Travoprost with timolol

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.