Tafluprost with timolol

How it works

Tafluprost is a prostaglandin F2-alpha analogue that increases uveoscleral aqueous outflow, while timolol is a non-selective beta-blocker that reduces aqueous humour production by the ciliary body; the two mechanisms are complementary.

Prescribing in practice

• The timolol component is systemically absorbed and can cause bronchospasm and bradycardia, so it is contraindicated in asthma, severe COPD and significant bradycardia, heart block or uncontrolled heart failure.
• The prostaglandin component can cause permanent iris and periocular skin darkening and increased eyelash growth, which can be cosmetically asymmetric if only one eye is treated.
• Apply once daily and use punctal occlusion or eyelid closure after instillation to reduce systemic beta-blocker absorption.

Monitoring

Monitor intraocular pressure to confirm response and review heart rate and respiratory symptoms given systemic beta-blockade.

Counselling the patient

• Press on the inner corner of the eye for a short time after the drop to reduce absorption into the body.
• Be aware the drop may darken the coloured part of the eye and surrounding skin and lengthen the lashes, sometimes unevenly.
• Report any wheeze, breathlessness or slow heartbeat, and do not stop suddenly without advice.

Evidence & guidelines

Fixed prostaglandin-beta-blocker combinations are an established step in glaucoma therapy for patients not controlled on monotherapy, with systemic beta-blocker cautions detailed in the SPC.