Names and pronunciation
(tye′moe-lole)
Source page 1292
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Individual generic drug information
Extracted information for timolol only.
(tye′moe-lole)
Source page 1292
Func. class.: Antihypertensive Func. class.: Antiglaucoma
Source pages 1292, 1294
Chem. class.: Nonselective β-blocker Chem. class.: β-Blocker
Source pages 1292, 1294
ACTION: Competitively blocks stimulation of β-adrenergic receptor within vascular smooth muscle (decreases rate of SA node discharge, increases recovery time); slows conduction of AV node and decreases heart rate, which decreases O2 consumption in myocardium; also decreases renin-aldosterone-angiotensin system; at high doses, inhibits β2-receptors in bronchial system ACTION: Can decrease aqueous humor and increase outflows
Source pages 1292, 1294
USES: Mild to moderate hypertension, migraine prophylaxis, to decrease mortality after MI Unlabeled uses: Tremors, angina pectoris USES: Treatment of chronic open- angle glaucoma and ocular hypertension
Source pages 1292, 1294
Extracted information for timolol only.
CONTRAINDICATIONS: Hyper- sensitivity to β-blockers, cardiogenic shock, heart block (2nd/3rd degree), sinus bradycardia, HF, cardiac failure, severe COPD, asthma Precautions: Pregnancy, breastfeed- ing, major surgery, diabetes mellitus, COPD, well-compensated heart failure, nonallergic bronchospasm, peripheral vascular disease, thyroid/renal/hepatic disease CONTRAINDICATIONS: Hyper- sensitivity, AV block, heart failure, bradycardia, sick sinus syndrome, asthma Precautions: Abrupt discontinuation, pregnancy, breastfeeding, children, COPD, depression, diabetes mellitus, myasthenia gravis, hyperthyroidism, pul- monary disease, angle-closure glaucoma
Source pages 1292, 1294
Black Box Warning: Abrupt discontinu- ation Black Box Warning: Abrupt discontinu- ation: may result in myocardial ischemia, MI, severe hypotension, ventricular dys- rhythmias in those with preexisting car- diovascular disease • Headaches: location, severity, dura- tion, frequency at baseline and through- out treatment • I&O, weight daily, edema in feet, legs daily • B/P during initial treatment, periodi- cally thereafter, pulse q4hr; note rate, rhythm, quality • Apical/radial pulse before administration; notify prescriber of any significant changes • Baselines of renal, hepatic studies be- fore therapy begins • Edema in feet, legs daily • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk, do not breastfeed, excreted in breast milk Black Box Warning: Not to discontinue product abruptly; to taper over 2 wk; may precipitate angina • Not to use OTC products containing α-adrenergic stimulants (nasal decon- gestants, cold preparations) unless di- rected by prescriber • To report bradycardia, dizziness, con- T fusion, depression, fever, sore throat, SOB to prescriber • Product masks hypoglycemia; monitor blood sugar • To take pulse at home; when to notify prescriber • To avoid alcohol, smoking, sodium intake • To comply with weight control, dietary adjustments, modified exercise program • To carry emergency ID to identify product, allergies • To avoid hazardous activities if dizzi- ness is present • To report symptoms of HF: difficulty breathing, especially on exertion or when lying down; night cough; swelling of ex- tremities • To take medication at bedtime; to wear support hose to minimize effect of ortho- static hypotension
Source pages 1292, 1293, 1294
SIDE EFFECTS CNS: Insomnia, dizziness, hallucinations, anxiety, fatigue, depression, headache CV: Hypotension, bradycardia, HF, edema, chest pain, claudication, angina, AV block, ventricular dysrhythmias EENT: Visual changes; sore throat; dou- ble vision; dry, burning eyes GI: Nausea, vomiting, ischemic colitis, diarrhea, abdominal pain, mesenteric arterial thrombosis, flatulence, constipation GU: Impotence, urinary frequency HEMA: Agranulocytosis, thrombocytope nia, purpura INTEG: Rash, alopecia, pruritus, fever META: Hypoglycemia MUSC: Joint pain, muscle pain RESP: Bronchospasm, dyspnea, cough, crackles, nasal stuffiness SIDE EFFECTS CNS: Insomnia, headache, dizziness, anxiety, depression, headache, night- mares, fatigue CV: Palpitations, heart failure, hypo- tension EENT: Eye stinging/burning, tearing, photophobia, visual disturbances GI: Nausea, dry mouth RESP: Bronchospasm
Source pages 1293, 1294
INTERACTIONS Increase: hypotension, bradycardia— hydrALAZINE, methyldopa, prazosin, anticholinergics, alcohol, reserpine, nitrates Increase: effects of β-blockers, calcium channel blockers Decrease: antihypertensive effects—NSAIDs, sympathomimetics, thyroid, salicylates Decrease: hypoglycemic effects—insu- lin, sulfonylureas Decrease: bronchodilation—theophyllines Drug/Lab Test Increase: renal, hepatic studies, uric acid Interference: glucose, insulin tolerance test INTERACTIONS β-blocking Increase: effect—oral β-blockers Increase: intraocular pressure reduc- tion—topical miotics, dipivefrin, EPI- NEPHrine, carbonic anhydrase inhibi- tors; this may be beneficial Increase: B/P, severe—when abruptly stopping cloNIDine Increase: depression of AV nodal con- duction, bradycardia, or hypotension— adenosine, cardiac glycosides, disopyra- mide, other antiarrhythmics, class 1C antiarrhythmic drugs (flecainide, propafenone, moricizine, encainide, quiNIDine, calcium-channel blockers, or drugs that significantly depress AV nodal conduction) Increase: AV block nodal conduction, induce AV block—high doses of procainamide Increase: antihypertensive effect—other antihypertensives
Source pages 1293, 1294, 1295
TREATMENT OF OVERDOSE: Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O2, diuretic for cardiac failure, hemodialysis; administer vasopressor (norepinephrine) (tie-moe′lol) Betimol, Istalol, Timop , Timol , Timoptic-XE, Timoptic
Source page 1294
Extracted information for timolol only.
