Timolol (ophthalmic): Drug information

(For additional information see "Timolol (ophthalmic): Patient drug information" and see "Timolol (ophthalmic): Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)

Brand Names: US

Betimol;
Istalol;
Timolol Maleate Ocudose;
Timoptic Ocudose;
Timoptic [DSC];
Timoptic-XE [DSC]

Brand Names: Canada

APO-Timop;
JAMP-Timolol;
SANDOZ Timolol;
Timolol Maleate-EX;
Timoptic;
Timoptic-XE

Pharmacologic Category

Beta-Blocker, Nonselective;
Ophthalmic Agent, Antiglaucoma

Dosing: Adult

Elevated intraocular pressure

Elevated intraocular pressure: Ophthalmic:

Open-angle glaucoma or ocular hypertension :

Gel-forming solution: Instill 1 drop (either 0.25% or 0.5% solution) once daily.

Solution:

Once daily timolol maleate formulations (Istalol and AB rated generics): Instill 1 drop (0.5% solution) once daily in the morning.

Twice daily timolol maleate and hemihydrate formulations (Betimol, Timoptic, and AB rated generics): Instill 1 drop (0.25% solution) into affected eye(s) twice daily; if response is not adequate, increase to 1 drop (0.5% solution) twice daily. May decrease dose to 1 drop once daily if intraocular pressure (IOP) is well controlled.

Angle-closure glaucoma, acute (off-label use): Instill 1 drop (0.5%) into the affected eye as part of a 4-drug regimen; may repeat in 30 to 60 minutes if IOP remains elevated (eg, >40 mm Hg). Note: Reserve medical management for emergency situations when an assessment by an ophthalmologist will be delayed by ≥1 hour (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Timolol (ophthalmic): Pediatric drug information")

Dosage guidance:

Dosage form information: Timolol maleate solutions formulated with potassium sorbate (eg, Istalol and AB rated generics) are intended for once-daily administration and are not approved for use in pediatric patients. These products are not interchangeable with other timolol maleate products.

Glaucoma

Glaucoma: Note: Use lowest effective dose; the gel formulation may be preferable due to decreased systemic absorption (Ref):

Infants, Children, and Adolescents: Limited data available in infants and children <2 years.

Gel-forming solution: Ophthalmic: Instill 1 drop (either 0.25% or 0.5% solution) once daily into affected eye(s) (Ref).

Solution (timolol maleate): Ophthalmic: Initial: 0.25% solution: Instill 1 drop twice daily into affected eye(s); if response is not adequate, may change to 0.5% solution 1 drop twice daily; maximum dose: 1 drop (0.5% solution)/dose (Ref).

Infantile hemangioma, thin and/or superficial

Infantile hemangioma, thin and/or superficial: Limited data available: Infants and Children: Ophthalmic gel-forming solution (0.5%) or Ophthalmic solution (timolol maleate 0.5%): Topical: Usual dose: Apply 1 to 2 drop(s) to the site of the hemangioma twice daily for 6 to 12 months; 1 drop three times daily has also been reported. Consider risk versus benefit and use lowest dose necessary to cover hemangioma to limit risk of adverse effects. Studies have demonstrated similar efficacy between the solution and gel-forming solution; however, the gel-forming solution is more commonly utilized because the viscosity of the product makes it easier to apply, and it may have lower potential for systemic absorption than the solution (Ref). Note: A 0.25% timolol gel-forming solution administered as 2 drops twice daily has been shown to be successful in the treatment of periocular infantile hemangiomas (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%: Ophthalmic: Blurred vision (1% to 33%), burning sensation of eyes (≤38%), stinging of eyes (≤38%)

1% to 10%:

Cardiovascular: Hypertension, peripheral edema (1% to 5%)

Gastrointestinal: Nausea (1% to 5%) xerostomia (1% to 5%)

Hypersensitivity: Hypersensitivity reaction (1% to 5%; including anaphylaxis and angioedema)

Infection: Common cold (1% to 5%), infection (4% to 10%)

Nervous system: Asthenia (1% to 5%), dizziness (1% to 5%), headache

Neuromuscular & skeletal: Limb pain (1% to 5%)

Ophthalmic: Blepharitis (1% to 5%), cataract, conjunctival injection (4% to 10%), conjunctivitis (1% to 5%), corneal staining (1% to 5%), decreased visual acuity (4% to 10%), dry eye syndrome (>5%), epiphora (1% to 5%), erythema of eyelid (>5%), eye discharge (1% to 5%, including crusting), eye discomfort, eye pain (1% to 5%), eye pruritus, foreign body sensation of eye, hyperemia (1% to 5%), keratitis (1% to 5%), lacrimation (1% to 5%), photophobia (1% to 5%), visual disturbance (1% to 5%)

Respiratory: Respiratory tract infection (1% to 5%; including upper respiratory tract infection), sinusitis (1% to 5%)

Postmarketing:

Cardiovascular: Bradycardia (Abbas 2020), cardiac arrhythmia, chest pain (Haga 2022), claudication, cold extremity, edema, exacerbation of angina pectoris, heart block (Wang 2019), heart failure (Linkewich 1981), hypotension, palpitations (Walia 2011), Raynaud disease, sick sinus syndrome (Walia 2011), syncope (Abbas 2020)

Dermatologic: Alopecia (Muramatsu 2017), exacerbation of psoriasis, pemphigoid-like lesion, psoriasiform eruption

Endocrine & metabolic: Decreased libido (Cimolai 2019)

Gastrointestinal: Anorexia (Cimolai 2019), diarrhea, dyspepsia

Genitourinary: Impotence (Cimolai 2019), Peyronie disease (Oliphant 2019), retroperitoneal fibrosis

Nervous system: Amnesia (Cimolai 2019), anxiety (Cimolai 2019), cerebral ischemia, cerebrovascular accident, confusion (Cimolai 2019), depression (Cimolai 2019), disorientation (Cimolai 2019), drowsiness (Haga 2022), exacerbation of myasthenia gravis (Cimolai 2019), fatigue (Cimolai 2019), hallucination (Cimolai 2019), insomnia (Cimolai 2019), nightmares (Cimolai 2019), paresthesia (Cimolai 2019)

Neuromuscular & skeletal: Systemic lupus erythematosus (Zamber 1992)

Ophthalmic: Blepharoptosis, choroidal detachment (following filtration surgery), cystoid macular edema, decreased corneal sensitivity, diplopia (Cimolai 2019), error of refraction, eye irritation

Otic: Tinnitus (Cimolai 2019)

Respiratory: Bronchospasm, cough (Patel 2015), dyspnea (Haga 2022), interstitial lung disease (Patel 2015), nasal congestion, pulmonary edema, respiratory failure

Contraindications

Hypersensitivity to timolol or any component of the formulation; bronchial asthma or history of bronchial asthma; severe chronic obstructive pulmonary disease (COPD); sinus bradycardia; second- or third-degree atrioventricular block; overt heart failure; cardiogenic shock

Warnings/Precautions

Concerns related to adverse events:

• Anaphylactic reactions: Use with caution in patients with history of atopy or a history of severe anaphylaxis to a variety of allergens; patients taking beta-blockers may become more sensitive to repeated challenges. Treatment of anaphylaxis (eg, epinephrine) in patients taking beta-blockers may be ineffective or promote undesirable effects.

