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Timolol
📖 About
Always check the BNF entry here for the latest prescribing advice. Timolol is a non-selective beta-blocker used mainly in ophthalmology.
⚙️ Mode of Action
- Reduces aqueous humour production in the ciliary body 👁️ → lowers intraocular pressure.
- Does not affect pupil size or accommodation significantly.
💊 Indication & Typical Dose
- Primary Open Angle Glaucoma (POAG) & Ocular Hypertension.
- Typical starting dose: 1 drop of 0.25–0.5% solution in affected eye(s) twice daily. ⚠️ Always confirm dose and formulation in the BNF or local formulary.
🔗 Interactions
- See BNF for full details.
- Potential for additive bradycardia or hypotension when combined with systemic beta-blockers, calcium channel blockers, digoxin, or antiarrhythmics.
⚠️ Cautions
- Systemic absorption may occur → monitor in patients with cardiovascular or respiratory disease.
- Elderly patients may be more sensitive to systemic beta-blockade.
🚫 Contraindications
- Asthma or severe chronic obstructive pulmonary disease (COPD) ❌.
- Sinus bradycardia, second- or third-degree AV block, overt cardiac failure.
💥 Side Effects
- Local: stinging, burning, dry eyes, blurred vision.
- Systemic (rare but reported): bronchospasm, bradycardia, hypotension, fatigue.
- Case reports exist of significant systemic effects despite ocular administration.
📚 References
- BNF – Timolol
- NICE Glaucoma Guideline (NG81)
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