Timolol (Systemic) - Uses, Dosage, MOA, Side effects

Timolol (Systemic use) is a non-selective beta-receptor blocker that does not have intrinsic sympathomimetic activity.

Indications of Timolol:

Hypertension:
- It is used for the management of hypertension.

Note: Beta-blockers are no longer the first-line treatment for hypertension, according to (ACC/AHA [Whelton 2017]).

Migraine prophylaxis:
- It is indicated as a prophylaxis of migraine.
As secondary prevention in Myocardial Infarction
- It has been demonstrated to lower mortality in myocardial infarction patients.
Timolol use in Adults ( Off Label )
- Timolol is effective as a rate controlling agent in atrial fibrillation.

Timolol dose in adults:

Treatment dose as alternative agent for hypertension:

Initial: 10 mg orally twice daily; dose adjustments should be made at least every seven days depending on the patient's reaction.
20 to 40 mg/day, divided into two doses, is the typical dosage.
60 mg/day is the maximum.

Timolol Dose in the prophylaxis of Migraine:

Initial:10mg per oral in two divided doses.
Maximum:30mg/day in 2 divided doses.

Treatment dose of Myocardial infarction (secondary prevention):

Initial:5 mg per oral b.i.d daily and titrated up to a required dose of 10mg two times a day.
It should be started within a day after a Myocardial event( STEMI) and should be given life long.
It is not recommended in case of any contraindication.
Timolol is not frequently used.

Timolol Treatment dose of Atrial fibrillation (rate control) (off-label):

Initial: 10 mg per oral b.i.d. daily; up to 20 mg twice day at weekly intervals as tolerated.
The maximum dose is 30 mg twice daily, and digoxin may be used with it.

Timolol use in Children:

Not indicated in Children.

Pregnancy Risk Factor C

Studies on animal reproduction did not show any adverse outcomes.
Timolol can cross placenta.
When timolol (used by mothers during pregnancy) is administered, a decreased fetal heart beat is observed.
Beta-blockers have been shown to cause adverse effects in utero, including low birth weight and fetal/neonatal hyperglycemia.
It is therefore important to monitor your baby closely after it has been born.
If preeclampsia and chronic maternal hypertension are not treated, adverse events can occur in the mother, infant, or both.
For treating pregnancy hypertension, alternative beta-blockers are more effective than timolol.
For migraine prophylaxis in pregnancy, it is better to use alternative agents than timolol.

Timolol use during breastfeeding:

Breast milk contains Timolol.
Following maternal ophthalmic-timolol use, it's crucial to watch out for any negative effects on nursing infants.
The manufacturer suggests that the mother decide whether to stop breastfeeding her infant or if the drug should be used.
This decision will depend on how important the mother is to her health.

Timolol Dose adjustment in renal disease:

There are no specific dosage adjustments provided in the manufacturer’s labeling.
However, as timolol is mostly removed by the kidneys, dose reduction is required.
Because considerable hypotension has been observed in patients who are receiving dialysis and have severe impairment, caution should be used.

Timolol Dose adjustment in Liver disease:

There are no specific dosage adjustments provided in the manufacturer’s labeling.
Dose reduction is required in hepatic impairment as timolol is partially metabolized by the liver.

Side Effects of Timolol:

Cardiovascular:
- Bradycardia
Central Nervous System:
- Dizziness
- Fatigue
Respiratory:
- Dyspnea

Uncommon Side effects of Timolol:

