking agents in patients undergoing elective surgery; may augment risk of general anesthesia in surgical procedures
  • Some patients receiving beta-adrenergic receptor blocking agents have experienced protracted severe hypotension during anesthesia; difficulty in restarting and maintaining heartbeat also reported
  • In patients undergoing elective surgery; gradual withdrawal of beta-adrenergic receptor blocking agents recommended; in patients undergoing elective surgery, some authorities recommend gradual withdrawal of beta-adrenergic receptor blocking agents; if necessary during surgery, effects of beta-adrenergic blocking agents may be reversed by sufficient doses of adrenergic agonists
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Pregnancy & Lactation

Pregnancy Category: C

Lactation: Secreted in breast milk; Mfr advises against breast feeding (AAP Committee states compatible with breast feeding)

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

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

Pharmacokinetics

Absorption: Minimal systemic absorption detected

Onset: 30 min

Peak effect: 1-2hr

Duration: <24 hr

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Images

BRAND FORM. UNIT PRICE PILL IMAGE
Istalol ophthalmic (eye)
-
0.5 % drops
Istalol ophthalmic (eye)
-
0.5 % drops
timolol maleate ophthalmic
-
0.25 % drops
timolol maleate ophthalmic
-
0.25 % drops
timolol maleate ophthalmic
-
0.5 % drops
timolol maleate ophthalmic
-
0.5 % drops
timolol maleate ophthalmic
-
0.5 % drops
timolol maleate ophthalmic
-
0.25 % drops
timolol maleate ophthalmic
-
0.5 % drops
timolol maleate ophthalmic
-
0.5 % solution
timolol maleate ophthalmic
-
0.25 % drops
timolol maleate ophthalmic
-
0.25 % drops
timolol maleate ophthalmic
-
0.25 % drops
timolol maleate ophthalmic
-
0.5 % drops
timolol maleate ophthalmic
-
0.5 % drops
timolol maleate ophthalmic
-
0.5 % drops
timolol maleate ophthalmic
-
0.25 % solution
timolol maleate ophthalmic
-
0.25 % drops
timolol maleate ophthalmic
-
0.5 % solution
timolol maleate ophthalmic
-
0.25 % drops
timolol maleate ophthalmic
-
0.5 % drops
timolol maleate ophthalmic
-
0.5 % drops
timolol maleate ophthalmic
-
0.5 % drops
timolol maleate ophthalmic
-
0.5 % drops
timolol maleate ophthalmic
-
0.5 % drops
timolol maleate ophthalmic
-
0.5 % drops
Timoptic ophthalmic (eye)
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0.5 % drops
Timoptic ophthalmic (eye)
-
0.5 % drops
Timoptic ophthalmic (eye)
-
0.25 % drops
timolol oral
-
20 mg tablet
timolol oral
-
10 mg tablet
timolol oral
-
5 mg tablet
timolol oral
-
10 mg tablet
Timoptic-XE ophthalmic (eye)
-
0.25 % solution

Copyright © 2010 First DataBank, Inc.

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Patient Handout

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Patient Education
timolol maleate ophthalmic

TIMOLOL SOLUTION-GEL - OPHTHALMIC

(TIE-moh-lohl)

COMMON BRAND NAME(S): Timoptic-XE

USES: This medication is used to treat high pressure inside the eye due to glaucoma (open angle-type) or other eye diseases (e.g., ocular hypertension). Lowering high pressure inside the eye helps to prevent blindness. This medication works by decreasing the amount of fluid within the eye. Timolol belongs to a class of drugs known as beta-blockers.

HOW TO USE: Read the Patient Information Leaflet provided by your pharmacist before you start using timolol and each time you get a refill. If you have any questions regarding the information, consult your doctor or pharmacist.This medication is for use in the eye(s), usually one drop in the affected eye(s) once a day, or as directed by your doctor.Apply other eye medications at least 10 minutes before timolol gel solution.To apply eye drops, wash your hands first. To avoid contamination, do not touch the dropper tip or let it touch your eye or any other surface.If you wear contact lenses, remove them before using the eye drops. Ask your doctor how long you should wait after using this medication before putting in your contact lenses.With the cap on tightly, turn the eye drop bottle upside down and shake once before each use. You do not need to shake the container more than once.Tilt your head back, look upward and pull down the lower eyelid to make a pouch. Hold the dropper directly over your eye and place one drop in your eye. Look downward and gently close your eyes for 1 to 2 minutes. Place one finger at the corner of your eye (near the nose) and apply gentle pressure. Try not to blink and do not rub your eye. This will prevent the medication from draining out. Repeat these steps for your other eye if so directed.Do not rinse the dropper. Replace the dropper cap after each use.Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time each day. Keep using this medication even if you feel well. Most people with glaucoma or high pressure in the eyes do not feel sick.

SIDE EFFECTS: Temporary blurred vision, temporary burning/stinging/itching/redness of the eye, watery eyes, dry eyes, feeling as if something is in the eye, or headache may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: dizziness, eye pain/swelling/discharge, slow/irregular heartbeat, muscle weakness, mental/mood changes, coldness/numbness/pain in the hands or feet, vision changes, unusual tiredness/weakness.Get medical help right away if you have any very serious side effects, including: trouble breathing, sudden unexplained weight gain, chest pain, weakness on one side of the body, trouble speaking, confusion, persistent dizziness, fainting.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: Before using timolol, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: lung disease (e.g., current or past history of asthma, severe chronic obstructive pulmonary disease), certain types of irregular heartbeats (e.g., sinus bradycardia, second or third degree AV block), certain types of heart disease (e.g., severe heart failure), kidney disease, liver disease, diabetes, low blood flow to the brain (cerebrovascular insufficiency), overactive thyroid disease, muscle weakness disorders, severe allergies.If you develop an eye infection or injury, or have eye surgery, check with your doctor about whether you should continue to use your current bottle of timolol. You may be advised to start using a new bottle.Before having surgery, tell your doctor or dentist that you are using this medication.If you have diabetes, this medication may prevent the fast/pounding heartbeat you would usually feel when your blood sugar level falls too low (hypoglycemia). Other symptoms of low blood sugar, such as dizziness and sweating, are unaffected by this drug.This drug may cause temporary blurred vision. Do not drive, use machinery, or do any activity that requires clear vision until you are sure you can perform such activities safely.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This drug passes into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: oral beta-blockers (such as propranolol), clonidine, certain antidepressants (including SSRIs such as fluoxetine), digoxin, epinephrine, fingolimod, methyldopa, quinidine.

OVERDOSE: This medicine may be harmful if swallowed. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: trouble breathing or slow/irregular heartbeat.

NOTES: Do not share this medication with others.Laboratory and/or medical tests (e.g., eye exams) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

STORAGE: Store at room temperature away from light and moisture. Avoid freezing. Do not store in the bathroom. Keep all medications away from children and pets.This product is normally colorless. Discard the solution if it changes color, becomes cloudy, or develops particles.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Information last revised September 2021. Copyright(c) 2021 First Databank, Inc.

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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Formulary

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Tier Description
1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.