• Choroidal detachment: Beta-blockade and/or other aqueous suppressive therapy have been associated with choroidal detachment following filtration procedures.

Disease-related concerns:

• Cerebrovascular disease: Use with caution in cerebrovascular insufficiency; consider alternative therapy for patients with signs/symptoms of decreased cerebral blood flow after therapy initiation.

• Diabetes: Use with caution in patients with diabetes mellitus (especially labile diabetes); may potentiate hypoglycemia and/or mask signs and symptoms.

• Heart failure: Use with caution in patients with compensated heart failure and monitor for a worsening of the condition; may lead to heart failure in patients without a history of heart failure. Use is contraindicated in overt heart failure. In a scientific statement from the American Heart Association, timolol has been determined to be an agent that may exacerbate underlying myocardial dysfunction (magnitude: major) (AHA [Page 2016]).

• Myasthenia gravis: Use with caution in patients with myasthenia gravis; may worsen disease or other myasthenic symptoms (eg, diplopia, ptosis, and generalized weakness).

• Peripheral vascular disease (PVD) and Raynaud disease: Can precipitate or aggravate symptoms of arterial insufficiency in patients with PVD and Raynaud disease. Use with caution and monitor for progression of arterial obstruction.

• Respiratory disease: In general, patients with bronchospastic disease should not receive beta-blockers; if used at all, should be used cautiously with close monitoring. Severe respiratory reactions, including fatalities due to bronchospasm in patients with asthma, have been reported with ophthalmic use. Use is contraindicated in bronchial asthma or history of bronchial asthma and severe COPD.

• Thyroid disease: May mask signs of hyperthyroidism (eg, tachycardia). If thyrotoxicosis is suspected, carefully manage and monitor; abrupt withdrawal may exacerbate symptoms of hyperthyroidism or precipitate thyroid storm.

Special populations:

• Contact lens wearers: Some products may contain benzalkonium chloride, which may be absorbed by soft contact lenses; remove lens prior to administration and wait 15 minutes before reinserting.

Other warnings/precautions:

• Absorption: Systemic absorption of timolol and adverse effects may occur with ophthalmic use, including respiratory and cardiovascular effects (eg, bradycardia and/or hypotension). Beta-blocker therapy should not be withdrawn abruptly in order to avoid acute tachycardia, hypertension, and/or ischemia.

• Appropriate use: Should not be used alone in angle-closure glaucoma (has no effect on pupillary constriction). Concomitant use of 2 topical beta-blockers is not recommended. Multidose vials have been associated with development of bacterial keratitis; avoid contamination.

• Product interchangeability: Timolol maleate products that contain potassium sorbate (eg, Istalol and AB rated generics) are only intended for once daily administration. Products that do not contain potassium sorbate (eg, Timoptic and AB rated generics) are intended for twice daily administration. Products formulated without potassium sorbate are not interchangeable with products formulated with potassium sorbate.

• Surgery: May block systemic effects of beta agonists (eg, epinephrine, norepinephrine); notify anesthesiologist if patient is receiving ophthalmic beta blocker therapy. Patients undergoing planned major surgery should be gradually tapered off therapy (if possible) prior to procedure. If necessary during surgery, effects of beta blocker therapy may be reversed by adrenergic agonists.

Warnings: Additional Pediatric Considerations

Pediatric patients, particularly infants, may attain higher plasma concentrations compared to adults (Coppens 2004; Passo 1984); systemic adverse effects may occur (eg, hypotension, bradycardia, bronchospasm, and apnea); use the lowest effective dose; some experts advocate avoiding the use of ophthalmic beta-blockers in premature and small infants (Moore 2007).

Systemic absorption has been reported following topical use of timolol ophthalmic products when used to treat infantile hemangiomas, which may lead to adverse events, such as hypothermia, hypotension, apnea, and bradycardia, particularly in patients with PMA <44 weeks, weight <2.5 kg, or those with a history of apnea, bradycardia, or chronic lung disease. In addition, use on or near mucosa, sites with thinner skin (eg, perineum), ulcerated hemangiomas, or sites under occlusion may enhance systemic absorption. Risk may be increased with higher doses (eg, >2 drops per day). The risk versus benefit must be weighed for each patient prior to use (AAP [Darrow 2015]; Frommelt 2016; McMahon 2012; Ng 2017; Püttgen 2016).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Gel Forming Solution, Ophthalmic, as maleate [strength expressed as base]:

Timoptic-XE: 0.25% (5 mL [DSC]) [contains tromethamine]

Timoptic-XE: 0.5% (5 mL [DSC])

Generic: 0.25% (5 mL); 0.5% (5 mL)

Solution, Ophthalmic, as hemihydrate [strength expressed as base]:

Betimol: 0.25% (5 mL); 0.5% (5 mL, 10 mL, 15 mL) [contains benzalkonium chloride]

Solution, Ophthalmic, as maleate [strength expressed as base]:

Istalol: 0.5% (2.5 mL, 5 mL) [contains benzalkonium chloride]

Timoptic: 0.25% (5 mL [DSC]); 0.5% (5 mL [DSC], 10 mL [DSC]) [contains benzalkonium chloride]

Generic: 0.25% (5 mL, 10 mL, 15 mL); 0.5% (2.5 mL, 5 mL, 10 mL, 15 mL)

Solution, Ophthalmic, as maleate [strength expressed as base, preservative free]:

Timolol Maleate Ocudose: 0.5% (60 ea)

Timoptic Ocudose: 0.25% (60 ea); 0.5% (60 ea)

Generic: 0.25% (4 ea, 60 ea); 0.5% (1 ea, 4 ea, 60 ea)

Generic Equivalent Available: US

Yes

Pricing: US

Solution (Betimol Ophthalmic)

0.25% (per mL): $33.12

0.5% (per mL): $36.57

Solution (Istalol Ophthalmic)

0.5% (per mL): $98.57

Solution (Timolol Maleate (Once-Daily) Ophthalmic)

