Adult: Travoprost 0.04 mg and timolol 5 mg per mL of eye drop solution
For the reduction of elevated IOP in patients who are inadequately responsive to topical β blockers, prostaglandin analogues, or other IOP-reducing agents and in whom combination therapy is appropriate: Instil 1 drop into the affected eye(s) once daily.
Contraindications
Reactive airway disease including active or a history of bronchial asthma, severe COPD; sick sinus syndrome, sinus bradycardia, sino-atrial block, 2nd- or 3rd-degree AV block not controlled with pacemaker, overt cardiac failure, cardiogenic shock, corneal dystrophies, severe allergic rhinitis. Pregnancy or women of childbearing potential.
Special Precautions
Patient with CV disease (e.g. Prinzmetal's angina, CHD, cardiac failure, hypotension, 1st-degree heart block), cerebrovascular insufficiency, peripheral circulatory disorders (e.g. Raynaud's syndrome), mild to moderate COPD; active or history of bronchospastic disease; spontaneous hypoglycaemia, diabetes mellitus, myasthenia gravis, corneal diseases, history of atopy or severe anaphylactic reaction to allergens; aphakia, pseudoaphakia with torn posterior lens capsule or anterior chamber lenses, known risk factors for cystoid macular oedema, iritis, or uveitis; active intraocular inflammation; chronic or recurrent choroidal detachment, orthostatic hypotension. Patients undergoing surgery. Timolol may mask the signs and symptoms of hypoglycaemia and hyperthyroidism. Not for use alone in treating acute angle-closure glaucoma. Renal impairment. Lactation.
Adverse Reactions
Significant: Dry eye; choroidal detachment (post-filtration procedures), change or increase brown pigmentation of the iris or eyelid skin; periorbital or lid changes including deepening of the eyelid sulcus; changes in the length, thickness, pigmentation, or number of eyelashes in the treated eye; macular oedema, exacerbation of myasthenia gravis; new onset or exacerbation of arterial insufficiency (patients with peripheral circulatory disorders and Raynaud’s disease). Cardiac disorders: Bradycardia. Eye disorders: Ocular hyperaemia, punctate keratitis, visual disturbance, blurred vision, ocular discomfort; eye pain, pruritus, or irritation, photophobia, abnormal sensations in the eye, iritis, conjunctivitis. Gastrointestinal disorders: Dysgeusia. General disorders and administration site conditions: Peripheral oedema. Immune system disorders: Hypersensitivity. Psychiatric disorders: Hallucination, depression. Skin and subcutaneous tissue disorders: Skin hyperpigmentation, rash. Vascular disorders: Hypotension. Potentially Fatal: Rarely, severe respiratory reactions due to bronchospasm (in patients with asthma), severe cardiac reactions (e.g. cardiac failure).
Patient Counseling Information
Remove contact lenses before administration and reinsert after 15 minutes. This drug may cause transient blurred vision, if affected, do not drive or operate machinery. Women of childbearing potential must use adequate contraception during use.
Monitoring Parameters
Monitor IOP, changes in iris colour and eyelash. Assess for signs of systemic β-blockade.
Drug Interactions
Timolol: May enhance the hypertensive reaction to sudden withdrawal of clonidine. Enhanced systemic β blockade with CYP2D6 inhibitors (e.g. fluoxetine, paroxetine, quinidine). May potentiate the hypoglycaemic effects of antidiabetic agents. Potential additive effects leading to hypotension and/or marked bradycardia with oral Ca channel blockers, β-blockers, antiarrhythmics (including amiodarone), digitalis glycosides, parasympathomimetics, MAOIs, and narcotics. May decrease the response of epinephrine in treating anaphylaxis; concomitant use may result to mydriasis. May have potentiated effects on IOP or the known effects of systemic β-blockade with oral or other β-adrenergic blockers.
Action
Description: Mechanism of Action: Travoprost is a highly selective full agonist prostaglandin F2α analogue with high affinity to prostaglandin FP receptor. It reduces intraocular pressure (IOP) by increasing outflow of aqueous humour through trabecular meshwork and uveoscleral pathways.
Timolol is a non-selective β-adrenergic receptor blocker and has no significant intrinsic sympathomimetic, direct myocardial depressant, or membrane-stabilising activity. It reduces IOP by decreasing aqueous humour production or by increasing the outflow of aqueous humour. Onset: Travoprost: Approx 2 hours.
Timolol: 30 minutes. Duration: Timolol: 24 hours. Pharmacokinetics: Absorption: Travoprost: Time to peak plasma concentration: 12 hours.
Timolol: Time to peak plasma concentration: 1-2 hours. Distribution: Timolol: Enters breast milk. Metabolism: Travoprost: Metabolised in the cornea via hydrolysis by esterases to active free acid. Undergoes further metabolism systemically into inactive metabolites. Excretion: Travoprost: Via urine (<2% as free acid). Elimination half-life: 45 minutes (range: 17-86 minutes).
Timolol: Via urine (approx 20% as unchanged drug; remainder as metabolites). Elimination half-life: 4 hours.
Chemical Structure
Travoprost Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 5282226, Travoprost. https://pubchem.ncbi.nlm.nih.gov/compound/Travoprost. Accessed Nov. 22, 2023.
Timolol Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 33624, Timolol. https://pubchem.ncbi.nlm.nih.gov/compound/Timolol. Accessed Nov. 22, 2023.
Storage
Store below 30°C. Use within 4 weeks after opening.
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