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Generic Timoptic is used to treat open-angle glaucoma and other causes of high pressure inside the eye.
How to take
Use Generic Timoptic exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the instructions on your prescription label.
Wash your hands before using the eye drops.
Do not use this medication while you are wearing contact lenses. Generic Timoptic may contain a preservative that can be absorbed by soft contact lenses. Wait at least 15 minutes after using Generic Timoptic before putting your contact lenses in.
To apply the eye drops:
- Tilt your head back slightly and pull down your lower eyelid. Hold the dropper above the eye with the dropper tip down. Look up and away from the dropper as you squeeze out a drop, then close your eye.
- Gently press your finger to the inside corner of the eye (near your nose) for about 1 minute to keep the liquid from draining into your tear duct. If you use more than one drop in the same eye, wait about 5 minutes before putting in the next drop.
- Do not allow the dropper tip to touch any surface, including the eyes or hands. If the dropper becomes contaminated it could cause an infection in your eye, which can lead to vision loss or serious damage to the eye.
Do not use the eye drops if the liquid has changed colors or has particles in it. Call your doctor for a new prescription.
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Stop using this medication and call your doctor at once if you have any of these serious side effects:
- swelling or redness of your eyelids;
- eye redness, discomfort, or sensitivity to light;
- drainage, crusting, or oozing of your eyes or eyelids;
- depressed mood, confusion, hallucinations, unusual thoughts or behavior;
- wheezing, gasping, or other breathing problems;
- swelling, rapid weight gain;
- chest pain, slow or uneven heart rate; or
- feeling short of breath, even with mild exertion.
Less serious side effects may include:
- blurred vision, double vision, drooping eyelid;
- burning or stinging in your eye;
- headache, weakness, drowsiness;
- numbness, tingling, or cold feeling in your hands or feet;
- ringing in your ears;
- dry mouth;
- nausea, diarrhea, loss of appetite, upset stomach;
- skin rash or worsening psoriasis;
- sleep problems (insomnia); or
- cough, stuffy nose.
This is not a complete list of side effects and others may occur.
Generic Timoptic can cause blurred vision. Be careful if you drive or do anything that requires you to be able to see clearly.
Do not use any other eye medication unless your doctor has prescribed it for you. If you use another eye medication, use it at least 10 minutes before or after using Generic Timoptic. Do not use the medications at the same time.
Before using timolol ophthalmic, tell your doctor if you are using any of the following drugs:
- Generic Clonidine (Catapres);
- quinidine (Cardioquin, Quinadex, Quinaglute);
- digitalis (digoxin, Lanoxin, Lanoxicaps);
- Generic Diamox (Diamox), dichlorphenamide (Daranide), or methazolamide (Neptazane);
- oral timolol (Blocadren);
- any other beta-blocker such as atenolol (Tenormin), bisoprolol (Zebeta), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), nadolol (Corgard), penbutolol (Levatol), pindolol (Visken), propranolol (Inderal, InnoPran), sotalol (Betapace), and others;
- a calcium channel blocker such as diltiazem (Tiazac, Cartia, Cardizem), felodipine (Plendil), nifedipine (Procardia, Adalat), Generic verapamil (Calan, Covera, Isoptin, Verelan), and others; or
- antidepressants such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft).
This list is not complete and there may be other drugs that can interact with Generic Timoptic.
Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and use the medicine at the next regularly scheduled time. Do not use extra medicine to make up the missed dose.
Store this medication at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.Hide / Show item
Buy cheap Generic Timoptic (Timolol 0.25% 5/0.5% 5ml) onlineTimolol is a non-selective beta-adrenergic receptor antagonist indicated for treating glaucoma, heart attacks, hypertension, and migraine headache. Brand names: *In Canada: Apo-Timol, Apo-Timop, Gen-Timolol, Nu-Timolol, Phoxal-timolol, PMS-Timolol, Tim-AK, Timoptic, Timoptic-XE. *In the United States: Betimol, Blocadren, Istalol, Timoptic, Timoptic-XE, Timoptic OcuDose.
TIMOPTIC0.25% and 0.5% (TIMOLOL MALEATE OPHTHALMIC SOLUTION) Sterile Ophthalmic Solution TIMOPTIC (timolol maleate ophthalmic solution) is a non-selective beta-adrenergic receptor blocking agent. Timoptic Ophthalmic Solution is indicated in the treatment of elevated intraocular pressure in patients with ocular hypertension or open-angle glaucoma.
Clinical supportIn an epidemiologic survey, patients who were switched to a preservative-free timolol experienced fewer ocular symptoms, such as pain and discomfort upon instillation.2
INDICATIONS AND USAGEPreservative-free TIMOPTIC in OCUDOSE is indicated in the treatment of elevated intraocular pressure in patients with ocular hypertension or open-angle glaucoma. It may be used when a patient is sensitive to the preservative in TIMOPTIC (timolol maleate ophthalmic solution), benzalkonium chloride, or when use of a preservative-free topical medication is advisable.
Side effectsThe most serious possible side effects include cardiac arrhythmias and severe bronchospasms. Timolol can also lead to fainting, congestive heart failure, depression, confusion, worsening of Raynaud’s syndrome and impotence.
Timoptol eye drops (timolol)Timoptol eye drops contain the active ingredient timolol maleate, which is a type of medicine called a beta-blocker. It works by blocking beta-receptors in the eye. (NB. Timolol eye drops are also available without a brand name, ie as the generic medicine.) The pressure within the eyeball is naturally maintained by a continuous flow of liquid called aqueous humour through the eyeball. Aqueous humour is produced by a part of the eye called the ciliary body, and it drains out of the eyeball through channels called the trabecular meshwork. If the outflow of aqueous humour is blocked, the aqueous humour builds up inside the eye, increasing the pressure within the eyeball. This pressure needs to be reduced, as otherwise it can damage the optic nerve and impair vision as a result. Timolol blocks beta-receptors that are found on the ciliary body. This action reduces the amount of aqueous humour that is secreted into the eyeball by the ciliary body. Timolol also blocks beta-receptors found on the blood vessels that supply the ciliary body. This causes the blood vessels to constrict, and reduces the amount of watery fluid that filters out of the blood vessels to form aqueous humour. Timolol therefore works by reducing the inflow of aqueous humour into the eyeball, which decreases the pressure within the eye. It is used to treat conditions where there is raised pressure in the eye, such as glaucoma. Sufficient timolol may be absorbed from the eye into the bloodstream to cause side effects on other parts of the body, or to react with medicines being taken by mouth, injection or suppository. You can minimise the amount of medicine that is absorbed into your bloodstream and increase the local action in the eye, by pressing on your tear duct (the corner of the eye closest to the nose) while putting in the eye drops and for a few minutes after. Timoptol eye drops are available in metered-dose bottles (Ocumeter) or preservative-free unit-dose vials.