0.5% (per mL): $64.47 - $70.19

Solution (Timolol Maleate Ocudose Ophthalmic)

0.5% (per each): $9.64

Solution (Timolol Maleate Ophthalmic)

0.25% (per mL): $0.72 - $3.00

0.5% (per mL): $1.31 - $3.40

Solution (Timolol Maleate PF Ophthalmic)

0.25% (per each): $9.19

0.5% (per each): $9.00 - $9.10

Solution (Timoptic Ocudose Ophthalmic)

0.25% (per each): $11.19

0.5% (per each): $12.77

Solution gel-forming (Timolol Maleate Ophthalmic)

0.25% (per mL): $37.57 - $48.56

0.5% (per mL): $41.62 - $53.22

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Gel Forming Solution, Ophthalmic, as maleate [strength expressed as base]:

Timolol Maleate-EX: 0.25% (5 mL); 0.5% (5 mL) [contains polysorbate 80]

Timoptic-XE: 0.5% (5 mL)

Solution, Ophthalmic, as maleate [strength expressed as base]:

Timoptic: 0.5% (5 mL, 10 mL) [contains benzalkonium chloride]

Generic: 0.25% (5 mL, 10 mL); 0.5% (5 mL, 10 mL)

Administration: Adult

Ophthalmic: For topical ophthalmic use only. Wash hands before use; invert closed bottle and shake gel-forming solutions once before use. Remove contact lenses prior to administration; wait 15 minutes before reinserting if using products containing benzalkonium chloride. In most cases, separate administration of other ophthalmic agents by at least 5 to 10 minutes. When treating acute angle-closure glaucoma, separate administration of other ophthalmic agents by ≥1 minute (Ref).

Administration: Pediatric

Ophthalmic: Administer other topically applied ophthalmic medications at least 10 minutes prior to timolol.

Wash hands before use; invert closed bottle and shake gel once before use; remove cap carefully so that tip does not touch anything; hold bottle between thumb and index finger; use index finger of other hand to pull down the lower eyelid to form a pocket for the eye drop and tilt head back; place the dispenser tip close to the eye and gently squeeze the bottle to administer 1 drop; remove pressure on bottle after a single drop has been released; do not allow the dispenser tip to touch the eye; replace cap and store bottle in an upright position in a clean area; do not enlarge hole of dispenser; do not wash tip with water, soap, or any other cleaner. Some solutions contain benzalkonium chloride; wait at least 15 minutes after instilling solution before inserting soft contact lenses. With solution, apply gentle pressure to lacrimal sac during and immediately following instillation (1 minute) or instruct patient to gently close eyelid after administration, to decrease systemic absorption of ophthalmic drops (Ref).

Topical: Infantile Hemangioma: Wash hands. Apply drop to hemangioma site area and rub in gently to cover entire hemangioma (Ref).

Use: Labeled Indications

Elevated intraocular pressure: Treatment of elevated intraocular pressure (IOP) in patients with ocular hypertension or open-angle glaucoma (manufacturer's labeling) or as part of a 4-drug medical management regimen in acute angle-closure glaucoma when the patient cannot be seen by an ophthalmologist for ≥1 hour (off-label use) (Pokhrel 2007).

Medication Safety Issues

Sound-alike/look-alike issues:

Timolol may be confused with atenolol, Tylenol

Timoptic may be confused with Betoptic S, Talacen, Viroptic

Other safety concerns:

Two timolol maleate formulations are available. Products that contain potassium sorbate (eg, Istalol and AB rated generics) are only intended for once daily administration. Products that do not contain potassium sorbate (eg, Timoptic and AB rated generics) are intended for twice daily administration. Products formulated without potassium sorbate are not interchangeable with products formulated with potassium sorbate.

International issues:

Betimol [US] may be confused with Betanol brand name for metipranolol [Monaco]

Metabolism/Transport Effects

Substrate of CYP2D6 (major); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Acetylcholinesterase Inhibitors: May enhance the bradycardic effect of Beta-Blockers. Risk C: Monitor therapy

Ajmaline: May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Risk C: Monitor therapy

Alpha2-Agonists: May enhance the AV-blocking effect of Beta-Blockers. Sinus node dysfunction may also be enhanced. Beta-Blockers may enhance the rebound hypertensive effect of Alpha2-Agonists. This effect can occur when the Alpha2-Agonist is abruptly withdrawn. Management: Closely monitor heart rate during treatment with a beta blocker and clonidine. Withdraw beta blockers several days before clonidine withdrawal when possible, and monitor blood pressure closely. Recommendations for other alpha2-agonists are unavailable. Risk D: Consider therapy modification

Amiodarone: May enhance the bradycardic effect of Beta-Blockers. Possibly to the point of cardiac arrest. Amiodarone may increase the serum concentration of Beta-Blockers. Risk C: Monitor therapy

Antidiabetic Agents: Beta-Blockers (Nonselective) may enhance the hypoglycemic effect of Antidiabetic Agents. Beta-Blockers (Nonselective) may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Antipsychotic Agents (Phenothiazines): May enhance the hypotensive effect of Beta-Blockers. Beta-Blockers may decrease the metabolism of Antipsychotic Agents (Phenothiazines). Antipsychotic Agents (Phenothiazines) may decrease the metabolism of Beta-Blockers. Risk C: Monitor therapy

Artemether and Lumefantrine: May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Risk C: Monitor therapy

Beta2-Agonists: Beta-Blockers (Nonselective) may diminish the bronchodilatory effect of Beta2-Agonists. Risk X: Avoid combination

Bradycardia-Causing Agents: May enhance the bradycardic effect of other Bradycardia-Causing Agents. Risk C: Monitor therapy

Cannabis: Beta-Blockers may enhance the adverse/toxic effect of Cannabis. Specifically, the risk of hypoglycemia may be increased. Risk C: Monitor therapy

Ceritinib: Bradycardia-Causing Agents may enhance the bradycardic effect of Ceritinib. Management: If this combination cannot be avoided, monitor patients for evidence of symptomatic bradycardia, and closely monitor blood pressure and heart rate during therapy. Risk D: Consider therapy modification

Cholinergic Agonists: Beta-Blockers may enhance the adverse/toxic effect of Cholinergic Agonists. Of particular concern are the potential for cardiac conduction abnormalities and bronchoconstriction. Risk C: Monitor therapy

CYP2D6 Inhibitors (Strong): May increase the serum concentration of Timolol (Ophthalmic). Risk C: Monitor therapy

Dipyridamole: May enhance the bradycardic effect of Beta-Blockers. Risk C: Monitor therapy

