timolol maleate + travoprost: clinical use

Prescribing considerations

• Licensed only for adults insufficiently responsive to a topical beta blocker or prostaglandin analogue alone.
• Assess cardiovascular and respiratory history because topical timolol is systemically absorbed.
• Use caution with first-degree heart block, hypotension, cardiovascular disease, mild or moderate COPD, Raynaud's disease, labile diabetes, myasthenia gravis and corneal disease.
• Use caution with active ocular inflammation or risk factors for cystoid macular oedema.
• Inform the anaesthetist before surgery; timolol may alter responses to beta agonists and anaesthetic medicines.
• Avoid duplicate topical beta blockers or local prostaglandins.

Contraindications and cautions

• Hypersensitivity to an active substance, excipient or another beta blocker
• Current or previous bronchial asthma, reactive airway disease or severe COPD
• Sinus bradycardia, sick-sinus syndrome or sinoatrial block
• Second- or third-degree atrioventricular block without pacemaker control
• Overt cardiac failure or cardiogenic shock
• Severe allergic rhinitis or corneal dystrophy

Monitoring

• Intraocular pressure and clinical response
• Pulse, blood pressure and symptoms of cardiac or respiratory deterioration where clinically relevant
• Ocular surface and cornea during prolonged use, particularly with dry eye or compromised cornea
• Changes in iris pigmentation, eyelashes, eyelids and periocular tissues
• Inflammation, reduced vision or features of macular oedema in susceptible patients

Clinical pharmacology

Travoprost is a prodrug hydrolysed in the cornea to an FP-receptor agonist that increases trabecular and uveoscleral aqueous outflow. Timolol is a non-selective beta-adrenoceptor antagonist that predominantly reduces aqueous-humour formation. Both can be absorbed systemically after ocular administration.

Formulation and product differences

• The selected product is a clear, colourless aqueous eye-drop solution in a multidose bottle supplied in a protective sachet.
• It contains benzalkonium chloride, which may irritate or affect the ocular surface and can be absorbed by soft contact lenses.
• It contains macrogolglycerol hydroxystearate 40, which may cause skin reactions.
• The bottle should be discarded four weeks after first opening.

Eye drops

Route: Ophthalmic

Strengths: 40 micrograms/mL + 5 mg/mL