Timolol

Timolol is a beta-blocker eye drop medication that helps treat increased eye pressure and glaucoma to help prevent blindness.

Overview:

Timolol belongs to the class of drugs known as beta-blockers. It’s available in the form of eye drops which help to treat increased eye pressure and glaucoma. Timolol works by reducing fluid production in the eye, thereby reducing the pressure inside the eye. It can take up to a month for the medication to lower the eye pressure to a reasonable level.

Your doctor may suggest Timolol for disorders other than those mentioned in this article. In addition, some forms of Timolol may not be taken for all the conditions covered here. If you haven’t talked about this with your physician or you're not sure why you should use Timolol, talk to him or her. Don’t stop using Timolol without consulting your physician.

Don’t give anyone else Timolol, even if they have symptoms similar to yours. It may be harmful to use Timolol if your doctor hasn’t prescribed it.

Each millimeter of clear, colorless or light yellow, isotonic, buffered, aqueous, sterile ophthalmic solution has timolol maleate, which is equivalent to 5 mg of Timolol. Non-medicinal ingredients include 0.01% benzalkonium (as a preservative), sodium hydroxide (for adjusting PH), water (for injection), and dibasic and monobasic sodium phosphate.

Timolol isn’t suitable for the following patients:

  • People who are allergic to the medication’s ingredients
  • People with chronic obstructive pulmonary disease (COPD), or asthma (present and past)
  • People with heart failure, heart block, or an abnormally slow heartbeat
  • People with severe heart issues that have put them into shock
  • People currently using a different beta-blocker medication on the eyes, for example betaxolol
  • Elderly people suffering from a heart condition known as sick sinus syndrome due to poor management of the functioning of the heart

There are several conditions that can be affected by Timolol drops. Therefore, you must inform your doctor and pharmacist if you have any underlying medical problems. So, let them know if you:

  • Are pregnant, trying to conceive, or nursing
  • Are taking any medicine, be it prescription, nonprescription, supplemental, or herb
  • Have an eye infection or injury, double vision, a drooping eyelid, or narrow-angle glaucoma
  • Have allergies to any ingredient
  • Have had pulmonary conditions before

There are also several medications that may interact with Timolol. Although you should always inform your healthcare giver about any drug you use, it’s especially important if you’re currently taking the following medications:

  • Insulin or oral antidiabetics—these can increase the risk of low blood sugar or slow heart rate
  • Clonidine—this could raise your blood pressure
  • Selective serotonin re-uptake inhibitors like digoxin, fluoxetine, reserpine, cimetidine, ketanserin; certain antiarrhythmics like flecainide, disopyramide, and quinidine; as well as calcium channel blockers such as bupivacaine, and verapamil—these medications can cause low blood pressure as well as heart problems like heart failure, slow heartbeat, and conduction problems.
  • Alpha-blockers (oral beta blockers, or other beta blocker ophthalmic solutions)—these drugs can increase the risk of suffering side effects.
  • Sympathomimetics like albuterol, theophylline, epinephrine, or salmeterol – these medications can become less effective if used with Timolol.

Conditions treated:

  • Glaucoma
  • Ocular hypertension (increased eye pressure)

Type of medicine:

  • Beta-blocker

Side effects:

Like all medications, Timolol may cause side effects but not everyone experiences them.

You can usually continue taking the eye drops unless the side effects are severe. If you’re concerned, speak to your doctor/pharmacist. Don’t stop using this drug without discussing with your doctor.

If you suffer a rare serious allergic reaction to Timolol, like difficulty breathing, swelling of lips, face, or tongue, closed throat, or hives, stop using Timolol and contact your physician right away.

Like other medications applied into the eyes, Timolol gets absorbed into the blood. This can cause the same side effects as those seen with oral and intravenous beta-blocking agents. There’s a lower frequency of side effects following topical ophthalmic application than when the medications are injected or taken by mouth, for example.

Check with your physician right away if you suffer any of these effects while using Timolol eye drops.

More common:

  • Burning/stinging in the eye
  • Blurred vision

Less common:

