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

Contraindications

Children under 18 years
Sinus node dysfunction
Asthma
Breastfeeding
Cardiogenic shock
History of asthma
Non-paced second degree atrioventricular block
Non-paced third degree atrioventricular block
Pregnancy
Severe chronic obstructive pulmonary disease
Sinoatrial exit block
Sinus bradycardia
Uncontrolled cardiac failure

Precautions and Warnings

Atopy
History of allergies including anaphylaxis
Predisposition to iritis
Predisposition to uveitis
Risk factors for cystoid macular oedema
Wearing of contact lenses
Aphakia
Cardiac failure
Cardiovascular disorder
Chronic obstructive pulmonary disease
Corneal disorder
Diabetes mellitus
First degree atrioventricular block
Herpetic keratitis
History of herpes simplex keratitis
Hyperthyroidism
Hypotension
Inflammatory glaucoma
Ischaemic heart disease
Myasthenia gravis
Narrow angle glaucoma
Neovascular glaucoma
Pigmentary glaucoma
Prinzmetal's angina
Pseudophakia with open angle glaucoma
Pseudophakia with torn posterior lens capsule
Raynaud's syndrome
Severe peripheral circulatory disorder
Severe Raynaud's syndrome
Spontaneous hypoglycaemia

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 patient blurred vision may affect ability to drive/operate machinery
Contains benzalkonium chloride
Contains polyoxyethylene hydrogenated castor oil; may cause skin reactions
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 intra-ocular pressure
Monitor patient with history of severe cardiac disease for signs of failure
Monitor patients with cardiac disorders
Advise patient of possible change in eye colour
Advise patient that some eye changes may be permanent
Beta blockers may reduce the response to adrenaline in anaphylaxis
Increased risk of choroidal detachment with use post filtration procedures
Systemic absorption & adverse effects of systemic beta blockers may occur
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
Remove contact lenses before use and re-insert 15 minutes after use

Preserved formulations contain benzalkonium chloride, which may cause eye irritation and may discolour soft contact lenses.

Preservative-free formulation contains macrogolglycerol hydroxystearate (castor oil polyoxyl hydrogenated) which may cause skin irritation.

Pregnancy and Lactation

Pregnancy

The combination of timolol with latanoprost is contraindicated in pregnancy.

Timolol
Systemic use of beta blockers shows a risk of intrauterine growth retardation (IUGR) and use near delivery has seen symptoms of beta blockade (e.g. bradycardia, hypotension, respiratory distress and hypoglycaemia) in the neonate, hence close monitoring is needed during the first days of life.

Latanoprost
There is limited information available but neither human nor animal experiences suggest any significant risk to the embryo-foetus.

Lactation

The combination of timolol with latanoprost is contraindicated in breastfeeding.

The manufacturer notes a decision should be made whether to cease breastfeeding or stop taking the medication.

Timolol
Timolol is excreted into breast milk but at therapeutic doses for eye drops it is unlikely that sufficient amounts will produce symptoms of beta blockade in the infant. 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.

Latanoprost
Latanoprost and its metabolites may pass into breast milk but plasma concentrations are probably very low.

Side Effects

Abdominal pain
Aggravation of angina
Aggravation of existing asthma
Allergic reaction
Alopecia
Anaphylactic reaction
Angioedema
Arrhythmias
Arthralgia
Asthenia
Asthma
Atrioventricular block
Blepharitis
Blurred vision (transient)
Bradycardia
Bronchospasm
Brown pigmentation of iris
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
Conjunctivitis
Corneal disorders
Corneal erosion
Corneal oedema
Cough
Darkening of the palpebral skin
Darkening, thickening and lengthening of eye lashes
Darkening, thickening and lengthening of vellus hair
Decreased corneal sensitivity
Depression
Diarrhoea
Diplopia
Distichiasis
Dizziness
Dry eyes
Dry mouth
Dysgeusia
Dyspepsia
Dyspnoea
Erythema
Exacerbation of myasthenia gravis
Exacerbation of pre-existing asthma
Exacerbation of psoriasis
Eyelid oedema
Eyelid reaction
Fatigue
Headache
Hypoglycaemia
Hypotension
Increased iris pigmentation
Increased lacrimation
Insomnia
Iris cyst
Iritis
Joint pain
Keratitis
Macular oedema
Memory loss
Misdirected eyelash growth
Muscle pain
Myalgia
Nasopharyngitis
Nausea
Nightmares
Ocular grittiness
Ocular hyperaemia
Ocular irritation
Ocular itching
Ocular pain
Oedema
Palpitations
Paraesthesia
Periorbital oedema
Photophobia
Pruritus
Pseudopemphigoid of ocular conjunctiva
Psoriasiform rash
Ptosis
Punctate epithelial erosions of eye (transient)
Pyrexia
Rash
Raynaud's phenomenon
Reduced libido
Refractive changes
Sensation of foreign body in eye
Syncope
Tearing
Tinnitus
Urticaria
Uveitis
Visual disturbances
Vomiting

Presentation

Eye drops containing timolol maleate and latanoprost preservative containing and 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