Cardiovascular:
- Angina Pectoris
- Cardiac Arrhythmia
- Cardiac Failure
- Cerebral Ischemia
- Cerebrovascular Accident
- Claudication
- Cold Extremities
- Edema
- Heart Block
- Hypotension
- Palpitations
- Raynaud's Phenomenon
Central Nervous System:
- Amnesia
- Anxiety
- Confusion
- Depression
- Disorientation
- Drowsiness
- Exacerbation Of Myasthenia Gravis
- Hallucination
- Insomnia
- Nervousness
- Nightmares
- Paresthesia
Dermatologic:
- Alopecia
- Exacerbation Of Psoriasis
- Pemphigoid-Like Lesion
- Psoriasiform Eruption
- Skin Rash
- Urticaria
Endocrine & Metabolic:
- Decreased Libido
- Hypoglycemia (Masked)
Gastrointestinal:
- Anorexia
- Diarrhea
- Dyspepsia
- Nausea
- Xerostomia
Genitourinary:
- Impotence
- Peyronie's Disease
- Retroperitoneal Fibrosis
Hypersensitivity:
- Angioedema
- Hypersensitivity Reaction
Neuromuscular & Skeletal:
- Systemic Lupus Erythematosus
Ophthalmic:
- Blepharoptosis
- Cystoid Macular Edema
- Decreased Corneal Sensitivity
- Diplopia
- Eye Discharge
- Eye Pain
- Keratitis
- Visual Disturbance (Including Refractive Changes)
- Xerophthalmia
Otic:
- Tinnitus
Respiratory:
- Bronchospasm
- Cough
- Nasal Congestion
- Pulmonary Edema
- Respiratory Failure

Contraindications to Timolol:

Hypersensitivity to timolol and any component of the formulation
Sinus bradycardia
Cardiogenic shock
Uncompensated cardiac Failure
Patients without an artificial pacemaker that is not functioning properly have a heart block of greater severity than the first.
Bronchospastic Disease
There is not much evidence of cross-reactivity between beta-blockers and allergenic beta-blockers.
Cross-sensitivity is possible due to similarities in chemical structure and/or drugcologic actions. However, this cannot be ruled out.

Canadian labeling: Additional contraindications not in US labeling

Allergy rhinitis
Severe COPD
Important cardiomegaly
pulmonary hypertension-related right ventricular failure during anaesthesia caused by myocardial depressants (eg ether hypersensitivity for timolol malate).

Warnings and precautions

Anaphylactic reactions
- Patients who experience severe allergic reactions to allergens should use beta-blockers with caution. With time, they could become more sensitive to hardships.
- Treatments for anaphylaxis, such as epinephrine, may not work as well in people on beta-blockers.
Bronchospastic disease
- Patients with bronchospastic diseases should not take beta-blockers.
- It should only be used if it is absolutely necessary.
Conductive abnormality
- Pre-existing conditions like sick sinus syndrome must be checked before you start beta-blocker treatment.
Diabetes:
- Patients with diabetes mellitus should be cautious when taking beta-blockers. They can lead to hypoglycemia, or mask signs and symptoms associated with diabetic complications.
Heart failure:
- Patients with compensated cardiac failure require careful monitoring and caution.
Myasthenia gravis:
- Beta-blockers have been shown to make myasthenia gravis worse, so it is important to be cautious with such patients.
Raynaud and peripheral vascular disease:
- Patients with Raynaud disease or peripheral vascular disease can experience symptoms of arterial insufficiency. To detect any signs or symptoms that are getting worse, it is important to keep your condition under close observation.
Untreated Pheochromocytoma
- A sufficient alpha-blockade in the case of pheochromocytoma is required before any beta-blocker can be used.
Angina Prinzmetal version:
- Patients with prinzmetal variant Angina should not receive beta-blockers that do not block alpha1 receptors.
Psoriasis:
- Beta-blocker therapy can be used to exacerbate or induce psoriasis, but the cause and effect of this treatment are not known.
Renal impairment
- Extreme caution is necessary for patients suffering from severe renal impairment.
- Patients on dialysis may experience severe hypotension.
Thyroid disease:
- Suspects with thyrotoxicosis are encouraged to closely monitor.
- Sudden withdrawal of therapy can lead to symptoms of hyperthyroidism and precipitation of thyroid storm.