Disopyramide: May enhance the bradycardic effect of Beta-Blockers. Beta-Blockers may enhance the negative inotropic effect of Disopyramide. Risk C: Monitor therapy

DOBUTamine: Beta-Blockers may diminish the therapeutic effect of DOBUTamine. Risk C: Monitor therapy

Dronedarone: May enhance the bradycardic effect of Beta-Blockers. Dronedarone may increase the serum concentration of Beta-Blockers. This likely applies only to those agents that are metabolized by CYP2D6. Management: Use lower initial beta-blocker doses; adequate tolerance of the combination, based on ECG findings, should be confirmed prior to any increase in beta-blocker dose. Increase monitoring for clinical response and adverse effects. Risk D: Consider therapy modification

EPHEDrine (Systemic): Beta-Blockers may diminish the therapeutic effect of EPHEDrine (Systemic). Risk C: Monitor therapy

EPINEPHrine (Nasal): Beta-Blockers (Nonselective) may enhance the hypertensive effect of EPINEPHrine (Nasal). Risk C: Monitor therapy

EPINEPHrine (Oral Inhalation): Beta-Blockers (Nonselective) may enhance the hypertensive effect of EPINEPHrine (Oral Inhalation). Risk C: Monitor therapy

Epinephrine (Racemic): Beta-Blockers (Nonselective) may enhance the hypertensive effect of Epinephrine (Racemic). Risk C: Monitor therapy

EPINEPHrine (Systemic): Beta-Blockers (Nonselective) may enhance the hypertensive effect of EPINEPHrine (Systemic). Risk C: Monitor therapy

Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates): Beta-Blockers may enhance the vasoconstricting effect of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk C: Monitor therapy

Etilefrine: May enhance the bradycardic effect of Beta-Blockers. Beta-Blockers may diminish the therapeutic effect of Etilefrine. Risk C: Monitor therapy

Etofylline: Beta-Blockers may diminish the therapeutic effect of Etofylline. Risk X: Avoid combination

Etrasimod: May enhance the bradycardic effect of Bradycardia-Causing Agents. Risk C: Monitor therapy

Fexinidazole: Bradycardia-Causing Agents may enhance the arrhythmogenic effect of Fexinidazole. Risk X: Avoid combination

Fingolimod: Bradycardia-Causing Agents may enhance the bradycardic effect of Fingolimod. Management: Consult with the prescriber of any bradycardia-causing agent to see if the agent could be switched to an agent that does not cause bradycardia prior to initiating fingolimod. If combined, perform continuous ECG monitoring after the first fingolimod dose. Risk D: Consider therapy modification

Grass Pollen Allergen Extract (5 Grass Extract): Beta-Blockers may enhance the adverse/toxic effect of Grass Pollen Allergen Extract (5 Grass Extract). More specifically, Beta-Blockers may inhibit the ability to effectively treat severe allergic reactions to Grass Pollen Allergen Extract (5 Grass Extract) with epinephrine. Some other effects of epinephrine may be unaffected or even enhanced (e.g., vasoconstriction) during treatment with Beta-Blockers. Management: Consider alternatives to either grass pollen allergen extract (5 grass extract) or beta-blockers in patients with indications for both agents. Canadian product labeling specifically lists this combination as contraindicated. Risk D: Consider therapy modification

Insulins: Beta-Blockers (Nonselective) may enhance the hypoglycemic effect of Insulins. Beta-Blockers (Nonselective) may diminish the therapeutic effect of Insulins. Risk C: Monitor therapy

Isoproterenol: Beta-Blockers may diminish the therapeutic effect of Isoproterenol. Risk C: Monitor therapy

Ivabradine: Bradycardia-Causing Agents may enhance the bradycardic effect of Ivabradine. Risk C: Monitor therapy

Lacosamide: Bradycardia-Causing Agents may enhance the AV-blocking effect of Lacosamide. Risk C: Monitor therapy

Mavacamten: Beta-Blockers may enhance the adverse/toxic effect of Mavacamten. Specifically, negative inotropic effects may be increased. Risk C: Monitor therapy

Methacholine: Beta-Blockers may enhance the adverse/toxic effect of Methacholine. Risk C: Monitor therapy

Methoxyflurane: May enhance the hypotensive effect of Beta-Blockers. Risk C: Monitor therapy

Midodrine: May enhance the bradycardic effect of Bradycardia-Causing Agents. Risk C: Monitor therapy

Mivacurium: Beta-Blockers may enhance the therapeutic effect of Mivacurium. Risk C: Monitor therapy

NIFEdipine: May enhance the hypotensive effect of Beta-Blockers. NIFEdipine may enhance the negative inotropic effect of Beta-Blockers. Risk C: Monitor therapy

Nitrendipine: May enhance the therapeutic effect of Beta-Blockers. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: May diminish the antihypertensive effect of Beta-Blockers. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents (Topical): May diminish the therapeutic effect of Beta-Blockers. Risk C: Monitor therapy

Ozanimod: May enhance the bradycardic effect of Bradycardia-Causing Agents. Risk C: Monitor therapy

Peginterferon Alfa-2b: May decrease the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Peginterferon Alfa-2b may increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Risk C: Monitor therapy

Ponesimod: Bradycardia-Causing Agents may enhance the bradycardic effect of Ponesimod. Management: Avoid coadministration of ponesimod with drugs that may cause bradycardia when possible. If combined, monitor heart rate closely and consider obtaining a cardiology consult. Do not initiate ponesimod in patients on beta-blockers if HR is less than 55 bpm. Risk D: Consider therapy modification

Reserpine: May enhance the bradycardic effect of Beta-Blockers. Reserpine may enhance the hypotensive effect of Beta-Blockers. Risk C: Monitor therapy

Rivastigmine: May enhance the bradycardic effect of Beta-Blockers. Risk X: Avoid combination

Siponimod: Bradycardia-Causing Agents may enhance the bradycardic effect of Siponimod. Management: Avoid coadministration of siponimod with drugs that may cause bradycardia. If combined, consider obtaining a cardiology consult regarding patient monitoring. Risk D: Consider therapy modification

Succinylcholine: Beta-Blockers may enhance the neuromuscular-blocking effect of Succinylcholine. Risk C: Monitor therapy

Sulfonylureas: Beta-Blockers (Nonselective) may enhance the hypoglycemic effect of Sulfonylureas. Beta-Blockers (Nonselective) may diminish the therapeutic effect of Sulfonylureas. Risk C: Monitor therapy

Tasimelteon: Beta-Blockers may diminish the therapeutic effect of Tasimelteon. Management: Consider avoiding nighttime administration of beta-blockers during tasimelteon therapy due to the potential for reduced tasimelteon efficacy. Risk D: Consider therapy modification

Theophylline Derivatives: Beta-Blockers (Nonselective) may diminish the bronchodilatory effect of Theophylline Derivatives. Risk C: Monitor therapy

Tofacitinib: May enhance the bradycardic effect of Bradycardia-Causing Agents. Risk C: Monitor therapy

White Birch Allergen Extract: Beta-Blockers may enhance the adverse/toxic effect of White Birch Allergen Extract. Specifically, beta-blockers may reduce the effectiveness of beta-agonists that may be required to treat systemic reactions to white birch allergen extract. Risk X: Avoid combination

Pregnancy Considerations

Decreased fetal heart rate has been observed following maternal use of ophthalmic timolol during pregnancy (Wagenvoort 1998). Timolol is absorbed systemically following ophthalmic use; additional adverse effects observed with systemic administration may occur.

