DuoTrav is indicated in adults for the decrease of intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension who are insufficiently responsive to topical beta blockers or prostaglandin analogues.

What is it used for?

  • Open angle glaucoma.
  • Raised pressure in the eye (ocular hypertension).

How does it work?

  • DuoTrav eye drops contain two active ingredients, travoprost and timolol maleate. These are both medicines that lower raised pressure within the eye. They work in different ways to produce a combined effect greater than either medicine produces on its own.
  • 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. 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.
  • Travoprost is a type of medicine called a prostaglandin analogue. It reduces the pressure in the eye by mimicking the action of a naturally-occuring prostaglandin. Prostaglandins are a group of natural body chemicals found in many places in the body. In the eye, they increase the drainage of the aqueous humour out of the eyeball. Travoprost is a synthetic prostaglandin that acts on the same receptors in the eye as the natural prostaglandins. It therefore causes an increase in the drainage of aqueous humour out of the eyeball. This decreases the pressure within the eye.
  • Timolol is a type of medicine called a beta-blocker. These medicines block beta-receptors in various parts of the body. Blocking the beta receptors in the eye reduces the amount of aqueous humour that is produced. Timolol therefore reduces the inflow of aqueous humour into the eyeball and so decreases the pressure within the eye in a different way.
  • The combination of these two medicines is used to lower the pressure in the eye when one of the medicines does not lower the pressure enough on its own.
  • How do I use it?

    • If you wear 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.
    • One drop should be put into the affected eye(s) once a day, at the same time each day. Click here for instructions on how to put in the eye drops. The medicine is most effective if the drops are put in in the evening.
    • It is recommended that immediately after administering the eye drops, you press on the tear duct (at the corner of the eye closest to your nose) for about one minute. This is to minimise the amount of medicine that may be absorbed into the bloodstream and increase the local effect in the eye.
    • When using the 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 with germs that could cause eye infections.

    Use with caution in

    • Closed angle glaucoma.
    • Glaucoma caused by the growth of new blood vessels over the iris (neovascular glaucoma).
    • Glaucoma caused by accumulation of pigment particles in the drainage channels of the eye (pigmentary glaucoma).
    • Glaucoma caused as a result of a disorder of part of the eyeball called the ciliary body (pseudoexfoliative glaucoma).
    • Glaucoma present from birth (congenital glaucoma).
    • Thyroid eye disease.
    • Inflammatory conditions of the eye, eg conjunctivitis.
    • People with an artificial lens in the eye (pseudophakia).
    • People with no lens in the eye (aphakia).
    • People with a closed or blocked retinal vein.
    • Diabetes (see warning above).
    • People with diabetes affecting the eyes (diabetic retinopathy).
    • People who suffer from drops in blood sugar (hypoglycaemia).
    • History of severe heart disease.
    • Heart failure.
    • A severe form of angina pectoris, not caused by exertion (Prinzmetal's angina).
    • People with poor blood circulation in the arteries of the extremities, eg hands and feet (peripheral arterial disorders such as Raynaud's syndrome or intermittent claudication).
    • People with low blood pressure (hypotension).
    • Overactive thyroid gland (hyperthyroidism).
    • History of allergies.
    • Psoriasis.
    • Abnormal muscle weakness (myaesthenia gravis).
    • Not to be used in
    • Allergy to other beta-blocker medicines.
    • Asthma or history of asthma.
    • Severe chronic obstructive pulmonary disease (COPD).
    • Severe hayfever (allergic rhinitis).
    • People with other breathing problems.
    • People with a slow heart rate caused by the pacemaker of the heart (sinus bradycardia).
    • People with a serious defect in the heart's electrical message pathways resulting in decreased function of the heart (2nd or 3rd degree heart block).
    • Uncontrolled heart failure.
    • Failure of the heart to maintain adequate circulation of blood (cardiogenic shock).
    • People with clouding of the front part of the eye (corneal dystrophy).
    • Pregnancy.
    • Breastfeeding.

    This medicine is not recommended for children and adolescents under 18 years of age, as there is no information regarding its safety and efficacy in this age group.
    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 should not be used during pregnancy unless considered essential by your doctor, as it may be absorbed into the bloodstream and could be harmful to the unborn baby. Women who could get pregnant should use an effective method of contraception to avoid getting pregnant while using these eye drops. Seek further medical advice from your doctor.
    • Women who are pregnant or are trying for a baby should also avoid getting the eye drops on the skin, as the medicine can be absorbed through the skin. If you accidentally get a lot of the eye drops solution on your skin you should wash it off straight away.
    • This medicine may pass into breast milk after being applied into the eye. The manufacturer states that it is not recommended for women who are breastfeeding. Seek further 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. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

    • Red eye(s) due to increased blood supply (hyperaemia).
    • Eye irritation including stinging, burning and itching.
    • Change in colour of the iris.
    • Darkening, thickening and lengthening of the eyelashes.
    • Eye pain.
    • Eye swelling.
    • Dislike of light (photophobia).
    • Inflammation of the lining of the eye(s), causing pain and redness (conjunctivitis).
    • Dry eye(s).
    • Irritation of the eyelid(s).
    • Darkening of the eyelid(s) or skin around the eye(s).
    • Headache.
    • Dizziness.
    • Nervousness.
    • Slowed heart rate (bradycardia).
    • Irregular heart beat.
    • Low blood pressure (hypotension).
    • Shortness of breath.
    • Skin rashes.

    Swelling of the area at the back of the eye responsible for seeing fine detail (macular oedema).
    The side effects listed above may not include all of the side effects reported by the medicine'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?

    You should always tell your doctor or pharmacist what medicines you are already using, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before using any new medicines while using this one, to make sure 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. Use eye gels or ointments last.

    Eye drops can be absorbed into the bloodstream from the eye and once in the bloodstream they have the potential to interact with other medicines. For this reason you should be aware of the following:

    • 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.
    • Timolol may have an additive effect with medicines that decrease blood pressure, particularly medicines that are used to treat high blood pressure (antihypertensives). This may cause dizziness, which can usually be relieved by lying down until the symptoms pass. If you feel dizzy while using this medicine in combination with medicines that can lower blood pressure you should let your doctor know, as your doses may need adjusting.

    The timolol in these eye drops may enhance the effects of the following medicines taken by mouth, which may result in low blood pressure and/or a slowed heart rate:

    • beta-blockers, eg atenolol
    • calcium channel blockers, eg nifedipine, verapamil, diltiazem
    • digoxin
    • medicines for abnormal heart rhythms (antiarrhythmics), eg amiodarone.

    If the medicine clonidine is suddenly stopped it can cause an increase in blood pressure. This increase in blood pressure may be worse in people taking beta-blockers, including eye drops such as this one.

    Beta-blockers oppose the action of medicines for asthma that open the airways, which is why these eye drops should not be used by people with asthma or other breathing difficulties.

    References:

    https://www.mims.co.uk/duotrav-benzalkonium-free/ophthalmology/article/1068264

    https://www.netdoctor.co.uk/medicines/eye-care/a7155/duotrav-eye-drops-travoprost-timolol/

    https://www.medicines.org.uk/emc/product/199/smpc

    https://chealth.canoe.com/drug/getdrug/duotrav

    https://www.nps.org.au/medical-info/medicine-finder/duotrav-eye-drops

    https://www.ema.europa.eu/en/documents/product-information/duotrav-epar-product-information_en.pdf

     

     

    Health Reference: Glaucoma