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Timolol ocular gel

Updated 2 Feb 2023 | Beta-blockers (in glaucoma)


Preservative free eye gel containing timolol

Drugs List

  • timolol 0.1% eye drops gel preservative-free
  • TIOPEX 0.1% eye drops gel preservative-free
  • Therapeutic Indications


    Treatment of elevated intraocular pressure in ocular hypertension
    Treatment of elevated intraocular pressure in open-angle glaucoma



    Instil one drop of eye gel in the affected eye(s) daily, preferably in the morning.


    Instil one drop of eye gel in the affected eye(s) daily, preferably in the morning.


    Timolol is not licensed in children under 18 years. Glaucoma is rare in children and patients should be under the care of a specialist.

    The following unlicensed dose may be suitable:
    Instil one drop of eye gel in the affected eye(s) daily, preferably in the morning.

    Additional Dosage Information

    Transfer from other beta-blocker eye drops
    When transferring a patient from other topical beta-blocking agents to timolol eye gel drops, discontinue the previous product after a full day of therapy and start treatment with the timolol eye gel drops the next morning.

    Transfer from a single anti-glaucoma agent other than a topical beta-blocking agent
    Continue the agent and instil one drop of 0.1% eye gel timolol maleate in each affected eye once a day, preferably in the morning. Discontinue the previous agent on the following day and continue with timolol eye gel drops.


    Cardiac failure
    Cardiogenic shock
    Corneal disorder
    History of asthma
    History of obstructive pulmonary disease
    Non-paced sinus node dysfunction
    Second degree atrioventricular block
    Severe chronic obstructive pulmonary disease
    Sinus bradycardia
    Third degree atrioventricular block
    Uncontrolled cardiac failure

    Precautions and Warnings

    Children under 18 years
    Wearing of contact lenses
    Cardiovascular disorder
    Chronic obstructive pulmonary disease
    Diabetes mellitus
    First degree atrioventricular block
    Ischaemic heart disease
    Metabolic acidosis
    Myasthenia gravis
    Narrow angle glaucoma
    Prinzmetal's angina
    Severe allergic rhinitis
    Severe peripheral circulatory disorder
    Uncontrolled phaeochromocytoma

    Advise diabetic patients that hypoglycaemic symptoms may be reduced/altered
    Control cardiac failure before starting treatment
    Give concurrent miotic treatment if used to treat narrow angle glaucoma
    May mask symptoms of hyperthyroidism
    May unmask the symptoms of myasthenia gravis
    Advise ability to drive/operate machinery may be affected by side effects
    Children under 18: Treatment to be initiated/supervised by a specialist
    In combined therapy, administer eye products at least five minutes apart
    To reduce systemic absorption compress lacrimal sac during administration
    Assess intra-ocular pressure about 4 weeks after starting treatment
    Examine cornea regularly
    Monitor intra-ocular pressure
    Monitor patient with history of severe cardiac disease for signs of failure
    Monitor pulse rates in patients with potential for cardiac failure
    Beta blockers may reduce the response to adrenaline in anaphylaxis
    Consider slow discontinuation if dry eyes and skin rashes occur
    Increased risk of choroidal detachment with use post filtration procedures
    Seek doctor's advice if intercurrent ocular condition develops
    Systemic absorption & adverse effects of systemic beta blockers may occur
    Consider gradual withdrawal of treatment prior to general anaesthesia
    Do not withdraw this drug suddenly
    Discontinue at the first signs of cardiac failure
    Possibly withdraw treatment if dry eyes and/or skin rash occur
    Not licensed for use in children under 18 years
    Advise contact lens wearers of possibility of reduced lacrimation
    Advise patient to avoid touching the eye/other surfaces with container tip
    Remove contact lenses before use and re-insert 15 minutes after use

    Pregnancy and Lactation


    Use timolol eye drops with caution in pregnancy.

    Studies have not shown malformations with systemic beta-blockers but intra-uterine growth retardation and reduced placental weight has occurred. Pharmacological effects have been seen in the neonate when administered up to delivery such as bradycardia, hypotension, respiratory distress and hypoglycaemia. Monitor the babies first few days of life for bradycardia and other symptoms of beta-blocker exposure if this product is used up to delivery.

    If, after careful consideration of the risks involved, timolol eye gel is used during pregnancy, it is advisable to consider lacrimal sac compression and removal of any excess on the skin with a tissue.

    With systemic beta-blockers the baby may show a decreased heart rate, hypoglycaemia and respiratory problems, particularly in preterm neonates. However these are less likely to occur with topical use.

    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 ( ).


    Use timolol eye drops with caution in breastfeeding.

    Beta-blockers are excreted into breast milk, however it is not likely with this product that adequate quantities would be present in breastmilk to produce signs of beta-blockade in the infant. Hale states untoward effects on the infant have not been reported, and confirms the levels in the milk are probably too small to be clinically relevant. However if any sedation or weakness occurs medical advice should be sought.

    If timolol eye gel is used during breastfeeding it is advisable to consider lacrimal sac compression and removal of any excess on the skin with a tissue.

    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


    Advise patient to wash their hands prior to use.

    Avoid contamination of the dropper as this may cause infection of the eye.

    Advise patient to take other eye drops 5 minutes apart and then wait another 15 minutes after the last other eye preparation before administering timolol eye gel.

    Patient should use the single-dose eye gel container once only and discard immediately after administering the dose, the container has enough gel to treat both eyes.

    Advise patient to put pressure on the tearduct in the corner of the eye (compression of the lacrimal sac) and for two minutes afterwards, which may help to reduce systemic absorption and increase the local effect.

    Advise patients to inform their doctor about their treatment if they develop another ocular condition.

    Athletes should be warned that this drug contains an active substance which may induce a positive analytical result in anti-doping controls.

    These eye drops may cause slight blurring of vision when the medicine is in the eye, wait until this goes away before resuming normal activities.

    Side Effects

    Angina pectoris
    Blurred vision (transient)
    Burning and stinging of the eyes
    Cardiac arrest
    Cerebral ischaemia
    Cerebrovascular accident
    Chest pain
    Choroidal detachment (following filtration surgery)
    Cold extremities
    Congestive cardiac failure
    Conjunctival hyperaemia
    Decreased corneal sensitivity
    Decreased exercise tolerance
    Difficulty in micturition
    Dry mouth
    Dryness and irritation of eyes
    Exacerbation of psoriasis
    Exfoliative dermatitis
    Extremity pain
    Heart block
    Hypersensitivity reactions
    Impaired concentration
    Increase in antinuclear antibodies (ANA)
    Increased dreaming
    Loss of libido
    Memory loss
    Myasthenia gravis-like syndrome
    Nasal congestion
    Non-thrombocytopenic purpura
    Ocular discharge
    Ocular itching
    Peyronie's disease
    Psoriasiform rash
    Pulmonary oedema
    Raynaud's phenomenon
    Refractive changes
    Respiratory failure
    Second and third degree AV block
    Sexual dysfunction
    Sino-atrial block
    Systemic lupus erythematosus
    Visual disturbances
    Worsening of arterial insufficiency


    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: April 2014

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

    Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.

    Summary of Product Characteristics: Tiopex 0.1% eye gel, Spectrum Thea, April 2012.

    NICE Evidence Services Available at: Last accessed: 09 April 2014.

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Timolol, Last revised: September 7, 2013.
    Last accessed: April 9, 2014.

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