Prostaglandin + β-blocker Pregnancy: Must not be used in women of child-bearing age/potential unless adequate contraceptive measures are in place. Travoprost has harmful pharmacological effects on pregnancy and/or the foetus/newborn; timolol should not be used during pregnancy unless clearly necessary — the combination should not be used during pregnancy unless clearly necessary. Oral beta blockers show a risk of intrauterine growth retardation, and signs of beta blockade have been seen in neonates when given until delivery — monitor the neonate carefully during the first days of life. Use by breast-feeding women is not recommended.

Travoprost with timolol

Brand names: DuoTrav

Travoprost with timolol is a fixed-combination eye drop for open-angle glaucoma and ocular hypertension, combining a prostaglandin analogue with a beta-blocker to reduce intraocular pressure when a single agent is insufficient.

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 the fixed combination (travoprost 40 micrograms/mL + timolol 5 mg/mL, e.g. DuoTrav) in the conjunctival sac of the affected eye(s)

Route: Ophthalmic (topical eye drops)

Frequency: Once daily, in the morning or evening — administered at the same time each day

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

Applies to adults including the elderly. If a dose is missed, continue treatment with the next dose as planned. When nasolacrimal occlusion is used or the eyelids are closed for 2 minutes, systemic absorption is reduced, which may decrease systemic side effects and increase local activity. If more than one topical ophthalmic medicinal product is being used, the products must be administered at least 5 minutes apart. When substituting another ophthalmic antiglaucoma product, discontinue it and start this combination the following day. Patients must remove soft contact lenses before application and wait 15 minutes after instillation before reinsertion. PAEDIATRIC (non-numeric — not structured): safety and efficacy in children and adolescents below 18 years have not been established; no data are available.

Dose adjustments

Renal

No studies have been conducted with the combination (or with timolol 5 mg/mL eye drops) in hepatic or renal impairment. Travoprost required no dose adjustment in mild to severe renal impairment (creatinine clearance as low as 14 mL/min) or mild to severe hepatic impairment; patients with hepatic or renal impairment are unlikely to require dose adjustment

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

Hypersensitivity to the active substances or to any of the excipients; hypersensitivity to other beta blockers
Reactive airway disease including bronchial asthma, or a history of bronchial asthma; severe chronic obstructive pulmonary disease
Sinus bradycardia, sick sinus syndrome including sino-atrial block, second- or third-degree atrioventricular block not controlled with pacemaker
Overt cardiac failure, cardiogenic shock
Severe allergic rhinitis and corneal dystrophies

Side effects

Ocular hyperaemia (very common, 12.0% of 2,170 patients in clinical studies)
Punctate keratitis, eye pain, visual disturbance, blurred vision, dry eye, eye pruritus, ocular discomfort, eye irritation (common)
Bradycardia (uncommon); arrhythmia and irregular heart rate (rare); cardiac failure, tachycardia, chest pain, palpitations (not known)
Dyspnoea and postnasal drip (uncommon); bronchospasm, cough, throat irritation, dysphonia (rare); asthma (not known)
Dizziness, headache (uncommon); hypertension, hypotension (uncommon); cerebrovascular accident, syncope, paraesthesia (not known)
Hypertrichosis, periocular skin hyperpigmentation, contact dermatitis (uncommon); macular oedema, eyelid ptosis, deepened lid sulcus, iris hyperpigmentation (not known)

Interactions

Systemic beta-blocking medicinal products — the effect on intra-ocular pressure or the known effects of systemic beta blockade may be potentiated; observe the response closely (§4.4)
The use of two topical beta-adrenergic blocking agents is not recommended (§4.4, referring to §4.5)
Surgical anaesthesia — beta-blocking ophthalmological preparations may block systemic beta-agonist effects (e.g. of adrenaline); inform the anaesthetist that the patient is receiving timolol (§4.4)
If more than one topical ophthalmic medicinal product is being used, administer at least 5 minutes apart (§4.2, referring to §4.5)

Clinical monograph

How it works

Travoprost is a prostaglandin F2-alpha analogue that enhances uveoscleral outflow of aqueous humour, and timolol is a non-selective beta-blocker that decreases aqueous production; combining them gives additive pressure lowering.

Prescribing in practice

Because of the timolol component's systemic absorption, it is contraindicated in asthma, severe airways disease and significant bradycardia, heart block or uncontrolled heart failure, and used cautiously with other cardiovascular medicines.
The travoprost component can produce permanent darkening of the iris and periocular skin and increased lash growth, which may be uneven when one eye is treated.
Use once daily with eyelid closure or punctal occlusion afterwards to limit systemic exposure to the beta-blocker.

Monitoring

Monitor intraocular pressure for therapeutic response and check pulse and respiratory status because of systemic beta-blockade.

Counselling the patient

Apply once daily and gently press the inner corner of the eye afterwards to reduce body-wide absorption.
Expect possible darkening of the iris and surrounding skin and longer eyelashes, which can differ between eyes.
Tell your clinician about any new breathlessness, wheeze or slow pulse and do not stop the drops abruptly.

Evidence & guidelines

Fixed prostaglandin-timolol combinations are an established option for glaucoma not controlled on monotherapy, with the beta-blocker contraindications and prostaglandin cosmetic effects set out in the SPC.

Reference: NICE NG81; 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