Timoptol Eye Drops

• Lowering raised pressure within the eyeball (ocular hypertension).
• Open angle glaucoma.
• Glaucoma caused by another disease of the eye (secondary glaucoma).

How do Timoptol eye drops work?

• 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, which lowers the pressure of the fluid inside the eyeball. (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.
• Timolol blocks beta-receptors that are found on the ciliary body. This 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 reduces the inflow of aqueous humour into the eyeball, which lowers the pressure within the eye.

How do I use Timoptol eye drops?

• Wash your hands before using the eye drops.
• Always follow the instructions given by your doctor. The usual dose is one drop put into the affected eye(s) twice a day, morning and evening. 
• When putting in the drops take care to not touch the dropper tip to any surface, or to your eye, in order to avoid contaminating the eye drops or introducing germs into your eye.
• Timoptol eye drops are available in metered-dose bottles (Ocumeter) containing a preservative or preservative-free unit dose containers.
• People who wear soft contact lenses should remove them before putting in eye drops from the metered-dose bottle. This is because the metered-dose bottles contain the preservative benzalkonium chloride, which can be absorbed by soft contact lenses and cause eye irritation. You should wait at least 15 minutes after using the drops before putting your contact lenses back in.
• The unit dose containers contain enough medicine to put one drop into each eye (if prescribed for both eyes). Each container is for single use only and should be disposed of after use, even if it still contains some medicine.
• It is recommended that you press on the tear duct (at the corner of the eye closest to your nose), or gently close your eyes for at least two minutes after putting in these drops (three to five minutes for children), in order to minimise the amount of medicine absorbed into the bloodstream and increase the local effect in the eye.
• If you forget to put in a dose of the eye drops, do this as soon as possible. However, if it is almost time for your next dose, leave out the missed dose and just use the next dose at your usual time. Do not use a double dose to make up for a forgotten dose.

Timoptol eye drops should be used with caution by

• Children.
• People with heart disease such as angina, heart failure or 1st degree heart block.
• People with low blood pressure (hypotension).
• 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 mild or moderate chronic obstructive pulmonary disease (COPD).
• People with an overactive thyroid gland (hyperthyroidism).
• People with a history of sudden drops in blood sugar levels (hypoglycaemia).
• People with diabetes. Timolol may mask the symptoms of low blood sugar, such as increased heart rate and tremor, so your blood sugar should be monitored more closely while you are using these eye drops; the dose of your diabetes medicine may need adjusting.
• People with a history of allergies. This medicine may increase sensitivity to substances that cause allergy and the seriousness of severe allergic reactions (anaphylaxis). People who experience an anaphylactic reaction while using this medicine may need larger than normal doses of adrenaline to treat the reaction. Seek further medical advice from your doctor.
• People with psoriasis.
• People with a condition called myaesthenia gravis, in which there is abnormal muscle weakness.
• People with diseases of the cornea (front of the eye).
• Timoptol eye drops should not be used by
• People with a history of asthma.
• People with severe chronic obstructive pulmonary disease (COPD).
• People with uncontrolled heart failure.
• People with a slow heart rate caused by the pacemaker of the heart (sinus bradycardia).
• People with a heart problem called sick sinus syndrome, which is common in elderly people and related to poor control of the working of the heart.
• 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 or sino-atrial block).
• People with a condition called cardiogenic shock, in which the heart fails to maintain adequate circulation of blood.

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 can pass into the bloodstream after application into the eye and could potentially have harmful effects on a developing baby. The eye drops should not be used during pregnancy unless your doctor thinks they are essential and that the benefits of the medicine outweigh any risks to the baby. If you are pregnant and your doctor has asked you to use these eye drops, you should make sure you always press on your tear duct (at the corner of the eye closest to your nose), or gently close your eyes for at least two minutes after putting in the drops, in order to minimise the amount of medicine absorbed into your bloodstream. If these eye drops are continued until delivery, the baby's heart rate and blood sugar should be carefully monitored for the first few days following the birth.
• This medicine may pass into breast milk in small amounts after application into the eye. These eye drops should only be used in mothers who are breastfeeding if considered essential by your doctor and the benefits to the mother outweigh any risks to the nursing infant. If you are breastfeeding and your doctor has asked you to use these eye drops, you should make sure you always press on your tear duct (at the corner of the eye closest to your nose), or gently close your eyes for at least two minutes after putting in the drops, in order to minimise the amount of medicine that could pass into your breast milk. Seek further medical advice from your doctor.

Possible side effects of Timoptol eye drops

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.

• Eye irritation, for example stinging, burning, itching, redness or watering of the eyes after putting in the drops.
• Blurred or double vision.
• Drooping of the upper eyelid (ptosis).
• 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.
• Feeling weak or tired.
• Low blood pressure (hypotension).
• Dizziness.
• Headache.
• Disturbances of the gut, such as nausea, vomiting, diarrhoea, indigestion.
• Allergic skin reactions.
• Disturbed sleep.
• Depression.
• Cold hands and feet.
• Chest pain.
• Awareness of your heartbeat (palpitations).
• Slow heart rate (bradycardia).
• 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 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.

If you think you have experienced a side effect from a medicine or vaccine you should check the patient information leaflet. This lists the known side effects and what to do if you get them. You can also get advice from your doctor, nurse or pharmacist. If they think it'’s necessary they'll report it for you.

How can Timoptol eye drops affect other medicines?

• The timolol in this eye gel can be absorbed into the bloodstream after application to the eye and it may therefore interact with other medicines that you are taking. You can minimise the amount of medicine that is absorbed into your bloodstream 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.
• 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 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.

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-blocker medicines taken by mouth, eg atenolol, propranolol
• calcium-channel blockers such as diltiazem, nifedipine or verapamil
• digoxin
• medicines for an irregular heartbeat (antiarrhythmics), such as amiodarone, quinidine or disopyramide.

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.

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 more closely while using these eye drops, as timolol can also mask the signs of hypoglycaemia.

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:

http://www.guildlink.com.au/gc/ws/mf/pi.cfm?product=mfptimop10416

https://www.netdoctor.co.uk/medicines/eye-care/a7655/timoptol-eye-drops-timolol/

https://www.medicines.org.uk/emc/product/5110/smpc

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

https://www.hpra.ie/HOMEPAGE/medicines/medicines-information/find-a-medicine/results/item?change=6735008&pano=PA0879/007/002&t=TIMOPTOL

https://medsafe.govt.nz/Consumers/cmi/t/timoptolxe.pdf