Bimatoprost with timolol

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.