Prostaglandin analogue + β-blocker Pregnancy: SPC §4.6: should NOT be used during pregnancy. There are no adequate data for either component in pregnant women; latanoprost animal studies show reproductive toxicity, and timolol should not be used unless clearly necessary (epidemiological studies show a risk of intrauterine growth retardation with oral beta-blockers, and neonatal beta-blockade — bradycardia, hypotension, respiratory distress, hypoglycaemia — has been observed when beta-blockers were given until delivery; if given until delivery the neonate should be carefully monitored during the first days of life). Breast-feeding: should not be used in women who are breast-feeding.

Latanoprost with timolol

Brand names: Xalacom

This is a topical ophthalmic fixed combination of latanoprost, a prostaglandin analogue, and timolol, a non-selective beta-blocker, used to reduce intraocular pressure in open-angle glaucoma and ocular hypertension where monotherapy is inadequate.

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 eye drop in the affected eye(s)

Route: Ocular use (latanoprost + timolol fixed combination; the fetched SPC is Fixapost — a preservative-free single-dose eye drops solution)

Frequency: Once daily

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

SPC §4.2, 'Adults (including the elderly)'. No separate elderly dose is given. If one dose is missed, treatment should continue with the next dose as planned. As with any eye drops, to reduce possible systemic absorption it is recommended that the lachrymal sac be compressed at the medial canthus (punctal occlusion) for two minutes immediately following instillation of each drop. Contact lenses should be removed before instillation and may be reinserted after 15 minutes. If more than one topical ophthalmic medicine is being used, the products should be administered at least five minutes apart. Single-dose presentation: one single-dose container holds enough solution to treat both eyes and is for single use only; the product is a sterile preservative-free solution, so it must be used immediately after opening and any remaining contents discarded immediately after administration. Store the unopened single-dose containers in the sachet. Paediatric population: the safety and efficacy in children and adolescents has not been established. No renal or hepatic dose adjustment is stated in the fetched sections. Dose quote — SPC §4.2: 'Recommended therapy is one eye drop in the affected eye(s) once daily... The dose should not exceed one drop in the affected eye(s) daily.'

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

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
Hypersensitivity to the active substances or to any of the excipients

Side effects

Iris hyperpigmentation — very common; 16–20% of patients in the pivotal trial extension phase developed increased iris pigmentation, which may be permanent (33% over 5 years with latanoprost alone)
Eye pain and eye irritation (including stinging, burning, itching, foreign body sensation) — common
Headache — common
Corneal disorders, conjunctivitis, blepharitis, eye hyperaemia, blurred vision, increased lacrimation — uncommon; rash and pruritus also reported
For the timolol component the most serious reactions are systemic: bradycardia, arrhythmia, congestive heart failure, bronchospasm and allergic reactions; latanoprost-specific reactions include eyelash/vellus hair changes, punctate keratitis, iritis, uveitis and macular oedema including cystoid macular oedema

Interactions

Systemic beta-blocking agents — the effect on intraocular pressure or the known effects of systemic beta-blockade may be potentiated when timolol is given to patients already receiving a systemic beta-blocker; observe these patients closely (SPC §4.4)
Other prostaglandins, prostaglandin analogues or prostaglandin derivatives — concomitant use of two or more is not recommended (SPC §4.4)
Other topical ophthalmic medicines — administer at least five minutes apart (SPC §4.2)
SPC §4.4 states 'Timolol may interact with other drugs (see section 4.5)'; the §4.5 interaction section was not present in the fetched bundle — clinician to consult it

Clinical monograph

How it works

Latanoprost enhances uveoscleral outflow of aqueous humour, while timolol reduces aqueous production via beta-adrenergic blockade, producing additive intraocular pressure lowering.

Prescribing in practice

The systemically absorbed timolol component means the combination is contraindicated in asthma, a history of bronchospasm, severe COPD, sinus bradycardia, heart block and uncontrolled heart failure.
Latanoprost may cause permanent iris darkening, periocular skin pigmentation and increased eyelash growth, especially with unilateral treatment.
Use once daily and apply nasolacrimal occlusion after instillation to limit systemic beta-blocker absorption.

Monitoring

Check intraocular pressure to assess response and review for systemic beta-blockade such as bradycardia and bronchospasm, alongside local prostaglandin effects on the iris and lashes.

Counselling the patient

Use the drop once daily, usually in the evening, and press on the inner corner of the eye afterwards.
The eye colour may darken and eyelashes may grow longer, which can be permanent.
Report wheeze, breathlessness, a slow heartbeat or unusual tiredness.

Evidence & guidelines

NICE glaucoma guidance (NG81) supports fixed-combination topical therapy, including a prostaglandin analogue with a beta-blocker, when single-agent treatment does not reach target intraocular pressure.

Reference: 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