What is it used for?Raised pressure within the eye (ocular hypertension) Open angle glaucoma Glaucoma caused by another disease of the eye (secondary glaucoma) Warning! This medicine is not to be taken by mouth. When using these eye drops you should take care to not touch the dropper tip to any surface, or to your eye, in order to avoid contaminating the eye drops. Timoptol eye drops are sterile until opened. The metered dose bottles contain a preservative that helps keep the eye drops sterile. Any remaining medicine in the bottle should be carefully disposed of four weeks after the first opening, as after this time it is likely to be contaminated. You may find it helpful to write the date of first opening on the packet. Dispose of carefully, preferably by returning to your pharmacy. The unit dose vials do not contain a preservative and are for single use only. Timoptol eye drops in a metered dose bottle contain the preservative benzalkonium chloride, which can be absorbed by soft contact lenses and cause eye irritation. If you wear soft contact lenses, you should remove them before putting in these eye drops. You should wait at least 15 minutes after using the drops before putting your contact lenses back in. This medicine may cause temporary blurred vision after you have applied it into the eye(s). If affected, do not drive or operate machinary until this has worn off. You should also take into account that this medicine can sometimes cause other visual disturbances, eg double vision, and dizziness or fatigue, all of which may affect your ability to drive or operate machinary. People with diabetes should carefully monitor their blood sugar while using this medicine. This medicine may mask the symptoms of low blood sugar, such as increased heart rate, palpitations, sweating, tremor and nausea. This medicine may increase sensitivity to substances which cause allergy and the seriousness of severe allergic reactions (anaphylaxis). People who experience an anaphylactic reaction while taking this medicine may need larger than normal doses of adrenaline to treat the reaction. Seek further medical advice from your doctor if you have a history of allergy. While using this medicine you should have regular eye examinations. Use with caution in A problem common in the elderly, related to poor control of the working of the heart (sick sinus syndrome) Slowed conduction of electrical messages between the chambers of the heart (1st degree heart block) History of severe heart disease Increase in the acidity of the blood (metabolic acidosis) Hyperthyroidism Diabetes History of allergies History of severe allergic reactions (anaphylaxis) Psoriasis Abnormal muscle weakness (myaesthenia gravis) Not to be used in Allergy to beta-blockers History of asthma History of chronic obstructive pulmonary disease (COPD) Slow heart rate caused by the pacemaker of the heart (sinus bradycardia) Serious defect in the heart’s electrical message pathways resulting in decreased function of the heart (2nd or 3rd degree heart block) Heart failure Failure of the heart to maintain adequate circulation of blood (cardiogenic shock) A severe form of angina pectoris, not caused by exertion (Prinzmetal’s angina) Low blood pressure (hypotension) Narrowing of the blood vessels in the hands, causing numb and painful fingers (Raynaud’s disease) Severe disturbance of blood circulation in the extremities Untreated tumour of the adrenal gland (phaeochromocytoma). This medicine is not recommended for children. This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately. Pregnancy and Breastfeeding Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine. This medicine is not recommended for use in pregnancy unless considered essential by your doctor. If the medicine is continued until delivery, the baby’s heart rate and blood sugar should be carefully monitored for the first three to five days following birth. Seek medical advice from your doctor. This medicine passes into breast milk and may cause a slow heart rate or low blood sugar in a nursing infant. It is recommended that women who need to use this medicine should not breastfeed their infants. Seek medical advice from your doctor. Side effects Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect. Blurred vision Inflammation of the membrane that lines the inside of the eyelids and outside of the eyeball, causing redness and discharge (conjunctivitis) Inflammation of the eyelids (blepharitis) Inflammation of the cornea (keratitis) Dry eyes Double vision Drooping of the upper eyelid (ptosis) Headache Fatigue Chest pain Allergic skin reactions Disturbed sleep Depression Low blood pressure (hypotension) Dizziness Cold hands and feet Slow heart rate (bradycardia) Disturbances of the gut, such as nausea, vomiting, diarrhoea, indigestion Heart block or heart failure Shortness of breath (dyspnoea) The side effects listed above may not include all of the side effects reported by the drug’s manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist. How can this medicine affect other medicines? The timolol in these eye drops can be absorbed into the bloodstream after application to the eye and it may therefore interact with other medicines that you are taking. It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while using this one, to ensure that the combination is safe. If you are using more than one type of eye drop you should administer them at least five minutes apart, to prevent the second drop washing away the first. This medicine should not generally be used in combination with the following medicines: amiodarone beta-blocker medicines taken by mouth, eg atenolol, propranolol calcium channel blockers such as bepridil, diltiazem, nifedipine or verapamil. If this medicine is used by people taking calcium channel blockers such as nifedipine, there may be an increased risk of slow heart rate, low blood pressure or heart failure. If this medicine is used with any of the following there may be an increased risk of slow heart rate: anti-arrhythmic medicines, eg quinidine or disopyramide digoxin. If this medicine is used with clonidine, there is a risk of a rebound increase in blood pressure if the clonidine is stopped suddenly. If the clonidine needs to be stopped, this medicine should be stopped several days before slowly stopping the clonidine. In people with diabetes, timolol can prolong the lowering of blood sugar (hypoglycaemia) caused by insulin or other antidiabetic medicines. People with diabetes should monitor their blood sugar, as timolol can also mask the signs of hypoglycaemia. Other medicines containing the same active ingredient Nyogel Timoptol-LA Timolol eye drops are also available without a brand name, ie as the generic medicine. Timolol ophthalmic What is timolol ophthalmic? Timolol is a beta-blocker that also reduces pressure inside the eye. Timolol ophthalmic (for the eyes) is used to treat open-angle glaucoma and other causes of high pressure inside the eye. Timolol ophthalmic may also be used for other purposes not listed in this medication guide. What is the most important information I should know about timolol ophthalmic? Do not allow the dropper to touch any