Timolol ocular gel-forming eye drops
- Drugs List
- Therapeutic Indications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
Gel-forming eye drop solution containing timolol (as timolol maleate).
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
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
Third degree atrioventricular block
Uncontrolled cardiac failure
Precautions and Warnings
History of allergies including anaphylaxis
Chronic obstructive pulmonary disease
Ischaemic heart disease
Narrow angle glaucoma
Severe peripheral circulatory disorder
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 ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
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 https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Blurred vision (transient)
Burning and stinging of the eyes
Choroidal detachment (following filtration surgery)
Congestive cardiac failure
Decreased corneal sensitivity
Decreased exercise tolerance
Difficulty in micturition
Dryness and irritation of eyes
Exacerbation of psoriasis
Increase in antinuclear antibodies (ANA)
Loss of libido
Myasthenia gravis-like syndrome
Second and third degree AV block
Systemic lupus erythematosus
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 ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Last Full Review Date: July 2017.
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: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Timolol Last revised: 10 March 2015
Last accessed: 06 July 2017
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 06 July 2017
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Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.