Timolol with bimatoprost ocular preservative-free
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Eye drops containing timolol and bimatoprost preservative-free.
Drugs List
Therapeutic Indications
Uses
Elevated IOP in ocular hypertension when beta blocker alone insufficient
Elevated IOP in open-angle glaucoma when beta blocker alone is insufficient
Dosage
Adults
Instil one drop into the affected eye(s) once daily, administered either in the morning or in the evening. Administer at the same time each day.
Additional Dosage Information
If a dose is missed, treatment should be continued with the next dose as planned. Do not exceed one drop in the affected eye(s) daily.
Contraindications
Children under 18 years
Asthma
Breastfeeding
Cardiogenic shock
History of asthma
Second degree atrioventricular block
Severe chronic obstructive pulmonary disease
Sinoatrial exit block
Sinus bradycardia
Third degree atrioventricular block
Uncontrolled cardiac failure
Precautions and Warnings
Atopy
History of allergies including anaphylaxis
Risk factors for cystoid macular oedema
Aphakia
Cardiac failure
Cardiovascular disorder
Chronic obstructive pulmonary disease
Corneal disorder
First degree atrioventricular block
Hepatic impairment
Hyperthyroidism
Hypotension
Ischaemic heart disease
Myasthenia gravis
Ocular inflammation
Pregnancy
Prinzmetal's angina
Pseudophakia with torn posterior lens capsule
Renal impairment
Severe peripheral circulatory disorder
Spontaneous hypoglycaemia
Uncontrolled diabetes mellitus
Uveitis
Advise diabetic patients that hypoglycaemic symptoms may be reduced/altered
Control cardiac failure before starting treatment
May mask symptoms of hyperthyroidism
May unmask the symptoms of myasthenia gravis
Advise patient blurred vision may affect ability to drive/operate machinery
Some formulations may contain traces of silver - risk of hypersensitivity
Advise patient hair growth may occur on areas of skin repeatedly exposed
In combined therapy, administer eye products at least five minutes apart
To reduce systemic absorption compress lacrimal sac during administration
Monitor for changes to iris pigmentation regularly
Monitor patient with history of severe cardiac disease for signs of failure
Advise patient that some eye changes may be permanent
Beta blockers may reduce the response to adrenaline in anaphylaxis
Systemic absorption & adverse effects of systemic beta blockers may occur
Consider gradual withdrawal of treatment prior to general anaesthesia
Advise patient to avoid touching the eye/other surfaces with container tip
Before initiating treatment inform patient of possibility of eyelash growth
Before initiating treatment inform patient of risk of eyelid skin darkening
Before starting treatment inform patient of risk of increased iris pigment
Pregnancy and Lactation
Pregnancy
Use bimatoprost and timolol eye drops with caution during pregnancy.
The manufacturer recommends this medication is not used during pregnancy unless the potential benefit to the mother outweighs the potential risk to the foetus. At the time of writing there is limited human data available. Risks are unknown.
Bimatoprost
Animal studies show reproductive toxicity at high maternotoxic doses.
Timolol
Malformative effects have not been shown in epidermiological studies, however an increased risk of intra uterine growth retardation has been linked to beta-blockers taken orally. Beta-blockade symptoms have also been observed in the neonate.
Animal studies show reproductive toxicity at doses much higher than would be used.
Lactation
Bimatoprost and timolol eye drops is contraindicated during breastfeeding.
The manufacturer confirms that this medication should not be used during breastfeeding.
At the time of writing there is limited published experience concerning the use of bimatoprost and timolol eye drops during breastfeeding.
Bimatoprost
It is not know if bimatoprost is excreted in human breast milk. However, it is excreted in the milk of lactating rats.
Timolol
Timolol is excreted in breast milk, however ophthalmic use should pose little risk to a breastfed infant.
Side Effects
Abdominal pain
Abnormal liver function tests
Allergic conjunctivitis
Allergic reaction
Alopecia
Anaphylaxis
Angioedema
Arrhythmias
Asthenia
Asthenopia
Atrioventricular block
Blepharal pigmentation
Blepharitis
Blepharospasm
Blurred vision (transient)
Bradycardia
Bronchospasm
Burning and stinging of the eyes
Cardiac arrest
Cardiac failure
Cerebral ischaemia
Cerebrovascular accident
Chest pain
Choroidal detachment (following filtration surgery)
Cold extremities
Congestive cardiac failure
Conjunctival hyperaemia
Conjunctival oedema
Corneal erosion
Cough
Cystoid macular oedema
Decreased corneal sensitivity
Depression
Diarrhoea
Diplopia
Dizziness
Dry eyes
Dry mouth
Dysgeusia
Dyspepsia
Dyspnoea
Epiphora
Erythema
Exacerbation of myasthenia gravis
Exacerbation of pre-existing asthma
Exacerbation of psoriasis
Eyelash darkening
Eyelash growth
Eyelid erythema
Eyelid oedema
Eyelid pain
Eyelid pruritus
Eyelid retraction
Eyelid sulcus
Fatigue
Hallucinations
Headache
Hirsutism
Hypertension
Hypoglycaemia
Hypotension
Increased iris pigmentation
Insomnia
Iritis
Keratitis
Memory loss
Myalgia
Nausea
Nightmares
Ocular discharge
Ocular irritation
Ocular pain
Ocular pruritus
Oedema
Palpitations
Paraesthesia
Periorbital skin pigmentation
Photophobia
Pruritus
Psoriasiform rash
Ptosis
Rash
Raynaud's phenomenon
Reduced libido
Reduced visual acuity
Retinal haemorrhage
Rhinitis
Sensation of foreign body in eye
Sexual dysfunction
Superficial punctate keratitis
Syncope
Trichiasis
Urticaria
Uveitis
Visual disturbances
Vomiting
Overdosage
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 ).
Further Information
Last Full Review Date: October 2019.
Reference Sources
Summary of Product Characteristics: Eyzeetan 0.3mg/ml + 5mg/ml eye drops, solution. Aspire Pharma Limited. January 2020.
Summary of Product Characteristics: Ganfort 0.3mg/ml + 5mg/ml eye drops, solution in single-dose container. Allergan Ltd. Revised July 2019.
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.