DOSAGE AND ROUTES Hypertension • Adult: PO 10 mg bid or 20 mg/day, may increase by 10 mg q7days, max 60 mg/day • Geriatric patients: PO initiate dose cautiously Myocardial infarction prophylaxis • Adult: PO 10 mg bid beginning 1-4 wk after MI for ≥2 yr Migraine headache prevention • Adult: PO 10 mg bid or 20 mg/day; may increase to 30 mg/day, 20 mg in AM, 10 mg in PM; discontinue if not effective after 8 wk DOSAGE AND ROUTES • Adult: instill 1 drop in each affected eye bid (0.25% solution) initially; if no response, 1 drop in each affected eye bid (0.5% solution) or 1 drop of gel in each affected eye daily
Source pages 1292, 1294
Available forms: Tabs 5, 10, 20 mg Available forms: Ophthalmic solu- tion 0.25, 0.5%; ophthalmic gel 0.25%, 0.5%
Source pages 1292, 1294
Administer: • PO before or immediately after meals, at bedtime; tab may be crushed or swal- lowed whole • Reduced dosage in renal dys function • Store at room temperature; do not freeze Administer: • For ophthalmic use only • Do not touch the tip of the dropper to the eye, fingertips, or other surface to prevent contamination • Wash hands before and after use • If >1 topical ophthalmic drug product is being used, the drugs should be ad- ministered at least 5 min apart • Administer other topically applied ophthalmic medications at least 10 min before gel-forming solution • To avoid contamination or the spread of infection, do not use dropper for more than one person • Some products contain the preserva- tive benzalkonium chloride, which can be absorbed by soft contact lenses; re- move contact lenses before using solu- tion; lenses may be reinserted 15 min after administration • Decreased intraocular pressure can take several weeks, monitor IOP after a month
Source pages 1292, 1293, 1294
Extracted information for timolol only.
Assess: Assess: • Systemic absorption: when used in the eye, systemic absorption is common with the same adverse reactions and interactions • Glaucoma: monitor intraocular pressure • Pregnancy/breastfeeding: use only if benefits outweigh fetal risks; do not breastfeed, excreted in breast milk
Source pages 1293, 1295
Evaluate: • Therapeutic response: decreased B/P after 1-2 wk Evaluate: • Decreasing intraocular pressure
Source pages 1293, 1295
CLINICAL CONSIDERATIONS CLINICAL CONSIDERATIONS
Source pages 1293, 1295
Patient and caregiver information: • To take before or immediately after meals Patient and caregiver information: • That product is for ophthalmic use only • Not to touch the tip of the dropper to the eye, fingertips, or other surface to prevent contamination • To wash hands before and after use • To tilt the head back slightly and pull the lower eyelid down with the index finger to form a pouch; squeeze the pre- scribed number of drops into the pouch; close eyes to spread drops • To apply finger pressure on the lacri- mal sac for 1-2 min following use to prevent excessive systemic absorption • To administer drugs at least 5 min apart if more than one topical ophthal- mic drug product is being used • To administer other topically applied ophthalmic medications at least 10 min before timolol gel-forming solution • To not use dropper for more than one person to avoid contamination or the spread of infection • That some products contain the pre- servative benzalkonium chloride, which may be absorbed by soft contact lenses; to remove contact lenses before administration of the solution; that lenses may be reinserted 15 min after administration HIGH ALERT
Source pages 1293, 1295
Extracted information for timolol only.
PHARMACOKINETICS Peak 1-2 hr; half-life 4 hr; metabolized by liver; excreted in urine, breast milk; protein binding <10% PHARMACOKINETICS Onset 30 min, peak 1-2 hr, duration 12-24 hr
Source pages 1293, 1294
Filter the extracted dose blocks for this individual drug.
Hypertension
• Adult: PO 10 mg bid or 20 mg/day, may increase by 10 mg q7days, max 60 mg/day
Candidate age grouping · source pages 1292, 1294
Hypertension
• Geriatric patients: PO initiate dose cautiously Myocardial infarction prophylaxis
Candidate age grouping · source pages 1292, 1294
Hypertension
• Adult: PO 10 mg bid beginning 1-4 wk after MI for ≥2 yr Migraine headache prevention
Candidate age grouping · source pages 1292, 1294
Hypertension
• Adult: PO 10 mg bid or 20 mg/day; may increase to 30 mg/day, 20 mg in AM, 10 mg in PM; discontinue if not effective after 8 wk DOSAGE AND ROUTES
Candidate age grouping · source pages 1292, 1294
Hypertension
• Adult: instill 1 drop in each affected eye bid (0.25% solution) initially; if no response, 1 drop in each affected eye bid (0.5% solution) or 1 drop of gel in each affected eye daily
Candidate age grouping · source pages 1292, 1294