Adult Dosing
Hypertension
- Initial dose 10 mg PO bid, may increase q7 days
- Total maintenance dose 20-40 mg/day PO
- Maximum dose 60 mg/day PO, divided into 2 doses
Notes:- Dosage may be increased or decreased based on heart rate and blood pressure response
- Monitor patients carefully during initiation of concomitant therapy, such as with a thiazide diuretic or other antihypertensive agents
MI
- For long-term prophylaxis in patients who have survived acute phase of MI, initiate 10 mg PO bid within 4 weeks of infarction
Migraine
- Initial dose 10 mg PO bid
- Maintenance dose of 20 mg/day may be administered as a single dose
- Total dose may be titrated to a maximum of 30 mg/day, given in divided doses, or decreased to 10 mg qd, depending on clinical response and tolerability
- If no satisfactory response is obtained after 6-8 weeks use of maximum daily dosage, consider discontinuing therapy
Angina [Non-FDA Approved]
- Start 10 mg PO bid; taper dose gradually over 1-2 wks to discontinue
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
See Supplemental Patient Information
- Beta-blockers should be avoided in overt congestive heart failure; however, they can be used with caution in patients with a history of failure who are well compensated (usually with digitalis and diuretics). If cardiac failure persists, withdraw timolol therapy
- In patients with no history of cardiac failure, continued depression of myocardium with beta-blocking agents over a period of time may lead to cardiac failure in certain cases. Digitalize patients receiving timolol and/or give a diuretic at the first sign or symptom of cardiac failure. However, if cardiac failure persists, withdraw timolol
- Hypersensitivity to catecholamines has been observed in patients withdrawn from beta-blocker therapy. Avoid abrupt withdrawal due to the risk of exacerbation of angina and MI [US Black Box Warning]
- While discontinuing chronically administered timolol (particularly in patients with IHD), reduce the dose gradually over a period of 1-2 wks and monitor carefully. Reinstitute timolol if angina markedly worsens or acute coronary insufficiency develops and take appropriate measures for the management of unstable angina [US Black Box Warning]
- Warn patients against interruption or discontinuation of therapy without physician's advice [US Black Box Warning]
- Do not discontinue therapy abruptly, even in patients treated only for hypertension, due to the risk of unrecognized CAD [US Black Box Warning]
Cautions: Use cautiously in
- Hepatic impairment
- Renal impairment
- Mild or moderate COPD including chronic bronchitis, emphysema
- Bronchospastic disease or a history of bronchospastic disease
- Major surgery
- Diabetes mellitus
- Thyrotoxicosis
- Patients with myasthenia gravis or myasthenic symptoms
- Cerebrovascular insufficiency
- Elderly patients
- Peripheral vascular disease
- History of severe anaphylactic reaction
- Pregnancy 2nd or 3rd trimester
- Pheochromocytoma
- Wolff-Parkinson-White syndrome
Supplemental Patient Information
- Warn patients against interruption or discontinuation of therapy without the physician's advice; advise patients not to discontinue therapy abruptly due to increased risk of unrecognized CAD
Pregnancy Category:C
Breastfeeding: Because of the variability in excretion of the drug into breastmilk and insufficient data regarding its use during breastfeeding, other agents must be preferred, particularly while nursing a newborn or preterm infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed on 17 Jun 2011). As per manufacturer's data, timolol is excreted in human milk. Because of the potential for serious adverse reactions from timolol in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, analyzing the importance of the drug to the mother.
Pricing data from www.DrugStore.com in U.S.A.
- Timolol Maleate 10 MG TABS [Bottle] (MYLAN)
60 mg = $39.99
120 mg = $69.98 - Timolol Maleate 20 MG TABS [Bottle] (MYLAN)
60 mg = $65.99
180 mg = $169.97 - Timolol Maleate 5 MG TABS [Bottle] (MYLAN)
60 mg = $34.99
180 mg = $79.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