  • Back, arm, or jaw pain
  • Hives, welts, itching, or blisters
  • Blue fingernails, skin, or lips
  • Burning, itching, prickling, numbness, crawling, tingling, or “pins and needles” feeling
  • Chest pain/discomfort
  • Change in vision
  • Depression
  • Chest heaviness or tightness
  • Confusion about time, place, and identity
  • Difficult, noisy, or fast breathing
  • Continuing buzzing, ringing, or other odd noise in ears
  • Dilated neck veins
  • Disturbed color perception
  • Coughing that occasionally produces pink frothy sputum
  • Difficulty with talking, chewing, or swallowing
  • Excessive tearing, discharge
  • Double vision
  • Lightheadedness, faintness, or dizziness when rising from a sitting/lying position
  • Dry/itching eyelids
  • Drooping eyelids
  • Extreme fatigue
  • Fear or nervousness
  • False state of well-being
  • Slow, fast, racing, pounding, or irregular heartbeat or pulse
  • Chills and fever
  • Feeling of having foreign matter in the eye
  • Hair loss
  • Headache
  • Floaters in vision, flashes of light
  • General feeling of illness or discomfort
  • Inability to speak
  • Halos around light
  • Increased sweating
  • Fast or slow, irregular, or shallow breathing
  • Mood swings
  • Memory loss
  • Dizziness, fainting, or lightheadedness
  • Large, swelling on the lips, face, eyelids, throat, tongue, legs, feet, hands, or genitals
  • Loss of vision
  • Joint/muscle pain
  • Muscle weakness
  • Nausea
  • No pulse or blood pressure
  • Night blindness
  • Lights appearing too bright
  • Pale skin
  • Pain, weakness, and tension when walking that eases when resting
  • Cold or paleness in the fingertips, hands, feet, and toes
  • Pounding in ears
  • Personality changes
  • Redness of skin
  • Swelling or puffiness around the eyes, in the eyelids, lips, face, or tongue
  • Swelling, pain, irritation, or redness of the eyelid, eye, or inner eyelid lining
  • Feeling, seeing, or hearing things that aren’t there
  • Sore throat
  • Seizures
  • Severe tiredness
  • Sweating
  • Stopping of heart
  • Slurred speech
  • Sudden or severe headache
  • Severe numbness, particularly on one side of face or body
  • Severe tiredness
  • Skin rash or irritation, including psoriasis-like rash
  • Swelling of the fingers, feet, ankles, lower legs, and face
  • Swollen glands
  • Temporary blindness
  • Tunnel vision
  • Pain/tingling in the toes or fingers during cold weather
  • Unconsciousness
  • Weight gain
  • Unusual weakness or tiredness
  • Sudden or severe weakness in the leg or arm on one side

Some Timolol side effects that usually don’t require treatment may occur. These may disappear during treatment while the body adapts to Timolol. Check with your physician if the following effects persist, trouble you or if you’ve got queries about them.

Less common:

  • Diarrhea
  • Acid/sour stomach
  • Hearing loss
  • Dry mouth
  • Belching
  • Pain or body aches
  • Ear congestion
  • Indigestion
  • Loss or lack of strength
  • Heartburn
  • Loss of voice
  • Loss of appetite
  • Runny nose
  • Nightmares
  • Unusual drowsiness
  • Sneezing
  • Stuffy nose
  • Weight loss
  • Stomach upset, discomfort, or pain
  • Trouble sleeping

Dosage:

Always take Timolol exactly as ordered by your doctor. If you’re unsure, check with your doctor/pharmacist.

The standard starting Timolol dose is a single drop of 0.25% Timolol into the affected eye(s) two times a day, about 12 hours apart. If you’re using Timolol with another ophthalmic solution, wait five to 15 minutes before you apply the next eye drop.

For children, a detailed assessment should be done before administering Timolol. Your physician will carefully weigh the benefits and risks when considering Timolol treatment. If the benefits are greater than the risks, it’s best to take the concentration with the lowest active agents once a day.

When it comes to children, an active agent concentration of 0.1% may be enough to control eye pressure. If the pressure isn’t sufficiently managed with this dose, it may be necessary to apply twice a day at 12-hour intervals. Patients, especially newborns, should be observed closely for one or two hours after dose number one and careful checking for adverse effects should be carried out until surgery is completed.

Instructions for use

  • Wash your hands first.
  • Don’t touch the eye or other areas with the bottle’s tip.
  • If you’re wearing soft contact lenses, take them out before applying the medication and wait at least 15 minutes before reinserting.
  • Timolol drops are sold in a tightly closed bottle that features a spiked cap. If it’s your first time using the bottle, tightly screw down the cap so you can pierce the bottle’s tip.
  • Tilt back your head and watch the ceiling.
  • Gently pull your lower eyelid downwards.
  • While holding the medicine’s bottle upside down over the eye, gently squeeze it to release one drop into the eye.
  • After applying Timolol, press your eye’s corner, by your nose for three to five minutes. This stops Timolol getting absorbed by the body.
  • Repeat the process for your other eye if need be.
  • After using Timolol, put back its cap and tighten it immediately.

Duration of treatment

For short-term use in children:

Be careful to not touch the bottle’s tip on the eye or other surface.

If handled wrongly, ocular solutions can get contaminated by bacteria and lead to eye infections. See your doctor right away if you develop another eye problem while using Timolol.

Keep using Timolol until your physician orders you to stop.

If you accidentally take too much Timolol, contact your physician or visit the casualty department of your nearest hospital. The signs of Timolol overdose include reduced blood pressure, slow heart rate, heart attack, and breathing difficulties. If someone else is not breathing or has collapsed, call your local emergency services.

If you forgot to take Timolol, apply the eye drops the moment you remember. However, if the next dose is minutes away, skip the dose you missed and follow the normal scheduled dose.