If ophthalmic agents are needed to treat glaucoma in pregnancy, the minimum effective dose should be used in combination with punctal occlusion to decrease exposure to the fetus (Johnson 2001; Salim 2014; Wagenvoort 1998).

Breastfeeding Considerations

Timolol is present in breast milk following ophthalmic administration.

Due to the potential for adverse events, breastfeeding infants (especially those with cardiorespiratory problems) should be monitored (Madadi 2008). The minimum effective dose should be used in combination with punctal occlusion to decrease potential exposure to the breastfeeding infant (Johnson 2001; Salim 2014; Samples 1988). Because of the potential for serious adverse reactions in the breastfeeding infant, the manufacturer recommends a decision be made whether to discontinue breastfeeding or to discontinue the drug, taking into account the importance of treatment to the mother.

Monitoring Parameters

Intraocular pressure (after ~4 weeks of therapy for chronic use; 30 to 60 minutes after acute administration for acute use [Pokhrel 2007]); monitor for systemic effect of beta-blockade with ophthalmic administration; blood pressure.

Mechanism of Action

Blocks both beta-1 and beta-2 adrenergic receptors and reduces intraocular pressure by reducing aqueous humor production or possibly increasing the outflow of aqueous humor.

The exact mechanism of beta-blockers for infantile hemangiomas is unclear, but is hypothesized to be related to vasoconstriction, angiogenesis inhibition, growth factor inhibition, and induction of apoptosis (Bhat 2016).

Pharmacokinetics (Adult Data Unless Noted)

Solution:

Onset of action: Intraocular pressure reduction: 30 minutes.

Peak effect: 1 to 2 hours.

Duration: 24 hours.

Absorption: Timolol is measurable in the serum following ophthalmic use. Timolol has been detected in the blood and urine of some infants who were treated topically for infantile hemangiomas (Weibel 2016).

Half-life elimination: 4 hours.

