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Timolol maleate + bendroflumethiazide oral


Oral formulations containing timolol maleate and bendroflumethiazide

Drugs List

  • timolol 10mg and bendroflumethiazide 2.5mg tablets
  • Therapeutic Indications





    The recommended dosage range is 1 to 4 tablets daily. The dosage can be taken in the morning or in two divided doses, morning and evening.

    If blood pressure control is not achieved on 4 tablets daily, consideration should be given to titrating timolol and bendroflumethiazide separately or adding another agent with hypotensive activity.


    Initiate treatment with one tablet daily and thereafter adjust according to response.

    Patients with Renal Impairment

    Use with caution in patients with renal impairment (mild to moderate). Monitor closely for hypokalaemia and changes in plasma electrolytes

    The Renal Drug Handbook (2014) states at glomerular filtration rate (GFR) below 10 ml/minute bendroflumethiazide is unlikely to work and that thiazide diuretics are unlikely to be of use once GFR below 30 ml/minute.

    The Renal Drug Handbook (2014) also recommends that in patients with GFR below 20 ml/minute that the treatment with timolol maleate should begin with the lowest dose and then be titrated according to patient response.


    Children under 18 years
    Addison's disease
    Cardiogenic shock
    Chronic obstructive pulmonary disease
    History of bronchospasm
    Metabolic acidosis
    Non-paced sinus node dysfunction
    Prinzmetal's angina
    Refractory hypokalaemia
    Second degree atrioventricular block
    Severe hepatic impairment
    Severe peripheral circulatory disorder
    Severe renal impairment
    Symptomatic hyperuricaemia
    Third degree atrioventricular block
    Uncontrolled cardiac failure
    Uncontrolled phaeochromocytoma

    Precautions and Warnings

    Disorder of fluid balance
    Bradycardia with pulse rate at rest < 50 beats per minute
    Diabetes mellitus
    Electrolyte imbalance
    First degree atrioventricular block
    Hepatic cirrhosis
    Hepatic impairment
    History of obstructive pulmonary disease
    History of psoriasis
    Intermittent claudication
    Ischaemic heart disease
    Myasthenia gravis
    Nephrotic syndrome
    Portal hypertension
    Raynaud's syndrome
    Renal impairment
    Systemic lupus erythematosus

    Advise diabetic patients that hypoglycaemic symptoms may be reduced/altered
    Control cardiac failure before starting treatment
    May exacerbate or activate systemic lupus erythematosus
    May mask symptoms of hyperthyroidism
    May mask symptoms of thyrotoxicosis
    May unmask the symptoms of myasthenia gravis
    Advise ability to drive/operate machinery may be affected by side effects
    Monitor fluid and electrolyte status
    Monitor for cardiac failure: if occurs withdraw gradually
    Monitor lung function in patients with respiratory disorders
    Monitor patients with existing or tendency towards diabetes mellitus
    Monitor renal function
    Reduce dose if bradycardia develops
    Beta blockers may reduce the response to adrenaline in anaphylaxis
    Consider slow discontinuation if dry eyes and skin rashes occur
    Excess consumption of liquorice may increase the risk of hypokalaemia
    May aggravate symptoms of peripheral arterial circulatory disorders
    May exacerbate psoriasis
    May increase sensitivity to/seriousness of allergic reactions
    May precipitate gout
    Do not withdraw this drug suddenly
    Gradually withdraw over 2 weeks

    The continued sympathetic effect of beta-blockade may result in cardiac failure. Monitor patients for evidence of cardiac failure, and if it occurs, treatment with beta blockers should be gradually withdrawn. If beta blocker treatment cannot be withdrawn then digitalisation and diuretic therapy should be considered.

    Pregnancy and Lactation


    Timolol maleate and bendroflumethiazide is contraindicated in pregnancy.

    Both constituents cross the placenta. Beta blockers reduce placental perfusion, which may result in immature/premature deliveries and intrauterine foetal death. Adverse effects (especially hypoglycaemia and bradycardia) may occur in the foetus and neonate. There is an increased risk of cardiac and pulmonary complications in the neonate in the postnatal period.
    Beta blockers can cause intrauterine growth restriction and reduced placental weight. Treatment beginning in the second trimester results in the greatest weight reductions. Treatment in the third trimester results in decreased weight of the placenta only. Although intrauterine growth restriction is a serious concern, the benefits to the mother might outweigh the risk to the foetus. Newborns exposed to beta blockers in utero must be observed for the first 48 hours after birth for bradycardia and other symptoms of beta blockade (Briggs, 2015).

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Timolol and bendroflumethiazide is contraindicated during breastfeeding.

    Both timolol and bendroflumethiazide pass into breast milk. The manufacturer does not recommend the use of this product during breastfeeding.

    Schaefer (2015) suggests that the use of beta blockers during breastfeeding is allowed. Consider changing therapy to one of the preferred beta blockers (metoprolol, oxprenolol, pindolol, propranolol, labetalol). Infants exposed to timolol via breast milk should be monitored for signs of beta blockade (Briggs, 2015).

    LactMed notes that if bendroflumethiazide is required by the mother, it is not a reason to discontinue breastfeeding. LactMed also suggests that due to the variability in excretion of timolol into breast milk, other agents may be preferred, especially while nursing a newborn or preterm infant.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Aggravation of angina
    Aggravation of pre-existing myopia
    Allergic dermatitis
    Atrioventricular block
    Blood dyscrasias
    Blood urea increased
    Cardiac failure
    Cold extremities
    Dry eyes
    Erectile dysfunction
    Erythematous rash
    Exacerbation of intermittent claudication
    Exacerbation of psoriasis
    Exacerbation of Raynaud's disease
    Exacerbation of systemic lupus erythematosus
    Fluid and electrolyte disturbances
    Impaired vision
    Increase in antinuclear antibodies (ANA)
    Muscle pain
    Necrotising vasculitis
    Psoriasiform rash
    Retroperitoneal fibrosis
    Withdrawal symptoms


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: January 2017

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Summary of Product Characteristics: timolol maleate/bendroflumethiazide. Beechmere Pharmaceuticals Ltd. Revised June 2015.

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Bendroflumethiazide. Last revised: March 10, 2015
    Last accessed: January 13, 2017

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Timolol. Last revised: March 10, 2015
    Last accessed: January 13, 2017

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