timolol

ROUTE	ONSET	PEAK	DURATION
PO	unknown	1–2 hr*	12–24 hr

Contraindicated in:

Uncompensated HF;
Pulmonary edema;
Cardiogenic shock;
Bradycardia or heart block.

Use Cautiously in:

Renal impairment;
Hepatic impairment;
Pulmonary disease (including asthma);
Diabetes mellitus (may mask signs of hypoglycemia);
Thyrotoxicosis (may mask symptoms);
Patients with a history of severe allergic reactions (intensity of reactions may be increased);
Geri: May have sensitivity to beta blockers; initial dosage recommended);
OB: Safety not established; may cause fetal/neonatal bradycardia, hypotension, hypoglycemia, or respiratory depression.

Adv. Reactions/Side Effects ⬆ ⬇

CV: HF, ARRHYTHMIAS, BRADYCARDIA, orthostatic hypotension, peripheral vasoconstriction, PULMONARY EDEMA

Derm: itching, rashes

EENT: blurred vision, dry eyes, nasal stuffiness

Endo: hyperglycemia, hypoglycemia

GI: constipation, diarrhea, nausea

GU: erectile dysfunction, ↓libido

MS: arthralgia, back pain, muscle cramps

Neuro: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status changes, nervousness, nightmares, paresthesia

Resp: bronchospasm, wheezing

Misc: ANAPHYLAXIS (RARE)

Interactions ⬆ ⬇

Drug-drug:

General anesthesia, IV phenytoin, and verapamil may ↑ myocardial depression.
↑bradycardia may occur with digoxin.
↑hypotension may occur with other antihypertensives, acute ingestion of alcohol, or nitrates.
Concurrent use with amphetamines, cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or pseudoephedrine may result in unopposed alpha-adrenergic stimulation (excessive hypertension, bradycardia).
Concurrent thyroid administration may ↓ effectiveness.
May alter the effectiveness of insulins or oral antidiabetics (dosage adjustments may be necessary).
May ↓effectiveness of bronchodilators and theophylline.
May↓ beneficial cardiovascular effects of dopamine or dobutamine.
Use cautiously within 14 days of MAO inhibitor therapy (may result in hypertension).
Cimetidine may ↑ toxicity.
Concurrent NSAIDs may ↓ antihypertensive action.

Route/Dosage ⬆ ⬇

PO (Adults ): Antihypertensive: 10 mg twice daily initially; may ↑ q 7 days as needed (usual maintenance dose is 10–20 mg twice daily; up to 60 mg/day). Prevention of MI: 10 mg twice daily, starting 1–4 wk after MI. Prevention of vascular headache: 10 mg twice daily initially, may be given as a single daily dose; may ↑ up to 10 mg in the morning and 20 mg in the evening.

Availability ⬆ ⬇

(Generic available)

Tablets: 5 mg; 10 mg; 20 mg

Assessment ⬆ ⬇

Monitor BP and pulse frequently during dose adjustment period and periodically during therapy. Assess for orthostatic hypotension when assisting patient up from supine position.
Monitor intake and output ratios and daily weight. Assess patient routinely for evidence of fluid overload (peripheral edema, dyspnea, rales/crackles, fatigue, weight gain, jugular venous distention).
Hypertension: Monitor frequency of prescription refills to determine adherence.
Vascular Headache Prophylaxis: Assess frequency, severity, characteristics, and location of vascular headaches periodically during therapy.

Lab Test Considerations:

May cause ↑ BUN, serum lipoprotein, potassium, triglyceride, and uric acid levels.
- May cause ↑ ANA titers.
- May cause ↑ in blood glucose levels.

Toxicity and Overdose:

Monitor patients receiving beta blockers for signs of overdose (bradycardia, severe dizziness or fainting, severe drowsiness, dyspnea, bluish fingernails or palms, seizures). Notify health care provider immediately if these signs occur.
- Glucagon has been used to treat bradycardia and hypotension.

Implementation ⬆ ⬇

PO: Take apical pulse before administering. If <50 bpm or if arrhythmia occurs, withhold medication and notify health care professional.
- May be administered with food or on an empty stomach.
- Tablets may be crushed and mixed with food.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed, at the same time each day, even if feeling well; do not skip or double up on missed doses. Take missed doses as soon as possible up to 4 hr before next dose. Abrupt withdrawal may precipitate life-threatening arrhythmias, hypertension, or myocardial ischemia.
Advise patient to make sure that enough medication is available for weekends, holidays, and vacations. A written prescription may be kept in wallet in case of emergency.
Teach patient and family how to check pulse daily and BP biweekly. Advise patient to hold dose and contact health care professional if pulse is <50 bpm or BP changes significantly.
May cause drowsiness or dizziness. Caution patients to avoid driving or other activities that require alertness until response to the drug is known.
Advise patients to change positions slowly to minimize orthostatic hypotension, especially during initiation of therapy or when dose is increased.
Caution patient that this medication may increase sensitivity to cold.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, or herbal products, especially NSAIDs and cold preparations, concurrently with this medication.
Patients with diabetes should closely monitor blood glucose, especially if weakness, malaise, irritability, or fatigue occurs. Medication may mask tachycardia and increased BP as signs of hypoglycemia, but dizziness and sweating may still occur.
Advise patient to notify health care professional if slow pulse, difficulty breathing, wheezing, cold hands and feet, dizziness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occurs.
Instruct patient to inform health care professional of medication regimen before treatment or surgery.
Advise patient to carry identification describing disease process and medication regimen at all times.
Hypertension: Reinforce the need to continue additional therapies for hypertension (weight loss, sodium restriction, stress reduction, regular exercise, moderation of alcohol consumption, and smoking cessation). Medication controls but does not cure hypertension.
Vascular Headache Prophylaxis: Caution patient that sharing this medication may be dangerous.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