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AE) United Arab Emirates: Apimol | Cusimolol | Nyolol | Ocumol | Oftan timolol | Ophtamolol | Optimol | Timo-comod | Timoptol;
(AR) Argentina: Bio eyes timo | Glatim | Klonalol | Ofal | Plostim | Poentimol | Proflax | Proflax-Xe | Protevis | Timoder | Timoler | Timolol denver farma | Timolol dorf | Timolol max vision | Timolpres | Timoptic | Zopirol;
(AT) Austria: Dispatim | Timabak | Timo comod | Timoftal | Timogel | Timohexal | Timolol | Timolol novartis | Timoptic;
(AU) Australia: Nyogel | Optimol | Tenopt | Timoptol;
(BD) Bangladesh: Aristomol | Gemolol | Intramol | Lotensin | Meloptol | Nyolol | Temlo | Timocare | Timodrop | Timolat | Timolol | Timolol apex | Timomin | Xilol;
(BE) Belgium: Geltim | Nyogel | Nyolol | Timabak | Timo comod | Timo-Pos | Timolol | Timoptol;
(BF) Burkina Faso: Normoptic;
(BG) Bulgaria: Arutimol | Cusimolol | Glaumol | Glucomol | Nyolol | Oftan timolol | Timolol | Timolol Rph | Timolol Vision | Timoptic | Unitimolol;
(BR) Brazil: Glaucotrat | Glautimol | Maleato de timolol | Nyolol | Tenoftal | Timabak | Timolol | Timoneo | Timoptol | Timosan;
(CH) Switzerland: Nyolol | Timo comod | Timogel | Timolol "fermic" | Timoptic;
(CL) Chile: Glausolets | Glautimol | Nyolol | Oculix | Timabak | Timolol | Timop | Timoptol | Tiof;
(CN) China: Cheng rui | Timolol | Timoptol;
(CO) Colombia: Glaucofin | Glaucomicron | Glaucopharm | Globitan | Imot Ofteno | Lolomit | Matimof | Nyolol | Ofepress | Oftabet | Oftalmotrilol | Ophthamolol | Optimol | Prestiblock | Syvimol | Timol-oft | Timolet | Timolol | Timolol maleato | Timopres | Timoptol | Timoptol xe | Wassertim;
(CZ) Czech Republic: Apo timoptol | Arutimol | Ocupres E | Oftan timolol | Oftensin | Timo comod | Timohexal | Timolol | Timolol pos | Timoptol | Uni timolol;
(DE) Germany: Arutimol | Dispatim | Nyogel | Tim-ophtal | Timo comod | Timo Vision | Timo-comod | Timogel | Timohexal | Timolol | Timolol AT 1A Pharma | Timolol cv | Timolol micro labs | Timolol pos | Timomann | Uniget-xe;
(DO) Dominican Republic: Imolgrin | Imot Ofteno | Neo timol | Nyolol | Oculpres | Oculpres 0.5% sc | Timolol | Timoptic | Timoptol | Tiof;
(EC) Ecuador: Citol timolol | Imot | Imot Ofteno | Mioticox | Nyolol | Poentimol | Timoptol | Timox | Tiof;
(EE) Estonia: Arutimol | Nyolol | Oftan timolol | Timohexal | Timoptic | Timosan | Unitimolol;
(EG) Egypt: Cusimolol | Nyolol | Timogel | Timolol;
(ES) Spain: Cusimolol | Nyolol | Timabak | Timoftol | Timogel;
(ET) Ethiopia: Biolal | Epitimol | Lopres | Timolol;
(FI) Finland: Aquanil | Blocanol | Ocubloc | Oftan-timolol | Timolol alcon | Timosan;
(FR) France: Digaol | Gaoptol | Geltim lp | Nyogel lp | Nyolol | Timabak | Timocomod | Timolol | Timolol alcon | Timolol chauvin | Timolol g gam | Timolol Sandoz | Timolol teva | Timoptol | Timoptol lp;
(GB) United Kingdom: Eysano | Glau opt | Nyogel | Timolol | Timolol almus | Timolol cox | Timolol kent | Timolol Sandoz | Timoptol | Timoptol la | Tiopex;
(GH) Ghana: Epitimol | Lavimol;
(GR) Greece: Geltim | Glafemak | Lithimole | Nyogel | Nyolol | Temserin | Thilotim | Waucosin | Yesan;
(GT) Guatemala: Alfer lolo;
(HK) Hong Kong: Apo timop | Europtic | Nyolol | Oftan timolol | Ophtamolol | Optimol | Timabak | Timo-comod | Timolol | Timolol maleate alcon | Timolol Martindale | Timoptol;
(HR) Croatia: Timalen;
(HU) Hungary: Arutimol | Cusimolol | Huma-timolol | Oftan timolol | Timoptic;
(ID) Indonesia: Glaucopress | Isotic adretor | Kentimol | Nyolol | Opthil | Opticom | Tim-ophtal | Timol | Timolol;
(IE) Ireland: Nyogel | Timoptol | Timoptol la;
(IL) Israel: Apotil | Nyolol | Tiloptic | Timolol | V-Optic;
(IN) India: Flocipron | Glaucare | Gluc aid | Glucomol | Glucomol-od | Glucotim | Glucotim LA | Gludrop | Glunil | Glutim | Iotim | Lopres | Nyolol | Oclean | Oculan | Ocupres | Ocutim | Opteze | Siotim | Timanol | Timdus | Timlol pf | Timo-5 | Timoblu | Timol | Timolast | Timolen | Timolet | Timolet-p | Timolong | Timopress | Timoptal | Timorite | Timostar | Timowa | Timozen;
(IQ) Iraq: Tilol;
(IR) Iran, Islamic Republic of: Timolin;
(IT) Italy: Cusimolol | Droptimol | Nyogel | Oftimolo | Omkipo | Timod | Timogel | Timolabak | Timololo | Timolux | Timoptol;
(JO) Jordan: Apimol | Cusimolol | Nyolol | Ophtalmolol | Timolol | Timoptol;
(JP) Japan: Brunne | Phartimo | Phartimo mita | Phartimo nidek | Rysmon | Rysmon tg | Rysmon wakamoto | Thiaboot | Timabak | Timoleate | Timoleate pf | Timolol | Timolol pf nitten | Timolol wakamoto | Timoptol;
(KE) Kenya: Akutim | Aurotim | Glucotim | Iotim | Ivytimol | Occumol | Timolet od | Timoptol | Tml;
(KR) Korea, Republic of: Cusimolol | Interalol | Nyolol | Rysmon tg | Timabak | Timo-comod | Timogla | Timolen | Timolol | Timolux | Timoptic | Timoptic-xe | Unitimo;
