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Timolol ocular gel-forming eye drops

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


Gel-forming eye drop solution containing timolol (as timolol maleate).

Drugs List

  • timolol 0.25% gel-forming eye drops
  • timolol 0.5% gel-forming eye drops
  • TIMOPTOL LA 0.25% gel-forming eye drops
  • TIMOPTOL LA 0.5% gel-forming eye drops
  • Therapeutic Indications


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



    Instil 1 drop of the 0.25% solution into the affected eye(s) once a day, increasing to the 0.5% solution if 0.25% dose is insufficient.

    Transfer from timolol eye drops to timolol gel-forming eye drops
    Start treatment of timolol gel-forming eye drops 24 hours after last dose of timolol eye drops.

    Transfer from another topical beta blocking agent
    Start treatment of 0.25% timolol gel-forming eye drops 24 hours after last dose of other topical beta blocking agent, increasing to 0.5% if 0.25% dose is insufficient.

    Transfer from a single anti-glaucoma medication other than a topical beta-blocking agent
    Continue the medication and instil 1 drop of 0.25% timolol gel-forming eye drops into the affected eye(s) once a day. Discontinue the previous medication on the following day and continue with the timolol gel-forming eye drops, increasing to 0.5% if the 0.25% dose is insufficient.


    Unlicensed alternative use in children under 18 years
    Instil 1 drop into the affected eye(s) once a day.


    Children under 18 years
    Wearing of contact lenses
    Cardiogenic shock
    History of asthma
    History of obstructive pulmonary disease
    Non-paced sinus node dysfunction
    Second degree atrioventricular block
    Severe chronic obstructive pulmonary disease
    Sinoatrial exit block
    Sinus bradycardia
    Third degree atrioventricular block
    Uncontrolled cardiac failure

    Precautions and Warnings

    History of allergies including anaphylaxis
    Cardiac failure
    Cardiovascular disorder
    Chronic obstructive pulmonary disease
    Corneal disorder
    Diabetes mellitus
    Ischaemic heart disease
    Myasthenia gravis
    Narrow angle glaucoma
    Prinzmetal's angina
    Severe peripheral circulatory disorder
    Uncontrolled phaeochromocytoma

    Advise diabetic patients that hypoglycaemic symptoms may be reduced/altered
    Anaesthetist should be made aware patient is taking this medication
    Control cardiac failure before starting treatment
    May mask symptoms of hyperthyroidism
    May unmask the symptoms of myasthenia gravis
    Advise ability to drive/operate machinery may be affected by side effects
    Contains benzododecinium bromide
    In combined therapy, administer eye products at least 10 minutes apart
    To reduce systemic absorption compress lacrimal sac during administration
    Assess intra-ocular pressure about 4 weeks after starting treatment
    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
    Seek doctor's advice if intercurrent ocular condition develops
    Systemic absorption & adverse effects of systemic beta blockers may occur
    Do not withdraw this drug suddenly
    Possibly withdraw treatment if dry eyes and/or skin rash occur
    Advise patient to avoid touching the eye/other surfaces with container tip

    Pregnancy and Lactation


    Use timolol eye drops with caution in pregnancy.

    Studies involving the systemic use of beta blockers did not indicate malformative effects, but some pharmacological effects such as bradycardia have been observed in foetuses and neonates. Systemic use of some beta-blockers can cause intra-uterine growth retardation (IUGR) and reduced placental weight. The use of timolol eye drops during pregnancy has been reported to cause foetal bradycardia.

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

    Any infant, exposed in utero to timolol eye drops should be monitored closely after birth for bradycardia and other symptoms.

    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 gel-forming eye drops with caution in breastfeeding.

    Timolol is excreted into breast milk. Both oral and ophthalmic drops produce modest levels in milk. In one case report, a woman with elevated intraocular pressure applied ophthalmic 0.5% timolol drops to one eye twice daily, resulting in excretion of the drug in her breast milk. Most authorities consider that the levels seen were below the daily dose that would be below that expected to produce cardiac effects in the infant.

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

    Infants exposed to timolol via breast milk should be closely observed for hypotension, weakness, hypoglycaemia, sedation, depression, bradycardia and other signs or symptoms of beta blockade.

    The manufacturer notes that a decision should be made whether to stop treatment whilst breastfeeding or cease breastfeeding and continue with treatment.

    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

    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
    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: July 2017.

    Reference Sources

    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.

    Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

    Summary of Product Characteristics: Timoptol LA 0.25% and 0.5% w/v Gel-Forming Eye Drops Solution. Santen UK Limited. July 2015.

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Timolol Last revised: 10 March 2015
    Last accessed: 06 July 2017

    NICE Evidence Services Available at: Last accessed: 06 July 2017

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