Contraindications

Children under 18 years
Sinus node dysfunction
Asthma
Breastfeeding
Cardiogenic shock
History of asthma
Non-paced second degree atrioventricular block
Non-paced third degree atrioventricular block
Pregnancy
Severe chronic obstructive pulmonary disease
Sinoatrial exit block
Sinus bradycardia
Uncontrolled cardiac failure

Precautions and Warnings

Atopy
History of allergies including anaphylaxis
Predisposition to iritis
Predisposition to uveitis
Risk factors for cystoid macular oedema
Wearing of contact lenses
Aphakia
Cardiac failure
Cardiovascular disorder
Chronic obstructive pulmonary disease
Corneal disorder
Diabetes mellitus
First degree atrioventricular block
Herpetic keratitis
History of herpes simplex keratitis
Hyperthyroidism
Hypotension
Inflammatory glaucoma
Ischaemic heart disease
Myasthenia gravis
Narrow angle glaucoma
Neovascular glaucoma
Pigmentary glaucoma
Prinzmetal's angina
Pseudophakia with open angle glaucoma
Pseudophakia with torn posterior lens capsule
Raynaud's syndrome
Severe peripheral circulatory disorder
Severe Raynaud's syndrome
Spontaneous hypoglycaemia

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 patient blurred vision may affect ability to drive/operate machinery
Contains benzalkonium chloride
Contains polyoxyethylene hydrogenated castor oil; may cause skin reactions
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 intra-ocular pressure
Monitor patient with history of severe cardiac disease for signs of failure
Monitor patients with cardiac disorders
Advise patient of possible change in eye colour
Advise patient that some eye changes may be permanent
Beta blockers may reduce the response to adrenaline in anaphylaxis
Increased risk of choroidal detachment with use post filtration procedures
Systemic absorption & adverse effects of systemic beta blockers may occur
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
Remove contact lenses before use and re-insert 15 minutes after use

Preserved formulations contain benzalkonium chloride, which may cause eye irritation and may discolour soft contact lenses.

Preservative-free formulation contains macrogolglycerol hydroxystearate (castor oil polyoxyl hydrogenated) which may cause skin irritation.

Pregnancy and Lactation

Pregnancy

The combination of timolol with latanoprost is contraindicated in pregnancy.

Timolol
Systemic use of beta blockers shows a risk of intrauterine growth retardation (IUGR) and use near delivery has seen symptoms of beta blockade (e.g. bradycardia, hypotension, respiratory distress and hypoglycaemia) in the neonate, hence close monitoring is needed during the first days of life.

Latanoprost
There is limited information available but neither human nor animal experiences suggest any significant risk to the embryo-foetus.

Lactation

The combination of timolol with latanoprost is contraindicated in breastfeeding.

The manufacturer notes a decision should be made whether to cease breastfeeding or stop taking the medication.

Timolol
Timolol is excreted into breast milk but at therapeutic doses for eye drops it is unlikely that sufficient amounts will produce symptoms of beta blockade in the infant. 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.

Latanoprost
Latanoprost and its metabolites may pass into breast milk but plasma concentrations are probably very low.

Side Effects

Abdominal pain
Aggravation of angina
Aggravation of existing asthma
Allergic reaction
Alopecia
Anaphylactic reaction
Angioedema
Arrhythmias
Arthralgia
Asthenia
Asthma
Atrioventricular block
Blepharitis
Blurred vision (transient)
Bradycardia
Bronchospasm
Brown pigmentation of iris
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
Conjunctivitis
Corneal disorders
Corneal erosion
Corneal oedema
Cough
Darkening of the palpebral skin
Darkening, thickening and lengthening of eye lashes
Darkening, thickening and lengthening of vellus hair
Decreased corneal sensitivity
Depression
Diarrhoea
Diplopia
Distichiasis
Dizziness
Dry eyes
Dry mouth
Dysgeusia
Dyspepsia
Dyspnoea
Erythema
Exacerbation of myasthenia gravis
Exacerbation of pre-existing asthma
Exacerbation of psoriasis
Eyelid oedema
Eyelid reaction
Fatigue
Headache
Hypoglycaemia
Hypotension
Increased iris pigmentation
Increased lacrimation
Insomnia
Iris cyst
Iritis
Joint pain
Keratitis
Macular oedema
Memory loss
Misdirected eyelash growth
Muscle pain
Myalgia
Nasopharyngitis
Nausea
Nightmares
Ocular grittiness
Ocular hyperaemia
Ocular irritation
Ocular itching
Ocular pain
Oedema
Palpitations
Paraesthesia
Periorbital oedema
Photophobia
Pruritus
Pseudopemphigoid of ocular conjunctiva
Psoriasiform rash
Ptosis
Punctate epithelial erosions of eye (transient)
Pyrexia
Rash
Raynaud's phenomenon
Reduced libido
Refractive changes
Sensation of foreign body in eye
Syncope
Tearing
Tinnitus
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: February 2109

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: Fixapost 50micrograms/ml + 5mg/ml eye drops, solution in single-dose container. Laboratoires THEA. Revised May 2018.

Summary of Product Characteristics: Medox 50micrograms/ml + 5mg/ml eye drops, solution. Medicom Healthcare Ltd. Revised October 2018.

Summary of Product Characteristics: Xalacom eye drops, solution. Pfizer Ltd. Revised September 2018.