Timolol Maleate

Dosage Forms

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Eye drops

0.25%

0.50%

Uses

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Open-angle glaucoma
Ocular hypertension
Some cases of secondary glaucoma

Dose and Duration

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All uses

Adult: instil 1 drop into affected eye every 12 hours. Dose may be increased to 1 drop of 0.5% solution if the clinical response is not adequate. Usual maintenance dose is 1 drop once a day.

Child: 1 drop instilled in the affected eye once a day, titrated to a maximum of 1 drop every 12 hours.

Contra-indications

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Bradycardia
Second and third degree atrioventricular block not controlled by a pace-maker
Uncontrolled heart failure
Reactive airway disease including bronchial asthma
Sick sinus syndrome, sino-atrial block
Sinus bradycardia
Cardiogenic shock
Presence or history of severe chronic obstructive pulmonary disease
Severe peripheral circulatory disturbances

Side Effects

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Ocular stinging, burning, pain, itching, erythema
Dry eyes
Allergic reactions
Diplopia, ptosis

Interactions

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Epinephrine (severe hypertension)
Lidocaine (increased myocardial depression)
Nifedipine (enhanced hypotensive effect)
Procainamide (increased myocardial depression)
Verapamil (severe hypotension and heart failure)

Patient Instructions

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Close your eyes for at least 2 minutes after instillation of the drops.
Discard remaining solution after 28 days from opening.
Wash hands well with water and soap before instillation.
Ensure the tip of the dispensing bottle does not touch the eyelid or any part of the body or surface at any time.
Remove soft contact lenses before instillation of timolol.

Pregnancy

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Can be used.

Breast-feeding

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Can be used.

⚠️ Caution

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If timolol eye drops are used till delivery, carefully monitor neonate for the first few days of life.
Use with caution in patients with corneal diseases.
Use with caution in the elderly due to risk of keratitis.
Systemic absorption may follow topical use in the eyes.
Nasolacrimal occlusion or closing the eyelids for 2–3 minutes after instillation of the eye drops reduces systemic absorption and increases local activity.
Reassess intra-ocular pressure at four weeks after starting treatment as response may take a few weeks to stabilize.
In case of switch from other topical beta- blocking agents, discontinue for 24 hours and start treatment with timolol thereafter. For other non-beta- blocker agents, discontinue agent after 2 doses of timolol.