surface, including the eyes or hands. If the dropper becomes contaminated it could cause an infection in your eye, which can lead to vision loss or serious damage to the eye. Do not use any other eye medication unless your doctor has prescribed it for you. If you use another eye medication, use it at least 10 minutes before or after using timolol ophthalmic. Do not use the medications at the same time. Timolol ophthalmic can cause blurred vision. Be careful if you drive or do anything that requires you to be able to see clearly. What should I discuss with my healthcare provider before using timolol ophthalmic? Do not use this medication if you are allergic to timolol, or if you have: asthma or severe chronic obstructive pulmonary disease (COPD); certain serious heart conditions, especially “AV block”; or severe or uncontrolled congestive heart failure. If you have any of these other conditions, you may need a dose adjustment or special tests to safely use this medication: breathing problems such as bronchitis or emphysema; a history of heart disease or congestive heart failure; diabetes; history of stroke, blood clot, or circulation problems; a thyroid disorder; a muscle disorder such as myasthenia gravis; kidney disease; or liver disease. FDA pregnancy category C. It is not known whether timolol ophthalmic is harmful to an unborn baby. Before using this medication, tell your doctor if you are pregnant or plan to become pregnant during treatment. Timolol ophthalmic passes into breast milk and could cause harm to a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not use this medicine for a child younger than 2 years old. How should I use timolol ophthalmic? Use timolol ophthalmic exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the instructions on your prescription label. Wash your hands before using the eye drops. Do not use this medication while you are wearing contact lenses. Timolol ophthalmic may contain a preservative that can be absorbed by soft contact lenses. Wait at least 15 minutes after using timolol before putting your contact lenses in. To apply the eye drops: Tilt your head back slightly and pull down your lower eyelid. Hold the dropper above the eye with the dropper tip down. Look up and away from the dropper as you squeeze out a drop, then close your eye. Gently press your finger to the inside corner of the eye (near your nose) for about 1 minute to keep the liquid from draining into your tear duct. If you use more than one drop in the same eye, wait about 5 minutes before putting in the next drop. Do not allow the dropper tip to touch any surface, including the eyes or hands. If the dropper becomes contaminated it could cause an infection in your eye, which can lead to vision loss or serious damage to the eye. Do not use the eye drops if the liquid has changed colors or has particles in it. Call your doctor for a new prescription. If you need to have any type of surgery, especially eye surgery, tell the surgeon ahead of time that you are using timolol ophthalmic. You may need to stop using the medicine for a short time. Store this medication at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use. What happens if I miss a dose? Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and use the medicine at the next regularly scheduled time. Do not use extra medicine to make up the missed dose.
What happens if I overdose?Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include feeling dizzy or short of breath, headache, slow heart beat, chest pain, or fainting.
What should I avoid while using timolol ophthalmic?Timolol ophthalmic can cause blurred vision. Be careful if you drive or do anything that requires you to be able to see clearly. Do not use any other eye medication unless your doctor has prescribed it for you. If you use another eye medication, use it at least 10 minutes before or after using timolol ophthalmic. Do not use the medications at the same time.
Timolol ophthalmic side effectsGet emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have any of these serious side effects: swelling or redness of your eyelids; eye redness, discomfort, or sensitivity to light; drainage, crusting, or oozing of your eyes or eyelids; depressed mood, confusion, hallucinations, unusual thoughts or behavior; wheezing, gasping, or other breathing problems; swelling, rapid weight gain; chest pain, slow or uneven heart rate; or feeling short of breath, even with mild exertion. Less serious side effects may include: blurred vision, double vision, drooping eyelid; burning or stinging in your eye; headache, weakness, drowsiness; numbness, tingling, or cold feeling in your hands or feet; ringing in your ears; dry mouth; nausea, diarrhea, loss of appetite, upset stomach; skin rash or worsening psoriasis; sleep problems (insomnia); or cough, stuffy nose. This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.
Timolol ophthalmic Dosing InformationUsual Adult Dose for Intraocular Hypertension: Solution: Initial dose: Instill 1 drop (0.25% solution) in the affected eye(s) twice daily. Maintenance dose: If response is unsatisfactory, may change to 0.5% solution. If satisfactory response is maintained, may decrease dose to once daily. Long-acting solution (Istalol(TM)): Initial dose: Instill 1 drop in the affected eye(s) once daily. If response is unsatisfactory, other pressure-lowering agents (non-beta blockers) may be added. Gel-forming solution: Instill 1 drop in the affected eye(s) once daily. Invert the container and shake once before administration. Usual Adult Dose for Glaucoma (Open Angle): Solution: Initial dose: Instill 1 drop (0.25% solution) in the affected eye(s) twice daily. Maintenance dose: If response is unsatisfactory, may change to 0.5% solution. If satisfactory response is maintained, may decrease dose to once daily. Long-acting solution (Istalol(TM)): Initial dose: Instill 1 drop in the affected eye(s) once daily. If response is unsatisfactory, other pressure-lowering agents (non-beta blockers) may be added. Gel-forming solution: Instill 1 drop in the affected eye(s) once daily. Invert the container and shake once before administration. Timolol ophthalmic solution, Timoptic GENERIC NAME: timolol ophthalmic solution BRAND NAME: Timoptic DRUG CLASS AND MECHANISM: Timolol is a beta- adrenergic blocking agent. Like other beta-adrenergic blocking agents, it mainly blocks the action of the sympathetic (adrenergic) nervous system, for example, on the heart. In addition to its effect on the heart, timolol causes a reduction of the pressure within the eye (intraocular pressure). This effect is thought to be caused by a reduction in the production of the liquid (aqueous humor) within the eye. The precise mechanism of this effect is not known. The reduction in intraocular pressure reduces the risk of damage to the optic nerve and loss of vision in patients with glaucoma. Timolol was approved by the FDA for ocular use in 1978. PRESCRIPTION: yes GENERIC AVAILABLE: yes PREPARATIONS: Ophthalmic solution: 0.25%, 0.5%. There is also a gel-forming solution (Timoptic-XE) in a 0.25% and 0.5% concentration. STORAGE: Ophthalmic solution should be kept at room temperature, 15-30°C (59-86°F) and