Non-selective beta-blocker (topical IOP reduction) Pregnancy: No adequate data in pregnant women — should not be used during pregnancy unless clearly necessary; reduce systemic absorption (see §4.2). Beta-blockers given by the oral route show a risk of intra-uterine growth retardation, and signs of beta-blockade (bradycardia, hypotension, respiratory distress, hypoglycaemia) have been seen in neonates when beta-blockers were given until delivery — monitor the neonate carefully during the first days of life. Timolol is detectable in human milk; decide between stopping the drug or stopping nursing based on its importance to the mother.

Timolol 0.25%–0.5% Eye Drops

Brand names: Timoptol, Tiopex (gel-forming)

Timolol eye drops are a topical non-selective beta-blocker used to reduce intraocular pressure in open-angle glaucoma and ocular hypertension.

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 0.25% solution in the affected eye; if clinical response is not adequate, one drop of 0.5% solution in each affected eye

Route: Ophthalmic (topical eye drops)

Frequency: Twice a day; provided intra-ocular pressure is maintained at satisfactory levels, many patients can then be placed on once-a-day therapy

SPC §4.2 verbatim basis: 'Recommended therapy is one drop 0.25% solution in the affected eye twice a day. If clinical response is not adequate, dosage may be changed to one drop 0.5% solution in each affected eye twice a day.' Reassess intra-ocular pressure approximately four weeks after starting treatment, because response may take a few weeks to stabilise. May be used with other agent(s) for lowering intra-ocular pressure, but the use of two topical beta-adrenergic blocking agents is not recommended. TRANSFER FROM OTHER AGENTS: from another topical beta-blocker — discontinue it after a full day of therapy and start timolol 0.25% one drop in each affected eye twice a day the next day, increasing to 0.5% twice a day if response is inadequate; from a single non-beta-blocker anti-glaucoma agent — continue that agent and add timolol 0.25% one drop in each affected eye twice a day, then discontinue the previous agent completely on the following day (substitute 0.5% twice a day if a higher dosage is required). ELDERLY: the dosage recommendations above reflect wide clinical experience in elderly patients; no separate adjustment given. PAEDIATRIC (non-numeric — not structured): the SPC states 'No specific dosage recommendation can be given as there is only limited clinical data.' Timolol is recommended only for primary congenital and primary juvenile glaucoma as a transitional measure while a surgical decision is made or after failed surgery; if benefit outweighs risk, use the lowest active agent concentration available once daily (the 0.1% concentration might already be sufficient), with careful up-titration to a maximum of two drops daily per affected eye if IOP is not sufficiently controlled, preferring a 12-hour interval if applied twice daily; observe patients, especially neonates, closely for one to two hours after the first dose. Treatment in children is transient. ADMINISTRATION: nasolacrimal occlusion or closing the eyelids for 2 minutes reduces systemic absorption; avoid contact of the dropper tip with the eye or surrounding structures.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Cardiogenic shock
Overt cardiac failure
Second- and third-degree atrioventricular block not controlled with pacemaker
Sinus bradycardia, sick sinus syndrome, sino-atrial block
Reactive airway disease including bronchial asthma or a history of bronchial asthma
Presence or history of severe chronic obstructive pulmonary disease
Hypersensitivity to the active substance, to any of the excipients, or to other beta-blocking agents

Side effects

Ocular irritation (burning, stinging, itching, tearing, redness), conjunctivitis, blepharitis, keratitis, dry eyes, decreased corneal sensitivity, corneal erosion
Blurred vision and visual disturbances including refractive changes, diplopia, ptosis; choroidal detachment following filtration surgery
Bradycardia, palpitations, arrhythmia, atrioventricular block, congestive heart failure, cardiac arrest
Bronchospasm (predominantly in patients with pre-existing bronchospastic disease), dyspnoea, cough, respiratory failure
Hypotension, Raynaud's phenomenon, cold hands and feet, intermittent claudication
Headache, syncope, dizziness-related CNS effects, depression, insomnia, nightmares; asthenia and fatigue

Interactions

Systemic beta-blocking agents — the effect on intra-ocular pressure or the known effects of systemic beta-blockade may be potentiated; observe the response of these patients closely (§4.4)
The use of two topical beta-adrenergic blocking agents is not recommended (§4.4, referring to §4.5)

Clinical monograph

How it works

Timolol blocks beta-adrenoceptors on the ciliary body, decreasing aqueous humour formation and so lowering intraocular pressure.

Prescribing in practice

Systemic absorption can cause clinically significant beta-blockade, making it contraindicated in asthma or a history of obstructive airways disease and in significant bradycardia, heart block or uncontrolled heart failure.
Caution is needed with concurrent systemic beta-blockers, verapamil or other rate-limiting agents owing to additive cardiovascular effects.
Advise nasolacrimal occlusion or eyelid closure after instillation to minimise systemic exposure.

Monitoring

Monitor intraocular pressure to confirm efficacy and watch for systemic beta-blockade such as bradycardia or bronchospasm in susceptible patients.

Counselling the patient

Close the eyes and press the inner corner gently after each dose to reduce absorption into the body.
Seek advice if you experience wheezing, breathlessness or a slow heartbeat.
Use regularly even though you may not feel any different.

Evidence & guidelines

Topical timolol is a long-standing, NICE-recognised therapy for raised intraocular pressure, with established cardiorespiratory contraindications.

Reference: NICE CG85; EGS Glaucoma Guidelines; 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