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Timolol
Chemical compound

Timolol is a beta blocker medication used either by mouth or as eye drops. As eye drops it is used to treat increased pressure inside the eye such as in ocular hypertension and glaucoma. By mouth it is used for high blood pressure, chest pain due to insufficient blood flow to the heart, to prevent further complications after a heart attack, and to prevent migraines.

Common side effects with the drops is irritation of the eye. Common side effects by mouth include tiredness, slow heart beat, itchiness, and shortness of breath. Other side effects include masking the symptoms of low blood sugar in those with diabetes. Use is not recommended in those with asthma, uncompensated heart failure, or chronic obstructive pulmonary disease (COPD). It is unclear if use during pregnancy is safe for the fetus. Timolol is a non-selective beta blocker.

Timolol was patented in 1968, and came into medical use in 1978. It is on the World Health Organization's List of Essential Medicines. Timolol is available as a generic medication. In 2022, it was the 155th most commonly prescribed medication in the United States, with more than 3 million prescriptions.

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Medical uses

By mouth

In its by mouth or oral form, it is used:

The combination of timolol and the alpha-1 blocker prazosin has sedative effects.18

Eye drops

In its eye drop form it is used to treat open-angle and, occasionally, secondary glaucoma.1920 The mechanism of action of timolol is probably the reduction of the formation of aqueous humor21 in the ciliary body in the eye. It was the first beta blocker approved for topical use in treatment of glaucoma in the United States (1978).22 When used by itself, it depresses intraocular pressure (IOP) 18–34% below baseline within first few treatments. However, there are short-term escape and long-term drift effects in some people. That is, tolerance develops. It may reduce the extent of the daytime IOP curve up to 50%. The IOP is higher during sleep. Efficacy of timolol in lowering IOP during the sleep period may be limited.232425 It is a 5–10× more potent beta blocker than propranolol. Timolol is light-sensitive; it is usually preserved with 0.01% benzalkonium chloride (BAC), but also comes BAC-free. It can also be used in combination with pilocarpine, carbonic anhydrase inhibitors26 or prostaglandin analogs.27

A Cochrane review compared the effect of timolol versus brimonidine in slowing the progression of open angle glaucoma in adults but found insufficient evidence to come to conclusions.28

On the skin

In its gel form it is used on the skin to treat infantile hemangiomas.29

Contraindications

The medication should not be taken by individuals with:30

Side effects

The most serious possible side effects include cardiac arrhythmias and severe bronchospasms.32 Timolol can also lead to fainting, congestive heart failure, depression, confusion, worsening of Raynaud's syndrome and impotence.33

Side effects when given in the eye include: burning sensation, eye redness, superficial punctate keratopathy, corneal numbness.3435

Formulations

It is available in tablet and liquid formulations.3637

For ophthalmic use, timolol is also available combined:

Brand names

Timolol is sold under many brand names worldwide.38 Timolol eye drops are sold under the brand names Timoptic and Istalol among others.3940

References

  1. "Timolol eent". The American Society of Health-System Pharmacists. Archived from the original on 28 December 2016. Retrieved 8 December 2016. https://www.drugs.com/monograph/timolol-eent.html ↩

  2. "Timolol Maleate". The American Society of Health-System Pharmacists. Archived from the original on 28 December 2016. Retrieved 8 December 2016. https://www.drugs.com/monograph/timolol-maleate.html ↩

  3. "Timolol eent". The American Society of Health-System Pharmacists. Archived from the original on 28 December 2016. Retrieved 8 December 2016. https://www.drugs.com/monograph/timolol-eent.html ↩

  4. "Timolol Maleate". The American Society of Health-System Pharmacists. Archived from the original on 28 December 2016. Retrieved 8 December 2016. https://www.drugs.com/monograph/timolol-maleate.html ↩

  5. "Timolol eent". The American Society of Health-System Pharmacists. Archived from the original on 28 December 2016. Retrieved 8 December 2016. https://www.drugs.com/monograph/timolol-eent.html ↩

  6. "Timolol Maleate". The American Society of Health-System Pharmacists. Archived from the original on 28 December 2016. Retrieved 8 December 2016. https://www.drugs.com/monograph/timolol-maleate.html ↩

  7. "Timolol eent". The American Society of Health-System Pharmacists. Archived from the original on 28 December 2016. Retrieved 8 December 2016. https://www.drugs.com/monograph/timolol-eent.html ↩

  8. "Timolol eent". The American Society of Health-System Pharmacists. Archived from the original on 28 December 2016. Retrieved 8 December 2016. https://www.drugs.com/monograph/timolol-eent.html ↩

  9. "Timolol ophthalmic Use During Pregnancy". The American Society of Health-System Pharmacists. Archived from the original on 28 December 2016. Retrieved 28 December 2016. https://www.drugs.com/pregnancy/timolol-ophthalmic.html ↩

  10. "Timolol eent". The American Society of Health-System Pharmacists. Archived from the original on 28 December 2016. Retrieved 8 December 2016. https://www.drugs.com/monograph/timolol-eent.html ↩

  11. Fischer J, Ganellin CR (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 460. ISBN 9783527607495. Archived from the original on 28 December 2016. 9783527607495 ↩

  12. World Health Organization (2023). The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization. hdl:10665/371090. WHO/MHP/HPS/EML/2023.02. /wiki/World_Health_Organization ↩

  13. "Timolol eent". The American Society of Health-System Pharmacists. Archived from the original on 28 December 2016. Retrieved 8 December 2016. https://www.drugs.com/monograph/timolol-eent.html ↩

  14. "Competitive Generic Therapy Approvals". U.S. Food and Drug Administration (FDA). 29 June 2023. Archived from the original on 29 June 2023. Retrieved 29 June 2023. https://www.fda.gov/drugs/generic-drugs/competitive-generic-therapy-approvals ↩

  15. "The Top 300 of 2022". ClinCalc. Archived from the original on 30 August 2024. Retrieved 30 August 2024. https://clincalc.com/DrugStats/Top300Drugs.aspx ↩

  16. "Timolol Drug Usage Statistics, United States, 2013 - 2022". ClinCalc. Retrieved 30 August 2024. https://clincalc.com/DrugStats/Drugs/Timolol ↩

  17. Marcus DA, Bain PA (27 February 2009). Effective Migraine Treatment in Pregnant and Lactating Women: A Practical Guide. シュプリンガー・ジャパン株式会社. pp. 141–. ISBN 978-1-60327-438-8. Archived from the original on 5 November 2017. Retrieved 14 November 2010. 978-1-60327-438-8 ↩

  18. Atkin T, Comai S, Gobbi G (April 2018). "Drugs for Insomnia beyond Benzodiazepines: Pharmacology, Clinical Applications, and Discovery". Pharmacol Rev. 70 (2): 197–245. doi:10.1124/pr.117.014381. PMID 29487083. S2CID 3578916. /wiki/Gabriella_Gobbi ↩

  19. "Timolol eent". The American Society of Health-System Pharmacists. Archived from the original on 28 December 2016. Retrieved 8 December 2016. https://www.drugs.com/monograph/timolol-eent.html ↩

  20. "Timolol Ophthalmic". MedlinePlus. 15 April 2017. Retrieved 31 December 2019. https://medlineplus.gov/druginfo/meds/a682043.html ↩

  21. "Timolol eent". The American Society of Health-System Pharmacists. Archived from the original on 28 December 2016. Retrieved 8 December 2016. https://www.drugs.com/monograph/timolol-eent.html ↩

  22. Sambhara D, Aref AA (January 2014). "Glaucoma management: relative value and place in therapy of available drug treatments". Therapeutic Advances in Chronic Disease. 5 (1): 30–43. doi:10.1177/2040622313511286. PMC 3871276. PMID 24381726. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3871276 ↩

  23. Liu JH, Kripke DF, Weinreb RN (September 2004). "Comparison of the nighttime effects of once-daily timolol and latanoprost on intraocular pressure". American Journal of Ophthalmology. 138 (3): 389–95. doi:10.1016/j.ajo.2004.04.022. PMID 15364220. /wiki/Doi_(identifier) ↩

  24. Liu JH, Medeiros FA, Slight JR, Weinreb RN (March 2009). "Comparing diurnal and nocturnal effects of brinzolamide and timolol on intraocular pressure in patients receiving latanoprost monotherapy". Ophthalmology. 116 (3): 449–54. doi:10.1016/j.ophtha.2008.09.054. PMID 19157559. /wiki/Doi_(identifier) ↩

  25. Liu JH, Slight JR, Vittitow JL, Scassellati Sforzolini B, Weinreb RN (September 2016). "Efficacy of Latanoprostene Bunod 0.024% Compared With Timolol 0.5% in Lowering Intraocular Pressure Over 24 Hours". American Journal of Ophthalmology. 169: 249–257. doi:10.1016/j.ajo.2016.04.019. PMID 27457257. https://doi.org/10.1016%2Fj.ajo.2016.04.019 ↩

  26. Strohmaier K, Snyder E, Adamsons I (July 1998). "A multicenter study comparing dorzolamide and pilocarpine as adjunctive therapy to timolol: patient preference and impact on daily life". Journal of the American Optometric Association. 69 (7): 441–51. PMID 9697378. /wiki/PMID_(identifier) ↩

  27. "Ganfort 0.3 mg/ml + 5 mg/ml eye drops, solution - Summary of Product Characteristics (SmPC)". (emc). 20 February 2020. Retrieved 1 March 2020. https://www.medicines.org.uk/emc/product/204/smpc ↩

  28. Sena DF, Lindsley K (January 2017). "Neuroprotection for treatment of glaucoma in adults". The Cochrane Database of Systematic Reviews. 1 (1): CD006539. doi:10.1002/14651858.CD006539.pub4. PMC 5370094. PMID 28122126. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5370094 ↩

  29. Novoa M, Baselga E, Beltran S, Giraldo L, Shahbaz A, Pardo-Hernandez H, et al. (April 2018). "Interventions for infantile haemangiomas of the skin". The Cochrane Database of Systematic Reviews. 2018 (4): CD006545. doi:10.1002/14651858.CD006545.pub3. PMC 6513200. PMID 29667726. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513200 ↩

  30. "Timolol Maleate tablet". DailyMed. 17 August 2006. Retrieved 1 December 2019. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=57c62928-63d8-4505-9b9e-c085a3a12c95 ↩

  31. "Package leaflet: Information for the user Timolol" (PDF). hpra.ie. Archived from the original (PDF) on 16 August 2018. Retrieved 15 August 2018. https://web.archive.org/web/20180816025712/https://www.hpra.ie/img/uploaded/swedocuments/PIL-2183359-20032017174542-636256287433370000.pdf ↩

  32. "Timolol Maleate tablet". DailyMed. 17 August 2006. Retrieved 1 December 2019. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=57c62928-63d8-4505-9b9e-c085a3a12c95 ↩

  33. "Timolol Maleate tablet". DailyMed. 17 August 2006. Retrieved 1 December 2019. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=57c62928-63d8-4505-9b9e-c085a3a12c95 ↩

  34. "Betimol- timolol solution". DailyMed. 18 March 2010. Retrieved 1 December 2019. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=00f62dd1-dad2-4892-8a5d-21e5e54509ce ↩

  35. "Timolol Ophthalmic". MedlinePlus. 15 April 2017. Retrieved 31 December 2019. https://medlineplus.gov/druginfo/meds/a682043.html ↩

  36. "Timolol Maleate tablet". DailyMed. 17 August 2006. Retrieved 1 December 2019. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=57c62928-63d8-4505-9b9e-c085a3a12c95 ↩

  37. "Betimol- timolol solution". DailyMed. 18 March 2010. Retrieved 1 December 2019. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=00f62dd1-dad2-4892-8a5d-21e5e54509ce ↩

  38. "Timolol". Drugs.com. Archived from the original on 7 March 2016. Retrieved 28 December 2016. https://www.drugs.com/international/timolol.html ↩

  39. "Generic Istalol Availability". Drugs.com. Retrieved 20 June 2019. https://www.drugs.com/availability/generic-istalol.html ↩

  40. "Istalol". Drugs.com. 1 August 2018. Retrieved 19 July 2019. https://www.drugs.com/pro/istalol.html ↩