(KW) Kuwait: Cusimolol | Nyolol | Oftan timolol | Optimol | Timabak | Timo comod | Timoptol;
(LB) Lebanon: Cusimolol | Digaol | Lithimole | Nyolol | Timabak | Timoptol;
(LT) Lithuania: Apo timop | Apo timoptol | Arutimol | End-timololis | Glucomol | Nyolol | Ocupres | Oftan timolol | Oftensin | Tim-ophtal | Timogel | Timohexal | Timolol | Timolol alcon | Timolol micro labs | Timoptic | Timoptol | Timosan;
(LU) Luxembourg: Dispatim | Geltim | Nyogel | Timabak | Timo comod | Timo-Pos | Timohexal | Timolol falcon | Timoptol;
(LV) Latvia: Apo timop | Apo timoptol | Arutimol | Nyolol | Ocupres | Oftan timolol | Oftensin | Optimol | Timohexal | Timoptic | Timosan | Unitimolol;
(MA) Morocco: Cusimolol | Timabak | Timo comod | Timo-comod | Timolol pos | Timoptol;
(MX) Mexico: Horex | Imot Ofteno | Nyolol | Profloxtec | Shemol | Tenglamol | Ticromic | Timatimsun | Timolol | Timolol Diba | Timolol maleato Kener | Timoptol | Timozzard | Tiof | Zinhypoc;
(MY) Malaysia: Cusimolol | Iotim | Nyolol | Optimol | Timo comod | Timo-comod | Timolol pos | Timoptol;
(NG) Nigeria: Aristomol | Bymol | Drumoptol | Ethimol | Hovid timolol | Iotim 0.5% eye drops | Ivytimol | Timomed | Timosol;
(NL) Netherlands: Loptomit | Nyogel | Timo-comod | Timogel | Timolol | Timolol Alpharma | Timoptol;
(NO) Norway: Aquanil | Blocadren | Blocadren depot | Oftamolol | Oftan | Timoptol la | Timosan;
(NZ) New Zealand: Apo timop | Arrow Timolol | Gen-Timolol | Timoptol;
(PE) Peru: Betamol | Betamolol | Glaucolip | Globitan | Imot Ofteno | Nyolol | Optimol | Timofta | Timolol | Timolol carrion | Timolol-wasser | Timoptic | Timoptol | Timox | Tiof | Vistol;
(PH) Philippines: Celsus Timolol Maleate | I Supres | Intramol | Normopres | Nyolol | Ocupres | Oftan | Optaluz | Optamol | Timabak | Timanol | Timoptol | Timostal | Vendizol;
(PK) Pakistan: Altim | Blotim | Dytim | Hioptal | Nyolol | Ocutim | Optim | Optimol | Optipress | Timentin | Timol | Timoptic | Timoptol | Timosol | Timotek;
(PL) Poland: Cusimolol | Nyolol | Oftan timolol | Oftensin | Timo comod | Timohexal | Timolol pos | Timoptic;
(PR) Puerto Rico: Betimol | Istalol | Timoptic;
(PT) Portugal: Cusimolol | Nyogel | Nyolol | Timabak | Timogel | Timolol chauvin | Timoptol;
(PY) Paraguay: Citol timolol | Ileton | Nyolol | Oftalmol timolol | Plostim | Poentimol | Proflax | Timolol biosano | Timolol chile | Tiof;
(QA) Qatar: Apimol | Cusimolol | Nyolol Gel | Ocumol | Optimol;
(RO) Romania: Glaumol | Glucomol | Ocupres E | Oftan timolol | Ophtamolol | Timabak | Timo comod | Timorom | Unitimolol;
(RU) Russian Federation: Arutimol | Cusimolol | Glaumol | Glautam | Glimol | Glymol | Niolol | Nyolol | Ocucer | Ocumed | Ocumol | Ocupres - e | Ocuryl | Ocutim | Oftan Timogel | Oftan timolol | Oftensin | Optimol | Rotima | Timadren | Timohexal | Timolol | Timolol acos | Timolol akos | Timolol betalek | Timolol dia | Timolol lens | Timolol Mez | Timolol pos | Timolol solopharm | Timolol teva | Timolollong | Timoptic;
(SA) Saudi Arabia: Apimol | Cusimolol | Nyolol | Ocumol | Ophtamolol | Optimol | Timoptol | Tunolol;
(SE) Sweden: Aquanil | Blocadren | Optimol | Timolol alcon | Timolol ccs | Timolol novartis | Timosan;
(SG) Singapore: Apo timop | Cusimolol | Nyolol | Tiamol | Timabak | Timo comod | Timolol | Timolol maleate alcon | Timoptol;
(SI) Slovenia: Metablen | Nyolol | Timalen | Timoptic;
(SK) Slovakia: Arutimol | Nyolol | Timohexal | Timolol | Timoptic timoptol | Timoptol | Unitimolol;
(TH) Thailand: Archimol | Glauco oph | Glucotim | Intramol | Nyolol | Oftan timolol | Opsartimol | Timo mac | Timo-optal | Timodrop | Timolens | Timoptol | Timosil;
(TN) Tunisia: Intramol | Normoptic | Nyolol | Tunolol;
(TR) Turkey: Cusimolol | Normatin | Nyolol | Timabak | Timo comod | Timo-comod | Timocopt | Timoftal | Timolol | Timoptic | Timosol | Timotem;
(TW) Taiwan: Cusimolol | Delolol | Himitan | Nyolol | Oftan timolol | Timin | Timo comod | Timohexal | Timol | Timolast | Timolol | Timoptol;
(UA) Ukraine: Arutimol | Cusimolol | Iotim | Niolol | Normatin | Ocupres E | Ocuryl | Oftan timolol | Oftimol | Timohexal | Timolol | Timoptic | Timoptol | Unitimolol;
(UG) Uganda: Ablol | Aurotim | Cusimolol | Iotim | Ivytimol | Timosol;
(UY) Uruguay: Beyonas timolol | Glautimol | Nyolol | Optifarm | Optimof | Plostim | Proflax | Proflax-Xe | Tensoprel | Timolol | Tiof;
(VE) Venezuela, Bolivarian Republic of: Globitan | Imot Ofteno | Matigel | Matilol | Nyolol | Timolol | Timolol maleato | Timoptol | Timox;
(ZA) South Africa: Glaucosan | Nyogel | Occumol | Timolol | Timoptol;
(ZM) Zambia: Cusimolol | Ivytimol | Ocupres;
(ZW) Zimbabwe: Iotim | Occumol | Oculan

