TimololTimolol Maleate

About Timolol

Timolol is a beta blocker. In the eye it reduces the fluid produced inside the eye, which lowers eye pressure. Timoptic and its generics are 0.25 and 0.5 percent drops, usually used twice a day; Timoptic-XE and its generics are a gel-forming solution used once a day; Istalol is a brand 0.5 percent solution used once each morning; Timoptic in Ocudose is preservative-free and single-use; Betimol is a brand made with a different timolol salt. Timolol tablets are a separate generic for high blood pressure, after a heart attack and to prevent migraine; Blocadren is discontinued, and the tablets are not stopped suddenly in heart disease.

Burning and stinging as the drop goes in are the most common complaints. Enough of the drug reaches the bloodstream to cause the problems of a beta-blocker tablet, so the drops must not be used with asthma or a history of asthma, severe chronic obstructive pulmonary disease, a slow heart rate, second or third degree heart block, overt heart failure or cardiogenic shock; severe breathing and heart reactions, including deaths, have been reported. They can also mask low blood sugar and an overactive thyroid. There is no boxed warning.

Timolol is also sold combined with dorzolamide (Cosopt and generics) and with brimonidine (Combigan and generics), each a separate prescription; no fixed combination with latanoprost or travoprost is FDA-approved in the US, so those are separate bottles. Soft contact lenses absorb the preservative, so they come out before a dose and go back in fifteen minutes later.

Taking Timolol

How to take it

Usually one drop in the affected eye twice a day, or once a day for the gel-forming solution and for Istalol, used in the morning. Pull the lower lid down, put the drop in without touching the tip to the eye, then close the eye and press a finger against the inner corner for two to three minutes. Shake the gel-forming bottle once before each use.

If you miss a dose

Put the drop in as soon as you remember, unless it is nearly time for the next dose; then skip it and carry on as usual. Do not use extra drops.

Storage

At room temperature in the original bottle, tightly closed, protected from light and from freezing, out of reach of children.

Interactions to know about

Oral beta blockers add to its effects, and clonidine, reserpine, digoxin, verapamil, diltiazem and quinidine can combine with it to slow the heart or lower blood pressure; quinidine and SSRI antidepressants can also raise timolol levels. Tell the prescriber if you use insulin or other diabetes medicines, and use other eye drops at least ten minutes apart.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Timolol differs from pharmacy to pharmacy

Generic timolol drops have many makers and cost pharmacies little, so a bottle is priced mostly on the dispensing fee and markup. The gel-forming solution has fewer makers and costs more per bottle; the preservative-free product and the brands cost far more again, and a prescription naming one of them can only be filled with that product.

Ways to pay less for Timolol without insurance

• Ask the prescriber whether the plain solution would suit you before paying for a gel-forming, once-daily or preservative-free product.
• Make sure the prescription allows generic substitution, and ask whether timolol is on the pharmacy’s flat-price list.
• Ask the prescriber to write the quantity so that one fill covers ninety days.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Timolol

1. 1.Is this the plain solution, the gel-forming solution or a once-daily brand?
2. 2.I have asthma, a lung condition or a slow heartbeat: is this drop safe for me?
3. 3.How long should I wait between timolol and my other eye drops?
4. 4.Does it interact with my blood pressure, heart or diabetes medicines?

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