protected for direct light. PRESCRIBED FOR: Timolol is used for the treatment of glaucoma. (Oral timolol tablets are used for treating high blood pressure and angina, but this dosage form is not discussed here.) DOSING: Both hands should be washed before each use of timolol or any other eye medication. The head should be tilted back and the lower lid pulled down with the index finger to form a pouch. The tip of the dropper should not be touched to the eye or eyelid. The bottle should be squeezed slightly to allow the prescribed number of drops into the pouch. The eye is closed gently for 1 to 2 minutes without blinking. The usual dose is one drop into the affected eye twice daily. Timoptic-XE gel forming solution usually is used once daily. DRUG INTERACTIONS: Combined use of oral beta- adrenergic blocking agents, for example, propranolol (Inderal), atenolol (Tenormin), metoprolol (Lopressor) or carvedilol (Coreg) with ophthalmic timolol can result in additive effects. Thus, patients may experience excessively low blood pressure or reductions in heart rate. PREGNANCY: Although there are no human studies that have examined the effects of oral timolol on the fetus, animal studies have shown adverse effects. Therefore, the physician must weigh the potential risks to the fetus against the potential benefits to the mother. It is unknown if the small amount of timolol that penetrates into the blood after administration into the eye affects the fetus. NURSING MOTHERS: Concentrations of timolol generic in breast milk can be three times those in the mother’s blood after oral administration. It is not known how much, if any timolol appears in breast milk after administration into the eye. Ideally, patients taking timolol should avoid breast-feeding. SIDE EFFECTS: Ophthalmic timolol can cause irritation to the eye which may manifest as pain or dryness in some people. Rarely, timolol eye drops can result in side effects that are seen with other oral beta adrenergic blockers. For example, persons can experience fatigue, insomnia, nausea, slow heart rate, low blood pressure, cold extremities, and shortness of breath or wheezing. Reference: FDA Prescribing Information Timolol ophthalmic Pregnancy and Breastfeeding Warnings Overview If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Timolol Drops while you are pregnant. Timolol Drops are found in breast milk. Do not breast-feed while taking Timolol Drops. Timolol ophthalmic Pregnancy Warnings One case report described the use of timolol ophthalmic drops, acetazolamide, and pilocarpine during pregnancy. The neonate was delivered at 36 weeks’ gestation and suffered hyperbilirubinemia, metabolic acidosis, hypocalcemia, and hypomagnesemia. These complications were believed to be secondary to acetazolamide therapy, and were reversible after treatment. The use of some beta-blockers during human pregnancy has resulted in persistent bradycardia and other signs of beta-blockade. Close observation for signs and symptoms of beta-blockade for at least 48 hours of newborns whose mothers were taking timolol is recommended. Another case report described the use of latanoprost and timolol gel-forming solution during an entire pregnancy. Placental insufficiency occurred, but the infant was normal. Timolol ophthalmic has been assigned to pregnancy category C by the FDA. Animal studies have failed to reveal evidence of teratogenicity at doses approximately 7000 times the systemic exposure following the maximum recommended human ophthalmic dose; while some maternotoxicity and/or fetotoxicity was observed with even higher doses. There are no controlled data from human pregnancy studies. Timolol ophthalmic is only recommended for use during pregnancy when benefit outweighs risk. Timolol ophthalmic Breastfeeding Warnings Timolol has been measured in human milk after use of timolol eyedrops. In one case the milk timolol concentration averaged 5.6 ng/mL 1.5 hours after dosing in a woman who was receiving timolol 0.5% eye drops to one eye twice a day. In this case, even if the infant nursed 4 times daily, receiving 75 mL each time, the daily dose to the nursing infant would be below that expected to produce beta-blockade. Following oral administration data reveal average milk to maternal plasma drug level ratios of approximately 0.80. In one series of nine patients, dosages of timolol 5 mg three times a day were associated with an average milk timolol level of 15.9 ng/mL. After the dosage was increased to 10 mg three times a day in four of the nine patients, the average milk timolol level rose to 41 ng/mL. Timolol is excreted into human milk following oral and ophthalmic administration. No adverse reactions in nursing infants have been reported, but close observation for bradycardia and other signs of beta-blockade in infants exposed to timolol via breast milk is recommended. Timolol is considered compatible with breast-feeding by the American Academy of Pediatrics. The manufacturer recommends that due to the potential for serious adverse reactions in nursing infants, a decision should be made to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother. Timolol ophthalmic Drug Interactions A total of 503 drugs (2821 brand and generic names) are known to interact with timolol ophthalmic. 49 major drug interactions 451 moderate drug interactions 3 minor drug interactions Show all medications in the database that may interact with timolol ophthalmic. Common medications checked in combination with timolol ophthalmic Aspirin Low Strength (aspirin) There were no interactions found in our database between Aspirin Low Strength and timolol ophthalmic However, this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist. Calcium 600 D (calcium/vitamin d) There were no interactions found in our database between Calcium 600 D and timolol ophthalmic However, this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist. Crestor (rosuvastatin) Fish Oil (omega-3 polyunsaturated fatty acids) Lasix (furosemide) furosemide – timolol Applies to:Lasix (furosemide) and timolol ophthalmic MONITOR: Although they are often combined in clinical practice, diuretics and beta-blockers may increase the risk of hyperglycemia and hypertriglyceridemia in some patients, especially in patients with diabetes or latent diabetes. In addition, the risk of QT interval prolongation and arrhythmias (e.g. torsades de pointes) due to sotalol may be increased by potassium-depleting diuretics. MANAGEMENT: Monitoring of serum potassium levels, blood pressure, and blood glucose is recommended during coadministration. Patients should be advised to seek medical assistance if they experience dizziness, weakness, fainting, fast or irregular heartbeats, or loss of blood glucose control. Lexapro (escitalopram) Lipitor (atorvastatin) Lumigan (bimatoprost ophthalmic) MiraLax (polyethylene glycol 3350) Nexium (esomeprazole) Norvasc (amlodipine) amlodipine – timolol Applies to:Norvasc (amlodipine) and timolol ophthalmic MONITOR: Additive reductions in heart rate, cardiac conduction, and cardiac contractility may occur when calcium channel blockers are used concomitantly with beta blockers, particularly in patients with ventricular or conduction abnormalities. While this combination may be useful and effective in some situations, potentially serious cardiovascular adverse effects such as congestive heart failure, severe hypotension, and/or exacerbation of angina may occur. The proposed mechanisms include additive slowing in AV conduction, reduced cardiac contractility secondary to beta-blockade, and decreased peripheral vascular resistance secondary to calcium channel blockade. In addition, some calcium channel blockers may inhibit the CYP450 metabolism of hepatically metabolized beta blockers, resulting in increased serum concentrations. MANAGEMENT: Close clinical monitoring of patient hemodynamic response and tolerance is recommended if a calcium channel blocker is prescribed with a beta blocker, and the dosage of one or both agents adjusted as necessary. The same precaution should be observed when beta blocker ophthalmic solutions are used, since they are systemically absorbed and can produce clinically significant systemic effects even at low or undetectable plasma levels. Timoptic generic. Plavix (clopidogrel) Synthroid (levothyroxine) Travatan (travoprost ophthalmic) Tylenol (acetaminophen) Vitamin B12 (cyanocobalamin) Vitamin D2 (ergocalciferol) Vitamin D3 (cholecalciferol) Xalatan (latanoprost ophthalmic) Zocor (simvastatin)
Timolol Ophthalmic DosageUsual Adult Dose for Intraocular Hypertension Solution: Initial dose: Instill 1 drop (0.25% solution) in the affected eye(s) twice daily. Maintenance dose: If response is unsatisfactory, may change to 0.5% solution. If satisfactory response is maintained, may decrease dose to once daily. Long-acting solution (Istalol(TM)): Initial dose: Instill 1 drop in the affected eye(s) once daily. If response is unsatisfactory, other pressure-lowering agents (non-beta blockers) may be added. Gel-forming solution: Instill 1 drop in the affected eye(s) once daily. Invert the container and shake once before administration. Usual Adult Dose for Glaucoma (Open Angle) Solution: Initial dose: Instill 1 drop (0.25% solution) in the affected eye(s) twice daily. Maintenance dose: If response is unsatisfactory, may change to 0.5% solution. If satisfactory response is maintained, may decrease dose to once daily. Long-acting solution (Istalol(TM)): Initial dose: Instill 1 drop in the affected eye(s) once daily. If response is unsatisfactory, other pressure-lowering agents (non-beta blockers) may be added. Gel-forming solution: Instill 1 drop in the affected eye(s) once daily. Invert the container and shake once before administration. Timolol Glaucoma eye drops Drug Name Timolol Ophthalmic (tye’ moe lole) Other Names Timoptic, Timoptic-XE WHY is Timolol prescribed? Timolol is used to treat glaucoma, a condition in which increased pressure in the eye can lead to gradual loss of vision. Timolol decreases the pressure in the eye. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information. HOW should Timolol be used? Timolol comes as eyedrops and eye gel. Timolol eyedrops usually are applied once or twice a day, at evenly spaced intervals, until pressure in your eyeball is controlled (about 4 weeks). Then you may be able to use it once a day. Timolol gel usually is applied once a day. Follow the directions on your prescription label carefully, and ask doctor or pharmacist to explain any part you do not understand. Use timolol exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor. Timolol controls glaucoma but does not cure it. Continue to use timolol even if you feel well. Do not stop using timolol without talking to your doctor. For eyedrop installation instructions, click here. Timolol SPECIAL PRECAUTIONS Before using Timolol eye drops or eye gel: • tell your doctor and pharmacist if you are allergic to Timolol, beta blockers, or any other drugs. • tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially other eye medications; beta blockers such as atenolol (Tenormin); carteolol (Cartrol); esmolol (Breviblic); labetalol (Normodyne, Trandate); metoprolol (Lopressor); nadolol (Corgard); propranolol (Inderal); sotalol (Betapace); and timolol (Blocadren); quinidine (Quinidex, Quinaglute Dura-Tabs); verapamil (Calan, Isoptin); and vitamins. • tell your doctor if you have or have ever had thyroid, heart, or lung disease; congestive heart failure; or diabetes. • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using timolol, call your doctor immediately. • if you are having surgery, including dental surgery, tell the doctor or dentist that you are using timolol. • if you are using another eyedrop medication, use the eye medications at least 10 minutes apart. What should I do if I FORGET A DOSE of Timolol? Apply the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not apply a double dose to make up for a missed one. What SIDE EFFECTS can Timolol cause? Although side effects from Timolol are not common, they can occur. Tell your doctor if any of these symptoms are severe or do not go away: • eye irritation • double vision • headache • depression • dizziness • upset stomach Generic timolol. If you experience any of the following symptoms, stop using timolol and call your doctor immediately: • slow or irregular heartbeat • difficulty breathing • sudden weight gain • swelling of the feet or lower legs • fainting What STORAGE CONDITIONS are needed for Timolol? Watch the “Vision” Animation Keep Timolol in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). If it becomes discolored or cloudy, obtain a fresh bottle. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication. What OTHER INFORMATION should I know? Keep all appointments with your doctor. Your doctor will order certain eye tests to check your response to timolol. Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription. Timoptic 0.25% and 0.5% (Timolol maleate ophthalmic solution) in ocudose (dispenser) receptor blocking agent. Its chemical name is (-)-1-(tert-butylamino)-3-[(4-morpholino-1,2,5-thiadiazol-3-yl)oxy]-2-propanol maleate (1:1) (salt). Timolol maleate possesses an asymmetric carbon atom in its structure and is provided as the levo-isomer. Timolol maleate has a molecular weight of 432.50. It is a white, odorless, crystalline powder which is soluble in water, methanol, and alcohol. Timolol maleate is stable at room temperature. Timolol maleate ophthalmic solution is supplied in two formulations: Ophthalmic Solution TIMOPTIC* (timolol maleate ophthalmic solution), which contains the preservative benzalkonium chloride; and Ophthalmic Solution TIMOPTIC* (timolol maleate ophthalmic solution), the preservative-free formulation. Preservative-free Ophthalmic Solution TIMOPTIC is supplied in OCUDOSE*, a unit dose container, as a sterile, isotonic, buffered, aqueous solution of timolol maleate in two dosage strengths: Each mL of Preservative-free TIMOPTIC in OCUDOSE 0.25% contains 2.5 mg of timolol (3.4 mg of timolol maleate). The pH of the solution is approximately 7.0, and the osmolarity is 252-328 mOsm. Each mL of Preservative-free TIMOPTIC in OCUDOSE 0.5% contains 5 mg of timolol (6.8 mg of timolol maleate). Inactive ingredients: monobasic and dibasic sodium phosphate, sodium hydroxide to adjust pH, and water for injection.
CLINICAL PHARMACOLOGYMechanism of Action Timolol maleate is a beta1 and beta2 (non-selective) adrenergic receptor blocking agent that does not have significant intrinsic sympathomimetic, direct myocardial depressant, or local anesthetic (membrane-stabilizing) activity. Beta-adrenergic receptor blockade reduces cardiac output in both healthy subjects and patients with heart disease. In patients with severe impairment of myocardial function, beta-adrenergic receptor blockade may inhibit the stimulatory effect of the sympathetic nervous system necessary to maintain adequate cardiac function. Beta-adrenergic receptor blockade in the bronchi and bronchioles results in increased airway resistance from unopposed parasympathetic activity. Such an effect in patients with asthma or other bronchospastic conditions is potentially dangerous. TIMOPTIC (timolol maleate ophthalmic solution), when applied topically on the eye, has the action of reducing elevated as well as normal intraocular pressure, whether or not accompanied by glaucoma. Elevated intraocular pressure is a major risk factor in the pathogenesis of glaucomatous visual field loss. The higher the level of intraocular pressure, the greater the likelihood of glaucomatous visual field loss and optic nerve damage. The onset of reduction in intraocular pressure following administration of TIMOPTIC (timolol maleate ophthalmic solution) can usually be detected within one-half hour after a single dose. The maximum effect usually occurs in one to two hours and significant lowering of intraocular pressure can be maintained for periods as long as 24 hours with a single dose. Repeated observations over a period of one year indicate that the intraocular pressure-lowering effect of TIMOPTIC (timolol maleate ophthalmic solution) is well maintained. The precise mechanism of the ocular hypotensive action of TIMOPTIC (timolol maleate ophthalmic solution) is not clearly established at this time. Tonography and fluorophotometry studies in man suggest that its predominant action may be related to reduced aqueous formation. However, in some studies a slight increase in outflow facility was also observed. Pharmacokinetics In a study of plasma drug concentration in six subjects, the systemic exposure to timolol was determined following twice daily administration of TIMOPTIC 0.5%. The mean peak plasma concentration following morning dosing was 0.46 ng/mL and following afternoon dosing was 0.35 ng/mL. Clinical Studies In controlled multiclinic studies in patients with untreated intraocular pressures of 22 mmHg or greater, TIMOPTIC (timolol maleate ophthalmic solution) 0.25 percent or 0.5 percent administered twice a day produced a greater reduction in intraocular pressure than 1, 2, 3, or 4 percent pilocarpine solution administered four times a day or 0.5, 1, or 2 percent epinephrine hydrochloride solution administered twice a day. In these studies, TIMOPTIC (timolol maleate ophthalmic solution) was generally well tolerated and produced fewer and less severe side effects than either pilocarpine or epinephrine. A slight reduction of resting heart rate in some patients receiving TIMOPTIC (timolol maleate ophthalmic solution) (mean reduction 2.9 beats/minute standard deviation 10.2) was observed. INDICATIONS AND USAGE Preservative-free TIMOPTIC in OCUDOSE is indicated in the treatment of elevated intraocular pressure in patients with ocular hypertension or open-angle glaucoma. Preservative-free TIMOPTIC in OCUDOSE may be used when a patient is sensitive to the preservative in TIMOPTIC (timolol maleate ophthalmic solution), benzalkonium chloride, or when use of a preservative-free topical medication is advisable. CONTRAINDICATIONS Preservative-free TIMOPTIC in OCUDOSE is contraindicated in patients with (1) bronchial asthma; (2) a history of bronchial asthma; (3) severe chronic obstructive pulmonary disease (see WARNINGS); (4) sinus bradycardia; (5) second or third degree atrioventricular block; (6) overt cardiac failure (see WARNINGS); (7) cardiogenic shock; or (8) hypersensitivity to any component of this product. WARNINGS As with many topically applied ophthalmic drugs, this drug is absorbed systemically. The same adverse reactions found with systemic administration of beta-adrenergic blocking agents may occur with topical administration. For example, severe respiratory reactions and cardiac reactions, including death due to bronchospasm in patients with asthma, and rarely death in association with cardiac failure, have been reported following systemic or ophthalmic administration of timolol maleate (see CONTRAINDICATIONS). Cardiac Failure Sympathetic stimulation may be essential for support of the circulation in individuals with diminished myocardial contractility, and its inhibition by beta-adrenergic receptor blockade may precipitate more severe failure. In Patients Without a History of Cardiac Failure continued depression of the myocardium with beta-blocking agents over a period of time can, in some cases, lead to cardiac failure. At the first sign or symptom of cardiac failure, Preservative-free TIMOPTIC in OCUDOSE should be discontinued. Obstructive Pulmonary Disease Patients with chronic obstructive pulmonary disease (e.g., chronic bronchitis, emphysema) of mild or moderate severity, bronchospastic disease, or a history of bronchospastic disease (other than bronchial asthma or a history of bronchial asthma, in which TIMOPTIC in OCUDOSE is contraindicated [see CONTRAINDICATIONS]) should, in general, not receive beta-blockers, including Preservativefree TIMOPTIC in OCUDOSE. Major Surgery The necessity or desirability of withdrawal of beta-adrenergic blocking agents prior to major surgery is controversial. Beta-adrenergic receptor blockade impairs the ability of the heart to respond to beta-adrenergically mediated reflex stimuli. This may augment the risk of general anesthesia in surgical procedures. Some patients receiving beta-adrenergic receptor blocking agents have experienced protracted severe hypotension during anesthesia. Difficulty in restarting and maintaining the heartbeat has also been reported. For these reasons, in patients undergoing elective surgery, some authorities recommend gradual withdrawal of beta-adrenergic receptor blocking agents. If necessary during surgery, the effects of beta-adrenergic blocking agents may be reversed by sufficient doses of adrenergic agonists. Diabetes Mellitus Beta-adrenergic blocking agents should be administered with caution in patients subject to spontaneous hypoglycemia or to diabetic patients (especially those with labile diabetes) who are receiving insulin or oral hypoglycemic agents. Beta-adrenergic receptor blocking agents may mask the signs and symptoms of acute hypoglycemia. Thyrotoxicosis Beta-adrenergic blocking agents may mask certain clinical signs (e.g., tachycardia) of hyperthyroidism. Patients suspected of developing thyrotoxicosis should be managed carefully to avoid abrupt withdrawal of beta-adrenergic blocking agents that might precipitate a thyroid storm. PRECAUTIONS General Because of potential effects of beta-adrenergic blocking agents on blood pressure and pulse, these agents should be used with caution in patients with cerebrovascular insufficiency. If signs or symptoms suggesting reduced cerebral blood flow develop following initiation of therapy with Preservative-free TIMOPTIC in OCUDOSE, alternative therapy should be considered. Choroidal detachment after filtration procedures has been reported with the administration of aqueous suppressant therapy (e.g. timolol). Angle-closure glaucoma: In patients with angle-closure glaucoma, the immediate objective of treatment is to reopen the angle. This requires constricting the pupil. Timolol maleate has little or no effect on the pupil. TIMOPTIC in OCUDOSE should not be used alone in the treatment of angle-closure glaucoma. Anaphylaxis: While taking beta-blockers, patients with a history of atopy or a history of severe anaphylactic reactions to a variety of allergens may be more reactive to repeated accidental, diagnostic, or therapeutic challenge with such allergens. Such patients may be unresponsive to the usual doses of epinephrine used to treat anaphylactic reactions. Muscle Weakness: Beta-adrenergic blockade has been reported to potentiate muscle weakness consistent with certain myasthenic symptoms (e.g., diplopia, ptosis, and generalized weakness). Timolol has been reported rarely to increase muscle weakness in some patients with myasthenia gravis or myasthenic symptoms. Information for Patients Patients should be instructed about the use of Preservative-free TIMOPTIC in OCUDOSE. Since sterility cannot be maintained after the individual unit is opened, patients should be instructed to use the product immediately after opening, and to discard the individual unit and any remaining contents immediately after use. Patients with bronchial asthma, a history of bronchial asthma, severe chronic obstructive pulmonary disease, sinus bradycardia, second or third degree atrioventricular block, or cardiac failure should be advised not to take this product. (See CONTRAINDICATIONS.) Drug Interactions Although TIMOPTIC (timolol maleate ophthalmic solution) used alone has little or no effect on pupil size, mydriasis resulting from concomitant therapy with TIMOPTIC (timolol maleate ophthalmic solution) and epinephrine has been reported occasionally. Beta-adrenergic blocking agents: Patients who are receiving a beta-adrenergic blocking agent orally and Preservative-free TIMOPTIC in OCUDOSE should be observed for potential additive effects of beta-blockade, both systemic and on intraocular pressure. The concomitant use of two topical beta-adrenergic blocking agents is not recommended. Calcium antagonists: Caution should be used in the coadministration of beta-adrenergic blocking agents, such as Preservative-free TIMOPTIC in OCUDOSE, and oral or intravenous calcium antagonists, because of possible atrioventricular conduction disturbances, left ventricular failure, and hypotension. In patients with impaired cardiac function, coadministration should be avoided. Catecholamine-depleting drugs: Close observation of the patient is recommended when a beta blocker is administered to patients receiving catecholamine-depleting drugs such as reserpine, because of possible additive effects and the production of hypotension and/or marked bradycardia, which may result in vertigo, syncope, or postural hypotension. Digitalis and calcium antagonists: The concomitant use of beta-adrenergic blocking agents with digitalis and calcium antagonists may have additive effects in prolonging atrioventricular conduction time. CYP2D6 inhibitors: Potentiated systemic beta-blockade (e.g., decreased heart rate, depression) has been reported during combined treatment with CYP2D6 inhibitors (e.g., quinidine, SSRIs) and timolol. Timolol no prescription. Clonidine: Oral beta-adrenergic blocking agents may exacerbate the rebound hypertension which can follow the withdrawal of clonidine. There have been no reports of exacerbation of rebound hypertension with ophthalmic timolol maleate. Injectable epinephrine: (See PRECAUTIONS, General, Anaphylaxis) Carcinogenesis, Mutagenesis, Impairment of Fertility In a two-year oral study of timolol maleate administered orally to rats, there was a statistically significant increase in the incidence of adrenal pheochromocytomas in male rats administered 300 mg/kg/day (approximately 42,000 times the systemic exposure following the maximum recommended human ophthalmic dose). Similar differences were not observed in rats administered oral doses equivalent to approximately 14,000 times the maximum recommended human ophthalmic dose. In a lifetime oral study in mice, there were statistically significant increases in the incidence of benign and malignant pulmonary tumors, benign uterine polyps and mammary adenocarcinomas in female mice at 500 mg/kg/day (approximately 71,000 times the systemic exposure following the maximum recommended human ophthalmic dose), but not at 5 or 50 mg/kg/day (approximately 700 or 7,000 times, respectively, the systemic exposure following the maximum recommended human ophthalmic dose). In a subsequent study in female mice, in which post-mortem examinations were limited to the uterus and the lungs, a statistically significant increase in the incidence of pulmonary tumors was again observed at 500 mg/kg/day. The increased occurrence of mammary adenocarcinomas was associated with elevations in serum prolactin which occurred in female mice administered oral timolol at 500 mg/kg/day, but not at doses of 5 or 50 mg/kg/day. An increased incidence of mammary adenocarcinomas in rodents has been associated with administration of several other therapeutic agents that elevate serum prolactin, but no correlation between serum prolactin levels and mammary tumors has been established in humans. Furthermore, in adult human female subjects who received oral dosages of up to 60 mg of timolol maleate (the maximum recommended human oral dosage), there were no clinically meaningful changes in serum prolactin. Timolol maleate was devoid of mutagenic potential when tested in vivo (mouse) in the micronucleus test and cytogenetic assay (doses up to 800 mg/kg) and in vitro in a neoplastic cell transformation assay (up to 100 mcg/mL). In Ames tests the highest concentrations of timolol employed, 5,000 or 10,000 mcg/plate, were associated with statistically significant elevations of revertants observed with tester strain TA100 (in seven replicate assays), but not in the remaining three strains. In the assays with tester strain TA100, no consistent dose response relationship was observed, and the ratio of test to control revertants did not reach 2. A ratio of 2 is usually considered the criterion for a positive Ames test. Reproduction and fertility studies in rats demonstrated no adverse effect on male or female fertility at doses up to 21,000 times the systemic exposure following the maximum recommended human ophthalmic dose. Pregnancy: Teratogenic Effects — Pregnancy Category C. Teratogenicity studies with timolol in mice, rats and rabbits at oral doses up to 50 mg/kg/day (7,000 times the systemic exposure following the maximum recommended human ophthalmic dose) demonstrated no evidence of fetal malformations. Although delayed fetal ossification was observed at this dose in rats, there were no adverse effects on postnatal development of offspring. Doses of 1000 mg/kg/day (142,000 times the systemic exposure following the maximum recommended human ophthalmic dose) were maternotoxic in mice and resulted in an increased number of fetal