Travoprost and Timolol are both medications used to treat high pressure inside the eye due to glaucoma or other eye diseases (ocular hypertension). They are often prescribed in combination to achieve better control of intraocular pressure (IOP).

• Travoprost: It belongs to a class of drugs called prostaglandin analogs. Prostaglandins are naturally occurring chemicals in the body that have various effects, including increasing the drainage of aqueous humor (the fluid inside the eye), thereby reducing intraocular pressure. Travoprost works by mimicking the action of prostaglandins, leading to increased drainage of fluid from the eye and hence lowering the pressure inside the eye.
• Timolol: This medication is a beta-blocker. It works by reducing the production of aqueous humor within the eye, thereby decreasing intraocular pressure. Timolol is effective at reducing intraocular pressure by decreasing the amount of fluid produced by the ciliary body in the eye.

Travoprost and Timolol eye drops are a combination of a prostanoid receptor agonist and a non-selective beta-blocker. It is used as eye drops in the treatment of patients with raised intraocular pressure or glaucoma who have not responded adequately to monotherapy.

Travoprost and timolol Uses:

Note: Not approved in the US

• Elevated intraocular pressure:
  • Used for reducing intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension who show an inadequate response to topical beta-blockers, prostaglandin analogs, or other IOP-reducing agents and in whom combination therapy is appropriate.
  • Limitations of use: Not indicated for use as initial therapy.

Travoprost and Timolol dose in Adults

Travoprost and Timolol dose in the treatment of elevated intraocular pressure:

• You just need to put one drop of this medicine into your affected eye or eyes once a day.
• You can do this either in the morning or evening, whichever time works best for you.
• It's a straightforward way to help manage elevated eye pressure.

Use in Children:

Not indicated.

Pregnancy Risk Category: D

• If a woman is pregnant or trying to get pregnant, it's not safe for her to use the combination product containing Travoprost and Timolol.
• This means it's not recommended for women in these situations.

Use during breastfeeding:

• Timolol has been found in human breast milk after using it as eye drops.
• We're not sure if travoprost also passes into breast milk.
• The decision about whether to stop breastfeeding or stop using the medication should consider how important the medicine is for the mother's health.
• It's best to talk with a healthcare provider to weigh the risks and benefits.
• You can also check information about each medication separately for more details.

Dose in Kidney Disease:

• The manufacturer's instructions don't include specific dosage adjustments for people with kidney problems because it hasn't been studied enough.

• So, if someone has kidney issues, it's essential to be careful when using this medication.

Dose in Liver disease:

• The manufacturer's instructions don't mention any specific changes to the dosage for people with liver problems.

Also, see individual agents. Based on long-term studies.

Common Side Effects of Travoprost and Timolol:

• Ophthalmic:
  • Ocular hyperemia
  • Eye Irritation
  • Eye Pruritus
  • Xerophthalmia
  • Increased Eyelash Length
  • Iris Discoloration
  • Blurred Vision
  • Eye Pain
  • Photophobia
  • Punctate Keratitis

Contraindications to Travoprost and Timolol:

• The use of this medication is not recommended for individuals who have had a hypersensitive reaction to travoprost, timolol, or any other ingredients in the formulation.
• It's also not advised for those with conditions like bronchial asthma, severe chronic obstructive pulmonary disease (COPD), sick sinus syndrome, sinus bradycardia, second- or third-degree atrioventricular block, overt cardiac failure, or cardiogenic shock.
• Additionally, it's contraindicated for women who are pregnant or trying to conceive.

Warnings and precautions

Anaphylactic reactions

• If someone has a history of severe anaphylactic reactions to allergens, they should use this medication cautiously.
• It's important to note that patients taking beta-blockers may become more sensitive to repeated challenges with allergens.
• In the event of an anaphylactic reaction, such as a severe allergic reaction, treatments like epinephrine may not work as effectively in patients taking beta-blockers, and they could even cause unwanted effects.

CNS depression:

• This medication may cause central nervous system (CNS) depression, which can affect a person's physical and mental abilities.
• Patients need to be careful when performing tasks that require mental alertness, such as operating machinery or driving.
• It's essential to be aware of how the medication affects you and to avoid these activities if you feel impaired.

Ocular effects

• There are several important ocular effects associated with the use of this medication.
• Agents that reduce or suppress the production of aqueous humor, like this one, have been linked to choroidal detachment after filtration procedures.
• Therefore, it's recommended to stop using this medication in patients who have chronic or recurrent choroidal detachment.
• Additionally, prostaglandin analogues such as travoprost, found in this medication, have been associated with macular edema, especially in patients who have had their natural lens removed and replaced (aphakic or pseudophakic) and have a torn posterior lens capsule.
• Furthermore, long-term use of this medication may cause permanent changes such as increased brown pigmentation of the iris, eyelid skin, and eyelashes.
• It can also lead to an increase in eyelash length and/or number, which may vary between eyes and develop slowly over months or years.
• Some patients may experience changes in the periorbital area and eyelids, including deepening of the eyelid sulcus.
• The long-term consequences and potential risks to the eye from these changes are not fully understood.

Angle-closure glaucoma:

• This medication should not be used alone to treat acute angle-closure glaucoma.
• This type of glaucoma requires immediate medical attention and typically involves treatments to reduce intraocular pressure rapidly, such as with medications or procedures to open the drainage angle in the eye.

Cardiovascular disease

• It's important to use this medication cautiously in individuals with cardiovascular disease, including conditions like coronary heart disease, Prinzmetal angina, and heart failure, as well as in those with low blood pressure (hypotension).
• Before starting therapy, patients with heart failure should have their condition adequately controlled.
• Patients with a history of severe cardiovascular disease should be monitored closely for signs of heart failure.
• Rarely, severe cardiac reactions, including cardiac failure, have been reported with the use of this medication.

Cerebrovascular disease

• This medication should be used cautiously in individuals with cerebrovascular disease, such as cerebrovascular insufficiency.
• If signs or symptoms of decreased blood flow to the brain occur after starting therapy, it's essential to consider alternative treatment options.
• Monitoring for any changes in cerebral blood flow and neurological symptoms is crucial in patients using this medication.

Diabetes:

• Using this medication in patients with diabetes mellitus requires caution.
• It's possible that it could make episodes of low blood sugar (hypoglycemia) more severe or frequent.
• Additionally, it might mask some of the signs and symptoms of hypoglycemia, making it harder for patients to recognize when their blood sugar levels are low.

Uveitis/Iritis:

• This medication should be used with caution in patients who have active intraocular inflammation, such as iritis or uveitis.
• Additionally, it's important to be cautious in patients who have risk factors that predispose them to developing uveitis.
• Using this medication in these individuals requires careful monitoring and consideration of the potential risks and benefits.

Myasthenia gravis:

• This medication should be used cautiously in patients with myasthenia gravis.
• It's possible that it could worsen the disease or other symptoms associated with myasthenia gravis, such as double vision (diplopia) or drooping of the eyelids (ptosis).
• Patients with myasthenia gravis should be closely monitored for any changes in their symptoms while using this medication.

Orthostatic hypotension

• This medication should be used cautiously in patients with orthostatic hypotension.
• Orthostatic hypotension is a condition where blood pressure drops significantly when standing up from a lying or sitting position, leading to symptoms like dizziness or lightheadedness.

Raynaud's Disease and Peripheral Vascular Disease (PVD).

• This medication can potentially precipitate or worsen symptoms of arterial insufficiency in patients with peripheral vascular disease (PVD) and Raynaud's disease.
• PVD involves reduced blood flow to the limbs, while Raynaud's disease causes blood vessels to narrow excessively in response to cold or stress, leading to decreased blood flow to the extremities.
• Therefore, caution should be exercised when using this medication in such patients.

Renal impairment

• This medication should be used cautiously in patients with renal impairment, which refers to decreased kidney function.
• Since the effects of the medication may be influenced by kidney function, careful monitoring is important in these individuals.

Respiratory disease

• Patients with respiratory conditions such as chronic obstructive pulmonary disease (COPD), chronic bronchitis, or emphysema, especially if it's mild or moderate, should avoid beta-blockers.
• If they must be used, they should be approached cautiously with close monitoring.
• Severe respiratory reactions, including rare fatalities due to bronchospasm, have been reported, particularly with ophthalmic use.
• Therefore, the use of this medication is not recommended in patients with bronchial asthma or a history of it, as well as in those with severe COPD.

Thyroid disease:

• This medication may mask signs of hyperthyroidism, such as a fast heart rate (tachycardia).
• If there is a suspicion of thyrotoxicosis (excess thyroid hormone), it's important to manage and monitor the condition carefully.
• Abruptly stopping this medication may worsen symptoms of hyperthyroidism or even trigger a severe complication called thyroid storm.

Travoprost and Timolol (United States: Not available): Drug Interaction

Monitoring parameters:

Effects of Eye Drops on Eye Pressure, Iris Color, and Eyelashes:

• Eye Pressure (IOP): These eye drops help lower pressure inside the eye.
• Iris Color Changes: They may cause permanent darkening of the iris, the colored part of the eye.
• Eyelash Changes: Over time, they may increase the length, thickness, or number of eyelashes.

Systemic Effects of Beta Blockade with Eye Drop Use:

• Beta blockers in these eye drops can affect the whole body, not just the eyes.
• This can lead to side effects like slowing the heart rate, lowering blood pressure, or worsening conditions like asthma or heart disease.
• It's essential to talk to your doctor about any health conditions you have before using these eye drops.

How to administer Travoprost and Timolol?

Using Ophthalmic Eye Drops:

• Clean Hands: Wash your hands before and after using the eye drops.
• Remove Contact Lenses: Take out your contact lenses before putting in the drops. Wait for at least 15 minutes before putting them back in.
• Tilt Head Back: Tilt your head backward.
• Pull Down Eyelid: Pull down your lower eyelid to create a small pocket between the eyelid and the eye.
• Instill the Drop: Put the drop into the pocket you created.
• Nasolacrimal Occlusion or Close Eyelid: After applying the drop, either press gently on the inner corner of your eye (nasolacrimal occlusion) or close your eyelid gently for 2 minutes.
• Avoid Touching Tip: Make sure not to touch the tip of the eye drop bottle.
• Separate Administration: If you're using other eye drops, wait at least 5 minutes between using different types of drops.

Mechanism of action of Travoprost and Timolol:

Travoprost is a medication that works by targeting a specific receptor called the FP prostanoid receptor. By activating this receptor, it helps to increase the outflow of fluid from the eye's trabecular meshwork, which in turn lowers intraocular pressure.

Timolol, on the other hand, works by blocking both beta-1 and beta-2 adrenergic receptors. This action helps to decrease the production of aqueous humor in the eye, which can contribute to reducing intraocular pressure. Additionally, there's a possibility that timolol might also increase the outflow of aqueous humor from the eye.

These two medications have different mechanisms of action but are often used together in the form of eye drops to effectively lower intraocular pressure in conditions like glaucoma. It's essential to understand how each medication works individually to appreciate their combined effect when used together.

International Brand Names of Travoprost and Timolol:

• APO-Travoprost-Timop
• DuoTrav PQ
• Avatan-T
• Avost Plus
• Duo-Travatan
• DuoTrav
• Kivizidiale
• Tapcom-S

Travoprost and Timolol Brand Names in Pakistan:

No Brands Available in Pakistan.