Timolol (systemic): Drug Interaction

Risk Factor C (Monitor therapy)
Acetylcholinesterase Inhibitors	Could make beta-blockers' bradycardic impact stronger.
Ajmaline	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
Alfuzosin	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Alpha1-Blockers	Beta-Blockers may enhance the orthostatic hypotensive effect of Alpha1Blockers. The risk associated with ophthalmic products is probably less than systemic products.
Aminoquinolines (Antimalarial)	May decrease the metabolism of Beta-Blockers.
Amiodarone	May enhance the bradycardic effect of Beta-Blockers. Possibly to the point of cardiac arrest. Amiodarone may increase the serum concentration of Beta-Blockers.
Amphetamines	May diminish the antihypertensive effect of Antihypertensive Agents.
Antipsychotic Agents (Phenothiazines):	May enhance the hypotensive effect of Beta-Blockers. Beta-Blockers may decrease the metabolism of Antipsychotic Agents (Phenothiazines). Antipsychotic Agents (Phenothiazines) may decrease the metabolism of Beta-Blockers.
Antipsychotic Agents (Second Generation [Atypical])	Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]).
Barbiturates	May decrease the serum concentration of Beta-Blockers.
Barbiturates	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Benperidol	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Bradycardia-Causing Agents	May enhance the bradycardic effect of other Bradycardia-Causing Agents.
Bretylium	May enhance the bradycardic effect of Bradycardia-Causing Agents. Bretylium may also enhance atrioventricular (AV) blockade in patients receiving AV blocking agents.
Brigatinib	May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents.
Brimonidine (Topical)	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Bupivacaine	Beta-Blockers may increase the serum concentration of Bupivacaine.
Calcium Channel Blockers (Nondihydropyridine)	May enhance the hypotensive effect of BetaBlockers. Bradycardia and signs of heart failure have also been reported. Calcium Channel Blockers (Nondihydropyridine) may increase the serum concentration of Beta-Blockers. Exceptions: Bepridil.
Cardiac Glycosides	Beta-Blockers may enhance the bradycardic effect of Cardiac Glycosides.
Cholinergic Agonists	Beta-Blockers may make Cholinergic Agonists' harmful or toxic effects worse. The possibilities for bronchoconstriction and aberrant cardiac conduction are of special concern. Management: Use cautious while combining these drugs, and keep an eye out for conduction issues. Because methacholine may cause further bronchoconstriction when used with any beta blocker, avoid using it.
CloBAZam	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
Cobicistat	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
CYP2D6 Inhibitors (Moderate)	CYP2D6 substrate metabolism may be decreased (High risk with Inhibitors).
Darunavir	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
Dexmethylphenidate	Can lessen an antihypertensive drug's therapeutic impact.
Diazoxide	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Dipyridamole	Could make beta-blockers' bradycardic impact stronger.
Disopyramide	Could make beta-blockers' bradycardic impact stronger. Beta-blockers might make Disopyramide's adverse inotropic impact worse.
DULoxetine	The hypotensive impact of DULoxetine may be enhanced by blood pressure lowering medications.
EPINEPHrine (Nasal)	The hypertensive impact of EPINEPHRINE may be enhanced by beta-blockers like Nonselective (Nasal).
EPINEPHrine (Oral Inhalation)	The hypertensive impact of EPINEPHRINE may be enhanced by beta-blockers like Nonselective (Oral Inhalation).
Epinephrine (Racemic)	Epinephrine's hypertensive action may be enhanced by beta-blockers like Nonselective (Racemic).
EPINEPHrine (Systemic)	The hypertensive impact of EPINEPHRINE may be enhanced by beta-blockers like Nonselective (Systemic).
Herbs (Hypertensive Properties)	May lessen the effectiveness of antihypertensive agents.
Herbs (Hypotensive Properties)	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Hypotension-Associated Agents	The hypotensive action of hypotension-associated agents may be strengthened by blood pressure lowering medications.
Imatinib	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
Insulins	Beta-Blockers might improve insulin's ability to lower blood sugar.
Ivabradine	Bradycardia-Causing Agents may intensify Ivabradine's bradycardic impact.
Lacosamide	Bradycardia-Causing Substances may intensify Lacosamide's AV-blocking effects.
Levodopa-Containing Products	Levodopa-Containing Products' hypotensive effects may be strengthened by blood pressure-lowering medications.
Lidocaine (Systemic)	Beta-blockers might boost the level of lidocaine in the blood (Systemic).
Lidocaine (Topical)	Beta-blockers might boost the level of lidocaine in the blood (Topical).
Lormetazepam	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Mepivacaine	Mepivacaine's serum levels may rise after taking beta-blockers.
Methoxyflurane	May enhance the hypotensive effect of Beta-Blockers.
Methylphenidate	May diminish the antihypertensive effect of Antihypertensive Agents.
Midodrine	May enhance the bradycardic effect of Bradycardia-Causing Agents.
Molsidomine	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Naftopidil	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Nicergoline	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Nicorandil	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
NIFEdipine	May enhance the hypotensive effect of Beta-Blockers. NIFEdipine may enhance the negative inotropic effect of Beta-Blockers.
Nitroprusside	Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside.
Nonsteroidal Anti-Inflammatory Agents	May diminish the antihypertensive effect of BetaBlockers.
Opioids (Anilidopiperidine)	Could make beta-blockers' bradycardic impact stronger. Beta-Blockers may have a greater hypotensive impact when combined with opioids (anilidopiperidine).
Panobinostat	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
Peginterferon Alfa-2b	May lower the serum level of CYP2D6 substrates (High risk with Inhibitors). The concentration of CYP2D6 Substrates in the serum may rise when using Peginterferon Alfa-2b (High risk with Inhibitors)
Pentoxifylline	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Perhexiline	The serum levels of perhexiline may increase when exposed to CYP2D6 Substrates (High Risk with Inhibitors). The serum concentration of CYP2D6 Substrates may rise in response to perhexiline (High risk with Inhibitors).
Pholcodine	Pholcodine's hypotensive impact may be strengthened by blood pressure lowering medications.
Phosphodiesterase 5 Inhibitors	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Propafenone	May raise the level of beta-blockers in the serum. There is some independent beta-blocking activity in propafenone.
Prostacyclin Analogues	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Quinagolide	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
QuiNINE	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
Reserpine	May strengthen beta-blockers' hypotensive effects.
Selective Serotonin Reuptake Inhibitors	May raise the level of beta-blockers in the serum. Citalopram, Escitalopram, and FluvoxaMINE are exceptions.
Sulfonylureas	Beta-Blockers might make Sulfonylureas' hypoglycemia effect more potent. Beta-blockers that are cardioselective (such penbutolol, acebutolol, atenolol, and metoprolol) may be less dangerous than nonselective beta-blockers. As the initial sign of hypoglycemia, tachycardia seems to be concealed by all beta-blockers. Beta-blockers used intravenously most likely carry a lesser risk than those used systemically.
Terlipressin	May enhance the bradycardic effect of Bradycardia-Causing Agents.
Tofacitinib	May enhance the bradycardic effect of Bradycardia-Causing Agents.
Yohimbine	May diminish the antihypertensive effect of Antihypertensive Agents.
Risk Factor D (Consider therapy modification)
Abiraterone Acetate	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Management: Avoid concurrent use of abiraterone with CYP2D6 substrates that have a narrow therapeutic index whenever possible. When concurrent use is not avoidable, monitor patients closely for signs/symptoms of toxicity.
Alpha2-Agonists	May enhance the AV-blocking effect of Beta-Blockers. Sinus node dysfunction may also be enhanced. Beta-Blockers may enhance the rebound hypertensive effect of Alpha2Agonists. This effect can occur when the Alpha2-Agonist is abruptly withdrawn. Management: Closely monitor heart rate during treatment with a beta blocker and clonidine. Withdraw beta blockers several days before clonidine withdrawal when possible, and monitor blood pressure closely. Recommendations for other alpha2-agonists are unavailable. Exceptions: Apraclonidine.
Amifostine	Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered.
Asunaprevir	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
Ceritinib	Bradycardia-Causing Agents may intensify Ceritinib's bradycardic impact. Management: If this combination cannot be avoided, continuously monitor patients' blood pressure and heart rate throughout therapy and look for any signs of symptomatic bradycardia in them. A separate monograph is dedicated to discussing exceptions.
CYP2D6 Inhibitors (Strong)	CYP2D6 substrate metabolism may be decreased (High risk with Inhibitors).
Dacomitinib	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Management: Avoid concurrent use of dacomitinib with CYP2D6 subtrates that have a narrow therapeutic index.
Dronedarone	May enhance the bradycardic effect of Beta-Blockers. Dronedarone may increase the serum concentration of Beta-Blockers. This likely applies only to those agents that are metabolized by CYP2D6. Management: Use lower initial beta-blocker doses; adequate tolerance of the combination, based on ECG findings, should be confirmed prior to any increase in betablocker dose.
Ergot Derivatives	Beta-Blockers may enhance the vasoconstricting effect of Ergot Derivatives. Exceptions: Nicergoline.
Fingolimod	Beta-Blockers may enhance the bradycardic effect of Fingolimod. Management: Avoid the concomitant use of fingolimod and beta-blockers if possible. If coadministration is necessary, patients should have overnight continuous ECG monitoring conducted after the first dose of fingolimod. Monitor patients for bradycardia.
Grass Pollen Allergen Extract (5 Grass Extract)	Beta-Blockers may enhance the adverse/toxic effect of Grass Pollen Allergen Extract (5 Grass Extract). More specifically, Beta-Blockers may inhibit the ability to effectively treat severe allergic reactions to Grass Pollen Allergen Extract (5 Grass Extract) with epinephrine. Some other effects of epinephrine may be unaffected or even enhanced (e.g., vasoconstriction) during treatment with Beta-Blockers.
Obinutuzumab	May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion.
Siponimod	Bradycardia-Causing Agents may enhance the bradycardic effect of Siponimod. Management: Avoid coadministration of siponimod with drugs that may cause bradycardia.
Theophylline Derivatives	Beta-Blockers (Nonselective) may diminish the bronchodilatory effect of Theophylline Derivatives.
Risk Factor X (Avoid combination)
Beta2-Agonists	Beta-Blockers (Nonselective) may diminish the bronchodilatory effect of Beta2Agonists.
Bromperidol	Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents.
Floctafenine	May enhance the adverse/toxic effect of Beta-Blockers.
Methacholine	Beta-Blockers may enhance the adverse/toxic effect of Methacholine.
Rivastigmine	May enhance the bradycardic effect of Beta-Blockers.

Monitoring parameters:

BP
Heart rate
Apical and radial pulses

Hypertension:

The 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults:

Confirmed hypertension and known CVD or 10-year ASCVD risk ≥10%:

Target blood pressure <130/80 mm Hg is recommended.

Confirmed hypertension without markers of increased ASCVD risk:

Target blood pressure <130/80 mm Hg may be reasonable.

How to administer Timolol?

It should be given orally with food at the same time each day.

Mechanism of action of Timolol:

It works by blocking both beta-adrenergic and beta-adrenergic receptors.
It works by decreasing sympathetic outflow and blocking adrenergic receptors, which in turn lowers blood pressure.
It produces negative inotropic and chronotropic activity through an unknown mechanism.

The onset of action:

Hypotensive: 15 to 45 minutes.

Peak effect:

0.5 to 2.5 hours.

Duration:

4 hours.

Absorption:

Rapid and complete (90%).

Protein binding:

60%.

Metabolism:

Extensively hepatic via CYP2D6; extensive first-pass effect.

Bioavailability:

50%.

Half-life elimination:

2 to 2.7 hours; prolonged with renal impairment.

Time to peak, plasma:

1 to 2 hours.

Excretion:

Urine (15% to 20% as unchanged drug).

International Brands of Timolol:

Arutimol
Blocadren
Blocadren Depot
Normatin

Timolol Brands in Pakistan (Systemic and Ophthalmic):

Timolol Injection 5 mg/10ml
Millisrol	S. Ejazuddin & Company

Timolol Maleate Eye Drops 0.5 %w/v
Altim	Jaens Pharma
Betalol	Sante (Pvt) Limited
Blotim	Remington Pharmaceutical Industries (Pvt) Ltd.
Dytim	Azron Pharmaceuticals (Pvt) Ltd
Meditim	Medipak Limited
Milosol	Polyfine Chempharma (Pvt) Ltd.
Nyolol	Novartis Pharma (Pak) Ltd
Ocutim	Farmigea Pak (Pvt) Ltd.
Optipress	Ethical Laboratories (Pvt) Ltd.
Tiloptic	Mascon Pharmacal
Timentin Drops	Atco Laboratories Limited
Timo Stulln Ud	Haroon Brothers
Timo Stulln Ud	Haroon Brothers
Timol	Panacea Pharmaceuticals
Timoptic	Helix Pharma (Private) Limited
Timoptol	Obs
Timorex	Vega Pharmaceuticals Ltd.
Timosol	The Schazoo Laboratories Ltd.
Timotek	Innvotek Pharmaceuticals

Timolol Maleate Eye Drops 0.25 %w/v
Blotim	Remington Pharmaceutical Industries (Pvt) Ltd.
Hioptol	Himont Pharmaceuticals (Pvt) Ltd.
Ocotimol	Ocu Care
Optipress	Ethical Laboratories (Pvt) Ltd.
Timoptol	Obs

Timolol (Systemic) - Uses, Dosage, MOA, Side effects

Indications of Timolol:

Hypertension:

Migraine prophylaxis:

As secondary prevention in Myocardial Infarction

Timolol use in Adults ( Off Label )

Timolol dose in adults:

Treatment dose as alternative agent for hypertension:

Timolol Dose in the prophylaxis of Migraine:

Treatment dose of Myocardial infarction (secondary prevention):

Timolol Treatment dose of Atrial fibrillation (rate control) (off-label):

Timolol use in Children:

Pregnancy Risk Factor C

Timolol use during breastfeeding:

Timolol Dose adjustment in renal disease:

Timolol Dose adjustment in Liver disease:

Side Effects of Timolol:

Cardiovascular:

Central Nervous System:

Respiratory:

Uncommon Side effects of Timolol:

Cardiovascular:

Central Nervous System:

Dermatologic:

Endocrine & Metabolic:

Gastrointestinal:

Genitourinary:

Hypersensitivity:

Neuromuscular & Skeletal:

Ophthalmic:

Otic:

Respiratory:

Contraindications to Timolol:

Warnings and precautions

Anaphylactic reactions

Bronchospastic disease

Conductive abnormality

Diabetes:

Heart failure:

Myasthenia gravis:

Raynaud and peripheral vascular disease:

Untreated Pheochromocytoma

Angina Prinzmetal version:

Psoriasis:

Renal impairment

Thyroid disease:

Monitoring parameters:

How to administer Timolol?

Mechanism of action of Timolol:

International Brands of Timolol:

Timolol Brands in Pakistan (Systemic and Ophthalmic):

Timolol Injection 5 mg/10ml

Timolol Maleate Eye Drops 0.5 %w/v

Timolol Maleate Eye Drops 0.25 %w/v

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