Abbas SA, Hamadani SM, Ahmad U, Desai A, Kitchloo K. Ophthalmic timolol and hospitalization for symptomatic bradycardia and syncope: a case series. Cureus. 2020;12(3):e7270. doi:10.7759/cureus.7270 [PubMed 32292680]
Betimol (timolol) [prescribing information]. Lexington, MA: Thea Pharma Inc; May 2022.
Bhat YJ, Yaseen A, Hassan I. Topical timolol maleate: an effectual and safe recourse for infantile hemangiomas. Indian Dermatol Online J. 2016;7(2):124-125. doi:10.4103/2229-5178.178076 [PubMed 27057498]
Borok J, Gangar P, Admani S, Proudfoot J, Friedlander SF. Safety and efficacy of topical timolol treatment of infantile haemangioma: a prospective trial. Br J Dermatol. 2018;178(1):e51-e52. doi:10.1111/bjd.15865 [PubMed 28771668]
Chakkittakandiyil A, Phillips R, Frieden IJ, et al. Timolol maleate 0.5% or 0.1% gel-forming solution for infantile hemangiomas: a retrospective, multicenter, cohort study. Pediatr Dermatol. 2012;29(1):28-31. [PubMed 22150436]
Chambers CB, Katowitz WR, Katowitz JA, Binenbaum G. A controlled study of topical 0.25% timolol maleate gel for the treatment of cutaneous infantile capillary hemangiomas. Ophthal Plast Reconstr Surg. 2012;28(2):103-106. [PubMed 22410658]
Chan H, McKay C, Adams S, Wargon O. RCT of timolol maleate gel for superficial infantile hemangiomas in 5- to 24-week-olds. Pediatrics. 2013;131(6):e1739-1747. [PubMed 23650294]
Cimolai N. Neuropsychiatric Adverse events from topical ophthalmic timolol. Clin Med Res. 2019;17(3-4):90-96. doi:10.3121/cmr.2019.1486 [PubMed 31462538]
Coppens G, Stalmans I, Zeyen T, et al, "The Safety and Efficacy of Glaucoma Medication in the Pediatric Population," J Pediatr Ophthalmol Strabismus, 2009, 46(1):12-8. [PubMed 19213271]
Danarti R, Ariwibowo L, Radiono S, Budiyanto A. Topical timolol maleate 0.5% for infantile hemangioma: its effectiveness compared to ultrapotent topical corticosteroids - a single-center experience of 278 cases. Dermatology. 2016;232(5):566-571. doi:10.1159/000448396 [PubMed 27592104]
Darrow DH, Greene AK, Mancini AJ, Nopper AJ; SECTION ON DERMATOLOGY, SECTION ON OTOLARYNGOLOGY–HEAD AND NECK SURGERY, and SECTION ON PLASTIC SURGERY. Diagnosis and management of infantile hemangioma. Pediatrics. 2015;136(4):e1060-e1104. doi:10.1542/peds.2015-2485 [PubMed 26416931]
Frommelt P, Juern A, Siegel D, et al. Adverse events in young and preterm infants receiving topical timolol for infantile hemangioma. Pediatr Dermatol. 2016;33(4):405-414. doi:10.1111/pde.12869 [PubMed 27246751]
Haga C, Waller T, Ahuja AS, Farford B, Dawson N, Yin M. There's danger in the drops: systemic effects of ophthalmic drops used to treat glaucoma. Cureus. 2022;14(1):e20945. doi:10.7759/cureus.20945 [PubMed 35154926]
Hoskins HD Jr, Hetherington J Jr, Magee SD, Naykhin R, Migliazzo CV. Clinical experience with timolol in childhood glaucoma. Arch Ophthalmol. 1985;103(8):1163-1165. [PubMed 4026647]
Istalol (timolol) [prescribing information]. Tampa, FL: Bausch & Lomb Inc; March 2022.
Johnson SM, Martinez M, and Freedman S, "Management of Glaucoma in Pregnancy and Lactation," Surv Ophthalmol, 2001, 45(5):449-54. [PubMed 11274697]
Krowchuk DP, Frieden IJ, Mancini AJ, et al. Clinical practice guideline for the management of infantile hemangiomas. Pediatrics. 2019;143(1):e20183475. doi:10.1542/peds.2018-3475 [PubMed 30584062]
Linkewich JA, Herling IM. Bradycardia and congestive heart failure associated with ocular timolol maleate. Am J Hosp Pharm. 1981;38(5):699-701. [PubMed 7282702]
Madadi P, Koren G, Freeman DJ, et al, "Timolol Concentrations in Breast Milk of a Woman Treated for Glaucoma: Calculation of Neonatal Exposure," J Glaucoma, 2008, 17(4):329-31. [PubMed 18552619]
McMahon P, Oza V, Frieden IJ. Topical timolol for infantile hemangiomas: putting a note of caution in "cautiously optimistic." Pediatr Dermatol. 2012;29(1):127-130. doi:10.1111/j.1525-1470.2011.01685.x [PubMed 22256996]
Moore W, Nischal KK. Pharmacologic management of glaucoma in childhood. Paediatr Drugs. 2007;9(2):71-79. [PubMed 17407363]
Muñoz-Garza FZ, Ríos M, Roé-Crespo E, et al. Efficacy and safety of topical timolol for the treatment of infantile hemangioma in the early proliferative stage: a randomized clinical trial. JAMA Dermatol. 2021;157(5):583-587. doi:10.1001/jamadermatol.2021.0596 [PubMed 33825828]
Muramatsu K, Nomura T, Shiiya C, Nishiura K, Tsukinaga I. Alopecia induced by timolol eye-drops. Acta Derm Venereol. 2017;97(2):295-296. doi:10.2340/00015555-2520 [PubMed 27545615]
Ng MSY, Tay YK, Ng SS, Foong AYW, Koh MJ. Comparison of two formulations of topical timolol for the treatment of infantile hemangiomas. Pediatr Dermatol. 2017;34(4):492-493. doi:10.1111/pde.13167 [PubMed 28543755]
Oliphant H, Gouws P. Peyronie's disease and Dupuytren's contracture secondary to topical timolol. Int Ophthalmol. 2019;39(3):683-685. doi:10.1007/s10792-018-0837-y [PubMed 29423783]
Page RL 2nd, O'Bryant CL, Cheng D, et al; American Heart Association Clinical Pharmacology and Heart Failure and Transplantation Committees of the Council on Clinical Cardiology; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular and Stroke Nursing; and Council on Quality of Care and Outcomes Research. Drugs That May Cause or Exacerbate Heart Failure: A Scientific Statement From the American Heart Association [published correction appears in Circulation. 2016;134(12):e261]. Circulation. 2016;134(6):e32-e69. [PubMed 27400984]
Passo MS, Palmer EA, Van Buskirk EM. Plasma timolol in glaucoma patients. Ophthalmology. 1984;91(11):1361-1363. [PubMed 6514303]
Patel H, Wilches LV, Guerrero J. Timolol-induced interstitial lung disease. Respir Med Case Rep. 2015;15:30-32. doi:10.1016/j.rmcr.2015.02.006 [PubMed 26236595]
Paul SP, Davis RF. Infantile haemangioma: topical timolol gel may be safer in premature babies. Br J Hosp Med (Lond). 2019;80(8):i. doi:10.12968/hmed.2019.80.8.i [PubMed 31437034]
Pokhrel PK, Loftus SA. Ocular emergencies [published correction appears in: Am Fam Physician. 2008;77(7):920]. Am Fam Physician. 2007;76(6):829-836. [PubMed 17910297]
Püttgen K, Lucky A, Adams D, et al; Hemangioma Investigator Group. Topical timolol maleate treatment of infantile hemangiomas. Pediatrics. 2016;138(3):e20160355. doi:10.1542/peds.2016-0355 [PubMed 27527799]
Refer to manufacturer's labeling.
Salim S. Glaucoma in pregnancy. Curr Opin Ophthalmol. 2014;25(2):93-97. [PubMed 24469077]
Samples JR, Meyer SM. Use of ophthalmic medications in pregnant and nursing women. Am J Ophthalmol. 1988;106(5):616-623. [PubMed 2903673]
Timoptic (timolol maleate) [prescribing information]. Bridgewater, NJ: Bausch & Lomb Americas Inc; April 2022.
Timoptic Ocudose (timolol maleate) [prescribing information]. Bridgewater, NJ: Bausch & Lomb Americas Inc; January 2022.
Timoptic-XE (timolol maleate) [prescribing information]. Tampa, FL: Bausch & Lomb Incorporated; March 2022.
Urtti A, Salminen L. Minimizing systemic absorption of topically administered ophthalmic drugs. Surv Ophthalmol. 1993;37(6):435-456. [PubMed 8100087]
Wagenvoort AM, van Vugt JM, Sobotka M, et al, “Topical Timolol Therapy in Pregnancy: Is It Safe for the Fetus?” Teratology, 1998, 58(6):258-62. [PubMed 9894675]
Walia HS, Walia SS, Emanuel ME. Sick sinus syndrome associated with topical timolol maleate instillation. J Pharmacol Pharmacother. 2011;2(4):300-302. doi:10.4103/0976-500X.85946 [PubMed 22025865]
Wang Z, Denys I, Chen F, et al. Complete atrioventricular block due to timolol eye drops: a case report and literature review. BMC Pharmacol Toxicol. 2019;20(1):73. doi:10.1186/s40360-019-0370-2 [PubMed 31791399]
Weibel L, Barysch MJ, Scheer HS, et al. Topical timolol for infantile hemangiomas: evidence for efficacy and degree of systemic absorption. Pediatr Dermatol. 2016;33(2):184-190. doi:10.1111/pde.12767 [PubMed 26840644]
Wu HW, Wang X, Zhang L, Zheng JW, Liu C, Wang YA. Topical timolol vs. oral propranolol for the treatment of superficial infantile hemangiomas. Front Oncol. 2018;8:605. doi:10.3389/fonc.2018.00605 [PubMed 30619747]
Zamber RW, Starkebaum G, Rubin RL, Martens HF, Wener MH. Drug induced systemic lupus erythematosus due to ophthalmic timolol. J Rheumatol. 1992;19(6):977-979. [PubMed 1404139]
Zimmerman TJ, Kooner KS, Kandarakis AS, Ziegler LP. Improving the therapeutic index of topically applied ocular drugs. Arch Ophthalmol. 1984;102(4):551-553. [PubMed 6704011]

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Timolol (ophthalmic): Drug information