Interactions:

Timolol may interact with the following medications:

  • Clonidine
  • Epinephrine
  • Insulin
  • Calcium channel blockers (for example diltiazem, verapamil, nifedipine)
  • Guanethidine
  • Quinidine
  • Ergot alkaloids (for example ergotamine, methysergide, dihydroergotamine)
  • Metformin
  • Prazosin
  • Reserpine
  • Theophylline
  • Terazosin
  • NSAIDs (non-steroidal inflammatory medications), e.g. indomethacin, naproxen, ibuprofen
  • Other beta-blockers (for example levobunolol, betaxolol)

If you’re using any of the above medicines, let your doctor/pharmacist know. Depending on your situation, you may be advised to:

  • Discontinue one of the drugs
  • Swap one of the medicines for another
  • Change the mode of taking both or one of the medicines
  • Don’t change a thing

An interaction between two drugs doesn’t necessarily mean you need to quit one of them. Discuss with your doctor how interactions should be controlled or how they’re being controlled.

Other medications not in the above list may interact with Timolol. Tell your pharmacist/pharmacist about all medications you’re taking, be it prescription, non-prescription, or herbal. Also report any supplements you’re taking. As alcohol, cigarettes, street drugs, and caffeine can have an effect on how medications work, be sure to let your pharmacist/physician know if you take them.

Warnings:

Before you start using any medication, make sure to inform your healthcare giver about any medicines you’re using, any allergies or medical conditions you may have, whether you’re nursing or pregnant, and any other essential details about your health. The following factors may affect how Timolol should be used:

Contact lenses—Timolol eye drops contain preservatives in both its formulations. Soft lenses can absorb these preservatives. Take off your contact lenses before applying Timolol and don’t reinsert them until at least 15 minutes after application.

Diabetes—Beta-blockers like Timolol can hide the symptoms of low blood sugar (hypoglycemia). Diabetics prone to low blood sugar or those who are using insulin or hypoglycemic drugs should regularly monitor their blood glucose.

General—Just like other topically applied ophthalmic solutions, Timolol can be absorbed into the blood. Similar side effects seen with oral medicines from the beta-blockers family (metoprolol, timolol, propranolol) may happen with Timolol eye drops.

Heart failure—People suffering from heart failure will need careful monitoring by their doctor while taking Timolol eye drops.

Overactive thyroid—Timolol eye drops can hide the signs of an overactive thyroid. Those with an overactive thyroid or are susceptible to it should be monitored by their doctor carefully.

Pregnancy—Timolol use among pregnant women hasn’t been studied enough. This drug shouldn’t be taken by pregnant women unless it has more benefits than the risks.

Breastfeeding—Timolol gets into human milk. Breastfeeding mothers who are taking Timolol can affect their baby. Discuss with your healthcare giver whether it’s wise to continue breastfeeding.

If you suffer an eye injury or get an eye infection, or have an eye operation, consult your physician about whether it’s wise to continue using your current Timolol bottle. Your physician may advise that you get a new bottle.

Don’t receive any dental care, emergency care, or surgery without informing your doctor that you take Timolol.

Storage:

Keep all your medications out of the sight and reach of kids.

Keep Timolol in its original container, tightly sealed, and at room temperature.

If the medicine becomes cloudy or discolored, get a fresh bottle.

Don’t flush Timolol down the toilet or pour in the drain.

Keep Timolol eye drops in a dry, cool place, away from light and heat.

Keep Timolol from freezing.

Don’t store out of date medications or ones no longer needed.

Always look at the expiry date on the container. Bottled eye drops only last four weeks after the bottle is opened, so don’t use the medication if the bottle was opened more than four weeks ago. This will help avert the chance of eye infections.

One-dose units should be used as soon as they’re opened. Don’t re-use or store opened units for future use. This is because one-dose units don’t have any preservative.

Summary:

Before you begin applying the eye drops, check out the manufacturer’s information in the leaflet inside the pack. You’ll get more details about the medication as well as the side effects you may experience while using it.

Use a drop in each eye affected. Some eye drops should be applied twice daily, others only once a day. Your physician will be able to choose the right eye drops for you. Remember to apply the eye drops regularly and try to not skip any doses.

If you forget to apply the drops, do so immediately once you remember, but don’t take double doses to make up for any missed doses.

Take care to not touch the bottle’s tip with your fingers, eyes, or any other part of the body. This will prevent the contamination of drops.

If you’re also using other different eye drops, allow five to 10 minutes between each application. This will help prevent excess fluid getting into your eye. Otherwise, the eye drops will spill from the eyes and not produce the desired effect.

When first applied, eye drops may occasionally cause blurred vision and make the eyes water. If this occurs, it should quickly go away. Make sure you’re able to see again clearly before you use any tool or machine, or drive.

If you’re using bottled eye drops, don’t put on soft contact lenses unless your physician tells you it is safe to do so. This is because bottled eye drops contain preservatives which can affect certain soft contact lenses. But you can put on soft contact lenses when applying single-dose eye drops as they don’t contain preservatives. However, remember to remove your lenses before applying the drops and wait at least fifteen minutes before re-inserting the lenses.

Honor your routine appointments with your eye clinic and doctor, so your progress may be checked. Your doctor may order some eye exams to assess your response to the medication.

If you’re having any dental treatment or surgery, remember to inform the person treating you that you’re using Timolol. This is because Timolol eye drops might affect some medications used during surgery.

Resources
Last Reviewed:
December 24, 2017
Last Updated:
December 22, 2017
Content Source: