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What is Timolol
Timolol is a nonselective, beta-adrenergic receptor antagonist similar to propranolol and nadolol.
Timolol does not demonstrate appreciable intrinsic sympathomimetic or membrane-stabilizing activities.
Like propranolol, timolol possesses a relatively high degree of lipid solubility and is subject to first-pass metabolism by the liver.
Timolol is available as oral tablets (Blocadren) and in a variety of ophthalmic formulations.
Timolol maleate was first approved by the FDA for optical use in 1978, and for oral use in 1981.
The US patents for Timoptic ophthalmic solution (timolol maleate) and Timoptic-XE gel-forming ophthalmic drops expired on September 26, 1995 and September 25, 1996, respectively.
Betimol, an ophthalmic formulation of timolol hemihydrate, was approved in 1995; this product lacks an equivalent generic salt formulation.
Istalol, a once-daily timolol ophthalmic solution, was approved by the FDA on June 4, 2004.
Indications
- angina
- glaucoma
- hypertension
- migraine prophylaxis
- myocardial infarction prophylaxis
- ocular hypertension
- reduction of cardiovascular mortality
- tremor
Side Effects
- agranulocytosis
- alopecia
- anaphylactoid reactions
- angina
- angioedema
- arrhythmia exacerbation
- arthralgia
- asthenia
- AV block
- blurred vision
- bradycardia
- bronchospasm
- cardiac arrest
- chest pain (unspecified)
- confusion
- conjunctivitis
- cough
- depression
- diabetes mellitus
- diaphoresis
- diarrhea
- diplopia
- dizziness
- drowsiness
- dyspepsia
- dyspnea
- edema
- elevated hepatic enzymes
- emotional lability
- exfoliative dermatitis
- fatigue
- fever
- foreign body sensation
- hallucinations
- headache
- heart failure
- hepatomegaly
- hyperglycemia
- hyperhidrosis
- hypertension
- hypertriglyceridemia
- hypoglycemia
- hypotension
- impotence (erectile dysfunction)
- insomnia
- lacrimation
- laryngospasm
- libido decrease
- memory impairment
- musculoskeletal pain
- myalgia
- myasthenia
- nausea
- nightmares
- ocular discharge
- ocular irritation
- ocular pain
- ocular pruritus
- palpitations
- paresthesias
- pruritus
- psoriasis
- ptosis
- pulmonary edema
- purpura
- rash
- sinus tachycardia
- skin hyperpigmentation
- skin irritation
- syncope
- tremor
- urticaria
- vertigo
- vomiting
- weakness
- withdrawal
- xerosis
Monitoring Parameters
- blood pressure
- heart rate
- intraocular pressure
- ophthalmologic exam
- serum creatinine/BUN
Contraindications
- abrupt discontinuation
- acute bronchospasm
- asthma
- AV block
- beta-blocker hypersensitivity
- bradycardia
- breast-feeding
- bronchitis
- cardiogenic shock
- cerebrovascular disease
- children
- chronic obstructive pulmonary disease (COPD)
- contact lenses
- depression
- diabetes mellitus
- dialysis
- driving or operating machinery
- emphysema
- geriatric
- heart failure
- hepatic disease
- hyperthyroidism
- hypotension
- infants
- myasthenia gravis
- neonates
- peripheral vascular disease
- pheochromocytoma
- pregnancy
- psoriasis
- pulmonary disease
- pulmonary edema
- Raynaud’s phenomenon
- renal disease
- renal failure
- renal impairment
- sick sinus syndrome
- surgery
- thyroid disease
- thyrotoxicosis
- vasospastic angina
- ventricular dysfunction
Interactions
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Propoxyphene
- Adenosine
- Albiglutide
- Aldesleukin, IL-2
- Alemtuzumab
- Alfentanil
- Alfuzosin
- Aliskiren; Amlodipine
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Alogliptin; Metformin
- Alpha-blockers
- Alpha-glucosidase Inhibitors
- Alprostadil
- Amifostine
- Amiodarone
- Amlodipine
- Amlodipine; Atorvastatin
- Amlodipine; Benazepril
- Amlodipine; Celecoxib
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
- Amobarbital
- Amyl Nitrite
- Antithyroid agents
- Apomorphine
- Apraclonidine
- Aripiprazole
- Artemether; Lumefantrine
- Articaine; Epinephrine
- Asenapine
- Aspirin, ASA
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Dipyridamole
- Aspirin, ASA; Omeprazole
- Aspirin, ASA; Oxycodone
- Aspirin, ASA; Pravastatin
- Atazanavir
- Atazanavir; Cobicistat
- Baclofen
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Beta-agonists
- Bismuth Subsalicylate
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Bosentan
- Bretylium
- Brexpiprazole
- Bupivacaine
- Bupivacaine Liposomal
- Bupivacaine; Lidocaine
- Bupropion
- Bupropion; Naltrexone
- Cabergoline
- Caffeine; Ergotamine
- Canagliflozin; Metformin
- Carbidopa; Levodopa
- Carbidopa; Levodopa; Entacapone
- Cariprazine
- Ceritinib
- Cevimeline
- Chloroprocaine
- Chlorthalidone; Clonidine
- Choline Salicylate; Magnesium Salicylate
- Cimetidine
- Cinacalcet
- Citalopram
- Clevidipine
- Clonidine
- Clozapine
- Co-Enzyme Q10, Ubiquinone
- Cobicistat
- Cocaine
- Colesevelam
- Conivaptan
- Crizotinib
- Dapagliflozin; Metformin
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Delavirdine
- Desflurane
- Dexmedetomidine
- Dextromethorphan; Quinidine
- Diazoxide
- Digoxin
- Dihydroergotamine
- Diltiazem
- Dipeptidyl Peptidase-4 Inhibitors
- Dipyridamole
- Disopyramide
- Donepezil
- Donepezil; Memantine
- Doxazosin
- Dronedarone
- Dulaglutide
- Duloxetine
- Dutasteride; Tamsulosin
- Eliglustat
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Empagliflozin; Linagliptin; Metformin
- Empagliflozin; Metformin
- Enalapril; Felodipine
- Encainide
- Enflurane
- Epoprostenol
- Ergonovine
- Ergotamine
- Ertugliflozin; Metformin
- Escitalopram
- Estradiol
- Estradiol Cypionate; Medroxyprogesterone
- Etomidate
- Exenatide
- Felodipine
- Fingolimod
- Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
- Flecainide
- Fluorescein
- Fluoxetine
- Fluoxetine; Olanzapine
- food
- Fospropofol
- Galantamine
- General anesthetics
- Ginger, Zingiber officinale
- Glipizide; Metformin
- Glucagon
- Glyburide; Metformin
- Guanabenz
- Guanfacine
- Haloperidol
- Halothane
- Hydralazine; Isosorbide Dinitrate, ISDN
- Icosapent ethyl
- Iloperidone
- Iloprost
- Imatinib
- Incretin Mimetics
- Insulin Degludec; Liraglutide
- Insulin Glargine; Lixisenatide
- Insulins
- Intravenous Lipid Emulsions
- Iobenguane I 131
- Isocarboxazid
- Isoflurane
- Isosorbide Dinitrate, ISDN
- Isosorbide Mononitrate
- Isradipine
- Ivabradine
- Ketamine
- Lacosamide
- Lanreotide
- Lasmiditan
- Levobupivacaine
- Levodopa
- Levothyroxine
- Levothyroxine; Liothyronine (Porcine)
- Levothyroxine; Liothyronine (Synthetic)
- Lidocaine
- Lidocaine; Prilocaine
- Linagliptin; Metformin
- Linezolid
- Liothyronine
- Liraglutide
- Lithium
- Lixisenatide
- Lofexidine
- Lopinavir; Ritonavir
- Lovastatin; Niacin
- Lurasidone
- Magnesium Salicylate
- Mefloquine
- Meglitinides
- Mephobarbital
- Mepivacaine
- Mepivacaine; Levonordefrin
- Mestranol; Norethindrone
- Metformin
- Metformin; Pioglitazone
- Metformin; Repaglinide
- Metformin; Rosiglitazone
- Metformin; Saxagliptin
- Metformin; Sitagliptin
- Methacholine
- Methohexital
- Methylergonovine
- Methysergide
- Milrinone
- Mirabegron
- Nefazodone
- Nesiritide, BNP
- Neuromuscular blockers
- Niacin, Niacinamide
- Niacin; Simvastatin
- Nicardipine
- Nifedipine
- Nimodipine
- Nisoldipine
- Nitrates
- Nitroglycerin
- Nitroprusside
- Non-Ionic Contrast Media
- Nonsteroidal antiinflammatory drugs
- Octreotide
- Olanzapine
- Ombitasvir; Paritaprevir; Ritonavir
- Oritavancin
- Oxymetazoline
- Paliperidone
- Paroxetine
- Pasireotide
- Peginterferon Alfa-2b
- Pentoxifylline
- Perindopril; Amlodipine
- Phenelzine
- Phenothiazines
- Phenoxybenzamine
- Phentolamine
- Pilocarpine
- Pramlintide
- Prazosin
- Prilocaine
- Prilocaine; Epinephrine
- Procainamide
- Procaine
- Propafenone
- Propofol
- Propoxyphene
- Quinidine
- Quinine
- Ranolazine
- Rasagiline
- Remifentanil
- Reserpine
- Risperidone
- Ritonavir
- Rivastigmine
- Rolapitant
- Ropivacaine
- Salsalate
- Selegiline
- Semaglutide
- Sevoflurane
- SGLT2 Inhibitors
- Silodosin
- Siponimod
- Sufentanil
- Sulfonylureas
- Sympathomimetics
- Tacrine
- Tamsulosin
- Tasimelteon
- Terazosin
- Tetrabenazine
- Tetracaine
- Thalidomide
- Thiazolidinediones
- Thiopental
- Thyroid hormones
- Tizanidine
- Trandolapril; Verapamil
- Tranylcypromine
- Trazodone
- Vemurafenib
- Verapamil
- Yohimbine
- Ziprasidone