resorptions. Increased fetal resorptions were also seen in rabbits at doses of 14,000 times the systemic exposure following the maximum recommended human ophthalmic dose, in this case without apparent maternotoxicity. There are no adequate and well-controlled studies in pregnant women. Preservative-free TIMOPTIC in OCUDOSE should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Nursing Mothers Timolol maleate has been detected in human milk following oral and ophthalmic drug administration. Because of the potential for serious adverse reactions from timolol in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Pediatric Use Safety and effectiveness in pediatric patients have not been established. Geriatric Use No overall differences in safety or effectiveness have been observed between elderly and younger patients. ADVERSE REACTIONS The most frequently reported adverse experiences have been burning and stinging upon instillation (approximately one in eight patients). The following additional adverse experiences have been reported less frequently with ocular administration of this or other timolol maleate formulations: BODY AS A WHOLE Headache, asthenia/fatigue, and chest pain. CARDIOVASCULAR Bradycardia, arrhythmia, hypotension, hypertension,syncope, heart block, cerebral vascular accident, cerebral TIMOPTIC® (timolol maleate ophthalmic solution) in OCUDOSE® (dispenser) ischemia, cardiac failure, worsening of angina pectoris, palpitation, cardiac arrest, pulmonary edema, edema, claudication, Raynaud’s phenomenon, and cold hands and feet. DIGESTIVE Nausea, diarrhea, dyspepsia, anorexia, and dry mouth. IMMUNOLOGIC Systemic lupus erythematosus. NERVOUS SYSTEM/PSYCHIATRIC Dizziness, increase in signs and symptoms of myasthenia gravis, paresthesia, somnolence, insomnia, nightmares, behavioral changes and psychic disturbances including depression, confusion, hallucinations, anxiety, disorientation, nervousness, and memory loss. SKIN Alopecia and psoriasiform rash or exacerbation of psoriasis. HYPERSENSITIVITY Signs and symptoms of systemic allergic reactions including anaphylaxis, angioedema, urticaria, and localized and generalized rash. RESPIRATORY Bronchospasm (predominantly in patients with pre-existing bronchospastic disease), respiratory failure, dyspnea, nasal congestion, cough and upper respiratory infections. ENDOCRINE Masked symptoms of hypoglycemia in diabetic patients (see WARNINGS). SPECIAL SENSES Signs and symptoms of ocular irritation including conjunctivitis, blepharitis, keratitis, ocular pain, discharge (e.g., crusting), foreign body sensation, itching and tearing, and dry eyes; ptosis; decreased corneal sensitivity; cystoid macular edema; visual disturbances including refractive changes and diplopia; pseudopemphigoid; choroidal detachment following filtration surgery (see PRECAUTIONS, General); and tinnitus. UROGENITAL Retroperitoneal fibrosis, decreased libido, impotence, and Peyronie’s disease. The following additional adverse effects have been reported in clinical experience with ORAL timolol maleate or other ORAL beta blocking agents, and may be considered potential effects of ophthalmic timolol maleate: Allergic: Erythematous rash, fever combined with aching and sore throat, laryngospasm with respiratory distress; Body as a Whole: Extremity pain, decreased exercise tolerance, weight loss; Cardiovascular: Worsening of arterial insufficiency, vasodilatation; Digestive: Gastrointestinal pain, hepatomegaly, vomiting, mesenteric arterial thrombosis, ischemic colitis; Hematologic: Nonthrombocytopenic purpura; thrombocytopenic purpura; agranulocytosis; Endocrine: Hyperglycemia, hypoglycemia; Skin: Pruritus, skin irritation, increased igmentation, sweating; Musculoskeletal: Arthralgia; Nervous System/Psychiatric: Vertigo, local weakness, diminished concentration, reversible mental depression progressing to catatonia, an acute reversible syndrome characterized by disorientation for time and place, emotional lability, slightly clouded sensorium, and decreased performance on neuropsychometrics; Respiratory: Rales, bronchial obstruction; Urogenital: Urination difficulties. OVERDOSAGE There have been reports of inadvertent overdosage with Ophthalmic Solution TIMOPTIC (timolol maleate ophthalmic solution) resulting in systemic effects similar to those seen with systemic beta-adrenergic blocking agents such as dizziness, headache, shortness of breath, bradycardia, bronchospasm, and cardiac arrest (see also ADVERSE REACTIONS). Overdosage has been reported with Tablets BLOCADREN* (timolol maleate tablets). A 30 year old female ingested 650 mg of BLOCADREN (maximum recommended oral daily dose is 60 mg) and experienced second and third degree heart block. She recovered without treatment but approximately two months later developed irregular heartbeat, hypertension, dizziness, tinnitus, faintness, increased pulse rate, and borderline first degree heart block. An in vitro hemodialysis study, using 14C timolol added to human plasma or whole blood, showed that timolol was readily dialyzed from these fluids; however, a study of patients with renal failure showed that timolol did not dialyze readily. DOSAGE AND ADMINISTRATION Preservative-free TIMOPTIC in OCUDOSE is a sterile solution that does not contain a preservative. The solution from one individual unit is to be used immediately after opening for administration to one or both eyes. Since sterility cannot be guaranteed after the individual unit is opened, the remaining contents should be discarded immediately after administration. Preservative-free TIMOPTIC in OCUDOSE is available in concentrations of 0.25 and 0.5 percent. The usual starting dose is one drop of 0.25 percent Preservative-free TIMOPTIC in OCUDOSE in the affected eye(s) administered twice a day. Apply enough gentle pressure on the individual container to obtain a single drop of solution. If the clinical response is not adequate, the dosage may be changed to one drop of 0.5 percent solution in the affected eye(s) administered twice a day. Since in some patients the pressure-lowering response to Preservative-free TIMOPTIC in OCUDOSE may require a few weeks to stabilize, evaluation should include a determination of intraocular pressure after approximately 4 weeks of treatment with Preservative-free TIMOPTIC in OCUDOSE. If the intraocular pressure is maintained at satisfactory levels, the dosage schedule may be changed to one drop once a day in the affected eye(s). Because of diurnal variations in intraocular pressure, satisfactory response to the once-a-day dose is best determined by measuring theintraocular pressure at different times during the day. Dosages above one drop of 0.5 percent TIMOPTIC (timolol maleate ophthalmic solution) twice a day generally have not been shown to produce further reduction in intraocular pressure. If the patient’s intraocular pressure is still not at a satisfactory level on this regimen, concomitant therapy with other agent(s) for lowering intraocular pressure can be instituted taking into consideration that the preparation(s) used concomitantly may contain one or more preservatives. The concomitant use of two topical beta-adrenergic blocking agents is not recommended. (See PRECAUTIONS, Drug Interactions, Beta-adrenergic blocking agents.)
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