Non-selective beta-blocker (topical IOP reduction)
Pregnancy: Avoid if possible — beta-blockade may cause fetal bradycardia and hypoglycaemia.
Timolol 0.25%–0.5% Eye Drops
Brand names: Timoptol, Tiopex (gel-forming)
Adult dose
Dose: 1 drop of 0.25% or 0.5% solution twice daily (or once daily with gel-forming)
Route: Ophthalmic
Frequency: Twice daily (solution); once daily (gel-forming formulation)
Max: 1 drop per eye twice daily
0.25% BD initially; 0.5% BD if insufficient. Tiopex gel-forming (0.1%): once daily (better adherence). Switch to monotherapy with prostaglandin analogue often preferred.
Paediatric dose
Route: Ophthalmic
Frequency: Twice daily
Max: 1 drop per eye twice daily
Use with caution in children — significant systemic absorption can cause bradycardia, bronchospasm, and apnoea in neonates and infants. Specialist use only. Punctal occlusion essential.
Dose adjustments
Renal
No local adjustment; monitor for systemic beta-blockade effects.
Hepatic
No local adjustment.
Clinical pearls
- Significant systemic absorption via nasolacrimal drainage — punctal occlusion reduces this
- Absolute contraindication in asthma — even eye drops
- Once-daily gel-forming (Tiopex) preferred for adherence
- Bradycardia may occur at rest — monitor HR especially in elderly
- May mask hypoglycaemic tachycardia in diabetics
Contraindications
- Asthma and COPD (significant bronchospasm risk)
- Second or third degree heart block
- Sick sinus syndrome
- Decompensated heart failure
- Raynaud's phenomenon / peripheral vascular disease (significant)
Side effects
- Systemic beta-blockade (despite topical route): bradycardia, hypotension, bronchospasm
- Ocular irritation and stinging
- Dry eyes
- Corneal anaesthesia (reduced sensation — caution with contact lens wear)
Interactions
- Systemic beta-blockers — additive bradycardia and AV block
- Calcium channel blockers (verapamil, diltiazem) — increased cardiac depression
- Digoxin — increased AV conduction delay
Monitoring
- IOP
- HR and BP
- Respiratory status
- Blood glucose (diabetics)
Reference: BNFc; BNF; NICE CG85; EGS Glaucoma Guidelines. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- MAGGIC Heart Failure Risk Score · Heart Failure
- IABP Timing Assessment · Mechanical Circulatory Support
- Long QT Syndrome (Schwartz Score) · Channelopathy / Sudden Cardiac Death
- C-Peptide to Glucose Ratio · Diabetes Classification
- International Staging System (ISS) for Multiple Myeloma · Multiple Myeloma
- Revised ISS (R-ISS) for Multiple Myeloma · Haematological Malignancy
Pathways
- Acute Red Eye / Vision Loss Screen · RCOphth 2020; NICE CKS
- Idiopathic Intracranial Hypertension · ABN; consensus 2018
- Acute Red Eye Assessment · RCOphth / AAO
- Acute Angle Closure Glaucoma · RCOphth / EGS Guidelines
- Retinal Detachment · RCOphth Guidelines / EURETINA
- Diabetic Retinopathy — Screening and Management · NICE NG28 2016 / NHS DES Programme