The mechanism of the antihypertensive effects of beta-adrenergic receptor blocking agents is not established at this time. Possible mechanisms of action include reduction in cardiac output, reduction in plasma renin activity, and a central nervous system sympatholytic action.
Timolol maleate should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. 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, taking into account the importance of the drug to the mother.
This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. Although beta blockers should be avoided in overt congestive heart failure, they can be used, if necessary, with caution in patients with a history of failure who are well-compensated, usually with digitalis and diuretics.
Both digitalis and timolol maleate slow AV conduction. If cardiac failure persists, therapy with timolol should be withdrawn. In Patients Without a History of Cardiac Failure continued depression of the myocardium with beta-blocking agents over a period of time can, in some cases, lead to cardiac failure. If cardiac failure continues, despite adequate digitalization and diuretic therapy, timolol should be withdrawn. However, if TIMOLOL is necessary in such patients, then the drug should be administered with caution since it may block bronchodilation produced by endogenous and exogenous catecholamine stimulation of beta2 receptors.
Major Surgery The necessity or desirability of withdrawal of beta-blocking therapy prior to major surgery is controversial. Beta-adrenergic receptor blockade impairs the ability of the heart to respond to beta-adrenergically mediated reflex stimuli.
This may augment the risk of general anesthesia in surgical procedures. Some patients receiving beta-adrenergic receptor blocking agents have been subject to protracted severe hypotension during anesthesia. Difficulty in restarting and maintaining the heartbeat has also been reported. For these reasons, in patients undergoing elective surgery, some authorities recommend gradual withdrawal of beta-adrenergic receptor blocking agents.
Diabetes Mellitus Timolol should be administered with caution in patients subject to spontaneous hypoglycemia or to diabetic patients especially those with labile diabetes who are receiving insulin or oral hypoglycemic agents. Beta-adrenergic receptor blocking agents may mask the signs and symptoms of acute hypoglycemia. Thyrotoxicosis Beta-adrenergic blockade may mask certain clinical signs e.
Patients suspected of developing thyrotoxicosis should be managed carefully to avoid abrupt withdrawal of beta blockade which might precipitate a thyroid storm. Dosing in the Presence of Marked Renal Failure: One to two tablets a day to prevent migraine attacks.
The tablet can be divided into equal doses. If you are elderly the doctor will probably start with the lowest adult dose and then adjust your dose carefully, depending on how you respond to treatment.
Timolol maleate 10 mg tablets are not suitable for children. Your doctor may change the number of tablets you take. This will depend on how well you respond to the treatment. Do not alter the number of tablets you are taking without checking with your doctor. The tablet can be divided into equal doses.
Timolol maleate 10 mg tablets are also indicated in the prophylactic treatment of migraine in order to reduce the number of attacks. Subsequent increases in dose should take place slowly, e. The recommended dose range is 5 - 30 mg twice daily. The initial dose should be 5 mg twice daily, increasing the daily dose by 10 mg not more frequently than every 3 to 4 days to achieve optimum results. The recommended dose range is 10 - 60 mg daily. Most hypertensive patients will be controlled by 10 - 30 mg timolol which can be administered once daily or in two divided doses if preferred.
Doses in excess of 30 mg daily should be given in two equally divided doses. The dose of Timolol maleate 10 mg tablets may need adjustment when used in conjunction with other antihypertensive drugs. If there are no adverse effects, increase dosage to 10 mg twice daily and maintain at this dose. For the prophylactic treatment of migraine: Dosage in the elderly: Initiate treatment with lowest adult dose and thereafter adjust according to response.
The safety and efficacy of Timolol maleate 10 mg tablets in children has not been established. No data are available. Method of administration 4. History of bronchospasm and bronchial asthma. If signs or symptoms suggesting reduced cerebral blood flow are observed, consideration should be given to discontinuing these agents.
Non-Steroidal Anti-Inflammatory Drugs Blunting of the antihypertensive effect of beta-adrenoceptor blocking agents by non-steroidal anti-inflammatory drugs has been reported. When using these agents concomitantly, patients should be observed carefully to confirm that the desired therapeutic effect has been obtained. Calcium Antagonists Literature reports suggest that oral calcium antagonists may be used in combination with beta-adrenergic blocking agents when heart function is normal, but should be avoided in patients with impaired cardiac function.
Hypotension, AV conduction disturbances, and left ventricular failure have been reported in some patients receiving beta-adrenergic blocking agents when an oral calcium antagonist was added to the treatment regimen. Hypotension was more likely to occur if the calcium antagonist were a dihydropyridine derivative, e. Intravenous calcium antagonists should be used with caution in patients receiving beta-adrenergic blocking agents.
Digitalis and Either Diltiazem or Verapamil The concomitant use of beta-adrenergic blocking agents with digitalis and either diltiazem or verapamil may have additive effects in prolonging AV conduction time.
Quinidine Potentiated systemic beta-blockade e. Clonidine Beta-adrenergic blocking agents may exacerbate the rebound hypertension which can follow the withdrawal of clonidine.
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