PG analogue + beta-blocker eye drops Pregnancy: Should not be used during pregnancy unless clearly necessary — no adequate data for the fixed combination. Oral beta-blockers carry a risk of intra-uterine growth retardation, and neonatal beta-blockade (bradycardia, hypotension, respiratory distress, hypoglycaemia) has been observed; if given until delivery, monitor the neonate carefully during the first days of life. Should not be used by breast-feeding women (SPC 4.6).

Bimatoprost with timolol

Brand names: Ganfort

This is a fixed-combination eye drop of bimatoprost, a prostaglandin analogue, with timolol, a non-selective beta-blocker, used to lower intraocular pressure in open-angle glaucoma and ocular hypertension when a single agent is insufficient.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One drop of bimatoprost/timolol in the affected eye(s)

Route: Ocular (topical eye drops)

Frequency: Once daily, administered either in the morning or in the evening, at the same time each day

Max: The dose should not exceed one drop in the affected eye(s) daily

Source: eMC SPC for 'Bimatoprost Timolol 0.3 mg/ml + 5 mg/ml eye drops solution, in single-dose container'. Existing literature data suggest evening dosing may be more effective in IOP lowering than morning dosing; however, the likelihood of compliance should be considered when choosing morning or evening dosing. If one dose is missed, treatment should continue with the next dose as planned. Method of administration: instil different topical ophthalmic products at least 5 minutes apart; nasolacrimal occlusion or closing the eyelids for 2 minutes reduces systemic absorption (fewer systemic side effects, increased local activity). Renal/hepatic impairment: not studied — caution should be used in treating such patients. Paediatric population: safety and efficacy in children aged 0 to 18 years has not been established; no data are available (SPC 4.2).

Dose adjustments

Renal

Not studied in patients with hepatic or renal impairment — caution should be used in treating such patients (SPC 4.2).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substances or to any of the excipients
Reactive airway disease including bronchial asthma or a history of bronchial asthma; severe chronic obstructive pulmonary disease
Sinus bradycardia, sick sinus syndrome, sino-atrial block, second or third degree atrioventricular block not controlled with a pacemaker
Overt cardiac failure; cardiogenic shock

Side effects

Conjunctival hyperaemia — very common (approximately 26% of patients; discontinuation in 1.5%)
Prostaglandin analogue periorbitopathy — very common
Punctate keratitis, corneal erosion, burning/stinging sensation, eye pruritus, dry eye, eye pain, photophobia, growth of eyelashes — common
Headache — common; rhinitis — common; dyspnoea — uncommon
Bradycardia, hypertension, bronchospasm (predominantly in patients with pre-existing bronchospastic disease) and asthma — frequency not known

Clinical monograph

How it works

Bimatoprost increases uveoscleral outflow of aqueous humour while timolol reduces aqueous production by the ciliary epithelium; the two complementary actions give greater pressure reduction than either alone.

Prescribing in practice

Because of the timolol component, avoid in patients with asthma, a history of bronchospasm, severe COPD, sinus bradycardia, heart block or uncontrolled heart failure, and warn about systemic beta-blockade.
Bimatoprost can cause permanent darkening and lengthening of eyelashes and iris hyperpigmentation, especially in mixed-colour irides.
Advise punctal occlusion or eyelid closure after instillation to reduce systemic absorption, and remove contact lenses before use.

Monitoring

Monitor intraocular pressure and, in at-risk patients, heart rate and respiratory status, with periodic assessment for periocular pigmentary and lash changes.

Counselling the patient

Instil once daily, usually in the evening, and press gently on the inner corner of the eye for a short while afterwards.
Iris and eyelid skin may darken and lashes may grow longer and thicker, sometimes permanently.
Tell your clinician about any breathing problems, wheeze or a slow heartbeat.

Evidence & guidelines

NICE glaucoma guidance supports fixed-combination prostaglandin/beta-blocker drops to improve adherence when monotherapy fails to control intraocular pressure adequately.

Reference: NICE NG81; RCOphth; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways