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[Treatment of glaucoma chronicum simplex with a combination of 0.5 percent timolol with 0.5 percent adrenaline plus 0.3 percent guanethidine].

The effect on the intraocular pressure of patients with primary open-angle glaucoma of a combination of timolol 0.5% with epinephrine 0.5% plus guanethidine 3% was studied and compared with the effects of timolol alone, of epinephrine 0.5% plus guanethidine 3%, and of other glaucoma drugs. The combination of timolol 0.5% with epinephrine 0.5% plus guanethidine 3% had a stronger effect on intraocular pressure (reduction 10.9 +/- 1.1 mm Hg) than epinephrine 0.5% plus guanethidine 3% (7.6 +/- 0.9 mm Hg) or timolol alone (5.8 +/- 1.1 mm Hg) or other glaucoma drugs. However, when the three substances are administered in combination therapy may show an addition of both pressure-lowering and side effects.

Clinical Trials as Topic↗

[Infrared thermographic investigation of the mechanism of action of timolol (author's transl)].

Distribution of local temperature in the anterior segment was investigated after topical administration of Timolol 0.5% utilizing infrared thermography. Eighty patients were included in this study; the untreated eye was used as a control. Within 30 minutes of instillation of Timolol a decrease in local temperature of up to 3 degrees C could be observed in 44% of the cases, whereas in 32% no change and in the remaining 24% a small increase of up to 1 degree C occurred. In ten other patients thermography and applanation tonometry were carried out simultaneously over a period of 4 hours following topical administration of Timolol; in this preliminary series a maximal local temperature decrease occurred after 90 minutes, i.e., prior to the maximal effect on intraocular pressure. It is concluded from these results that topical administration of Timolol reduces the ciliary blood flow.

Eye Diseases↗

[Long-term therapy with timolol for three years (author's transl)].

From an original group of 36 Patients (15 with relatively advanced chronic open-angle glaucoma and 21 with ocular hypertension) 21 (seven glucoma and 14 ocular hypertension) were well controlled with Timolol alone or in combination with other pressure-lowering drugs after a three years' observation period. Dropouts occurred mainly in the first half of the treatment period. In most of these cases a glaucoma operation was necessary; more rarely, Timolol was discontinued due to intolerance. The overall success rate of 40% with Timolol alone (14 out of 36 patients) is lower than the 60% to 70% found in other long-term studies. If one considers only the results in the ocular hypertension group, the figure of 68% is more in line with the aforementioned results. In the light of similar studies it appears essential to take into account not only the total number of patients treated but also the degree of severity of the glaucoma. In severe glaucoma Timolol alone is seldom effective enough.

Acetazolamide↗

[Timolol response in denervational syndromes (author's transl)].

In eyes with pupillotony (Argyll Robertson) the effect of locally applied timolol maleate (0.5%) on intraocular pressure is considerably less pronounced than in normal control eyes. In Fuchs' heterochromic cyclitis the timolol response is the same as in controls. Infrared thermography of the anterior segment of the eye showed that the maximum drop in IOP was preceded by a fall in temperature. These findings suggest that the IOP-lowering effect of timolol depends on parasympathetic innervation and that timolol decreases the blood flow in the ciliary body.

Fuchs' Endothelial Dystrophy↗

[Pressure-lowering effect of timolol in various forms of glaucoma (author's transl)].

The action of Timolol, which lowers IOP in open-angle glaucoma, was investigated in patients with aphakic glaucoma and, with simultaneous administration of a miotic, in patients with narrow-angle glaucoma. Follow-ups, in some cases over periods of up to one year, showed that Timolol lowers IOP in almost all cases. Timolol alone reduced the pressure in 46% of the patients. Additional administration of other glaucoma drugs enabled IOP to be lowered to 22 mmHg or less in 82%. In five patients the pressure-lowering effect was unsatisfactory or, respectively, treatment with the drug had to be discontinued. All the patients had previously taken numerous pressure-lowering drugs without achieving adequate stabilization. In view of its minor side-effects and convenient mode of application (drops twice a day), Timolol should always be used in younger patients with wide chamber angles before surgery is contemplated.

Glaucoma↗

[Tachyphylaxis in timolol therapy for chronic glaucoma (author's transl)].

Forty-three patients with open-angle glaucoma were treated locally with 0.5% Timolol. The drop in intraocular pressure on the day following commencement of Timolol therapy was remarkable. However, 14 patients, ten of whom had responded insufficiently to other glaucoma drugs, developed tachyphylaxis either two or three days after being put on Timolol therapy; in some cases tachyphylaxis was observed in follow-up examinations two months later. Intraocular pressure in these eyes was in some cases even higher than it had been prior to treatment with Timolol.

Adolescent↗

Ocular and retrobulbar blood flow in ocular hypertensives treated with topical timolol, betaxolol and carteolol.

The purpose of this study was to evaluate the effect of topical timolol 0.5%, betaxolol 0.5% and carteolol 2% on the blood flow velocity of the central retinal artery (CRA), the posterior ciliary artery (PCA) and the ophthalmic artery (OA) in patients with ocular hypertension. A group of 14 patients with ocular hypertension and a group of 11 normals were studied. The color Doppler was used to measure the peak systolic flow velocity (PSFV) and the end diastolic flow velocity (EDFV) of the CRA, the PCA and the OA in the normals and in the patients. The normals were under no treatment, while the patients were studied before and after treatment with topical timolol 0.5%, betaxolol 0.5% and carteolol 2%. In the systolic phase, there was a significant increase in the flow velocity of the CRA with all three drugs. In the diastolic phase of the CRA, the increase was significant for timolol 0.5% and carteolol 2% but not for betaxolol 0.5%. The flow velocity of the PCA and OA remained unchanged. In this study of 14 patients with ocular hypertension, topical timolol 0.5%, betaxolol 0.5% and carteolol 2% led to a significant increase in the flow velocity of the CRA without creating a steal or decrease in the flow velocity of the PCA.

Administration, Topical↗

Effects of eyelid closure and nasolacrimal duct occlusion on the systemic absorption of ocular timolol in human subjects.

Eyelid closure and nasolacrimal occlusion may decrease the systemic absorption of topically applied drugs. We studied the absorption kinetics of 20 microliter 0.5% timolol eyedrops in eight healthy volunteers. Each subject was supine for 30 minutes after the drug application. In randomized order, the volunteers kept their eyelids closed (ELC), or applied nasolacrimal occlusion (NLO) or blinked normally. Blood samples were drawn up to 90 minutes and analyzed for timolol with a radioreceptor assay. There was great interindividual variation in the timolol absorption. NLO reduced the total timolol absorption, but in some subjects the initial absorption was also enhanced by this procedure.

Absorption↗

Celiprolol versus timolol and placebo: a two week double-blind comparison.

Celiprolol (5%) was compared to timolol (0.5%) and placebo in patients with primary open angle glaucoma or ocular hypertension. A total of 28 patients participated in this double blind study and received treatment for two weeks. Intraocular pressure decreased an average of 4.4 mmHg with celiprolol and 7.1 mmHg with timolol two hours after instillation. This was maintained 12 hours after administration of timolol but not after celiprolol. There was a small but statistically significant decrease in pulse rate 2 hours after administration of timolol (from 72 to 64 beats per minute) which was not observed after celiprolol. Side effects were mild and similar for all 3 groups.

Adrenergic beta-Antagonists↗

Influence of corneal epithelial integrity on the penetration of timolol prodrugs.

The interplay of corneal epithelial integrity and prodrug lipophilicity in the corneal penetration of a homologous series of timolol prodrugs was studied. A reversed phase HPLC procedure was used to assay for timolol and its prodrugs. The optimal distribution coefficient for corneal penetration on a logarithmic basis was found to be 2.5, and for two prodrugs of equal lipophilicity the enzymatically labile one was better absorbed. The corneal permeability coefficient of O-acetyl, propionyl, and butyryl timolol was unaffected by deepithelizing the cornea, whereas that of the other prodrugs was reduced. This suggests that these three prodrugs diffused across the corneal epithelium proper as readily as across its basement membrane, which was not removed by the deepithelizing procedure. In contrast to the in vitro results, deepithelizing the cornea did not affect the aqueous humor concentration of timolol at 20 min afforded by any of the prodrugs except the O-propionyl and octanoyl esters. This suggests that factors other than corneal penetration exerted a more important role in affecting the aqueous humor drug concentration when the cornea was deepithelized.

Animals↗

Pharmacokinetics and intraocular pressure lowering effect of timolol preparations in rabbit eyes.

Two timolol preparations, a gel and an eyedrop with a thickening agent, and one commercial eyedrop without a thickening agent, were studied in rabbits. After topical administration of these three preparations in rabbits, aqueous humor was withdrawn and the proteins removed from the samples by precipitation with acetonitrile. Timolol concentrations were determined directly by an HPLC method. The HPLC mobile phase was composed of methanol and 5 mM d-camphorsulfonic acid (in 1% acetic acid) with a ratio of 49:51 (v/v). A reversed phase C18 column was used to separate samples with a flow rate of 0.8 mL/min and a UV detector set at 284 nm. A two-compartment pharmacokinetic model was used to fit the aqueous humor level for determining the drainage (kd) and absorption rate constants (ka) in the precorneal area as well as the elimination rate constant (ke) of timolol in aqueous humor. For ka +kd, the eyedrop without a thickening agent had the highest value (0.160 min-1), followed by the eyedrop with a thickening agent (0.030 min-1), and the gel had the lowest value (0.009 min-1). It suggests that the gel has a longer retention time in eyes to improve ocular bioavailability and decrease side effects. The AUC0 approximately infinity for the aqueous humor profile with time coordinates were 4142, 2974, and 1604 micrograms min/mL, for the gel, the eyedrop with a thickening agent, and the eyedrop without a thickening agent, respectively. In another study, timolol preparations were also topically administered in alpha-chymotrypsin-induced glaucoma rabbits for determining the lowering effect on intraocular pressure (IOP). The durations of depressing IOP for the gel, the eyedrop with a thickening agent, and the eyedrop without a thickening agent were 24, 14 and 10 hrs, respectively. Thus, the gel preparation has a longer duration and a higher ocular bioavailability which might be further developed in the treatment of open-angle glaucoma.

Absorption↗

Continuous monitoring of circadian variations in intraocular pressure by telemetry system throughout a 12-week treatment with timolol maleate in rabbits.

AIM: The aim of this study was to examine the effect of a 12-week treatment with two formulations of timolol maleate on the amplitude of the circadian fluctuation in intraocular pressure (IOP). METHODS: Conscious Japanese White rabbits housed under a controlled 12-hour light-dark cycle were used. IOP was measured by a telemetry system. Each animal was treated topically for 12 weeks with 0.5% timolol solution (TM) twice-daily, 0.5% timolol gel-forming solution (TM-gel) once-daily, or saline twice-daily, and the circadian variation in IOP was measured every week. RESULTS: Administration of TM or TM-gel did not change IOP in the light phase, but significantly reduced it in the dark phase in each of the 12 weeks. The IOP reductions at 2 h after administration in the TM and TM-gel groups over the 12 weeks were, respectively, 3.6 +/- 0.3 mmHg and 3.4 +/- 0.2 mmHg versus the Saline group. The amplitudes of the circadian fluctuations in IOP in the TM group in weeks 3, 6, and 12 were 15%, 15%, and 18% smaller than those in the Saline group, while the corresponding values for the TM-gel group were 18%, 16%, and 19%, respectively. CONCLUSIONS: TM-gel administered once-daily was as effective at lowering IOP as TM administrated twice-daily over the 12-week experimental period. This study reveals that, in rabbits, both formulations of the timolol maleate induced significant IOP reductions in the dark phase and decreased the amplitudes of the circadian fluctuations in IOP for 12 successive weeks.

Adrenergic beta-Antagonists↗

Dorzolamide and timolol saves retinal ganglion cells in glaucomatous adult rats.

PURPOSE: This study was designed to evaluate the effects of a dorzolamide-timolol combination or dorzolamide on retinal ganglion cell (RGC) density and intraocular pressure (IOP) in glaucomatous eyes of adult rats. METHODS: Glaucoma was induced in the right eye of adult Wistar rats by episcleral venous occlusion. One experimental group was administered dorzolamide 2%-timolol 0.5% combination eye drops, while the other experimental group was administered dorzolamide 2% eye drops. Control groups had surgery without drug administration. Drug application was initiated either 2 weeks before surgery (Group A), from the day of surgery (Group B), 2 weeks after surgery (Group C), or 4 weeks after surgery (Group D). RGCs were labeled by intratectal Fluorogold injections and counted from flat-mount preparations, and IOP was measured using Tonopen. RESULTS: Both dorzolamide-timolol combination and dorzolamide, when applied topically, significantly reduced IOP and improved RGC densities in experimental eyes when compared to control eyes. Earlier initiation, as well as longer duration of drug application, resulted in higher RGC densities. CONCLUSIONS: Topical application of a dorzolamide-timolol combination or dorzolamide saved RGCs to a significant extent and reduced IOP in glaucomatous rat eyes.

Animals↗

Intraoperative bradycardia and hypotension associated with timolol and pilocarpine eye drops.

A 69-yr-old man, who was concurrently being treated with pilocarpine nitrate and timolol maleate eye drops, developed a bradycardia and became hypotensive during halothane anaesthesia. Both timolol and pilocarpine were subsequently identified in a 24-h collection of urine. Timolol (but not pilocarpine) was detected in a sample of plasma removed during surgery; the plasma concentration of timolol (2.6 ng ml-1) was consistent with partial beta-adrenoceptor blockade. It is postulated that this action may have been enhanced during halothane anaesthesia with resultant bradycardia and hypotension. Pilocarpine may have had a contributory effect.

Aged↗

Effects of timolol on adenine nucleotide catabolism in cat hearts with acute regional ischaemia.

The effects of the beta-adrenergic blocking agent timolol on cardiac function and adenine nucleotide metabolism were investigated in cats with 45 min of acute ischaemia following coronary occlusion. Regional myocardial blood flow was measured by 15 micron radiolabelled microspheres, and adenine nucleotides and their degradation products were measured by high performance liquid chromatography in 16 tissue regions in each cat. During ischaemia, cats treated with timolol exerted a reduced cardiac performance as judged from reduced heart rate and cardiac contractility; consequently preocclusion tissue blood flow was reduced compared with a control group of cats. The ATP concentration was less severely depleted in ischaemic regions of the left ventricle in cats treated with timolol. The energy charge was reduced to a lesser extent in ischaemic regions, and in intermediate flow ranges the contents of the inosine and hypoxanthine/xanthine were reduced compared with untreated cats. These results indicate that the beta-adrenergic blocking agent timolol might protect the myocardium within a 45 min ischaemic period. The mechanism for this effect is most probably related to the reduction in overall cardiac performance.

Acute Disease↗

Cellular lipid accumulation in different regions of myocardial infarcts in cats during beta adrenergic blockade with timolol.

The effects of non-selective beta adrenergic blockade on intracellular lipid accumulation in hearts with acute ischaemia were studied by electron microscopy of myocardial biopsy specimens using quantitative stereological techniques. Pentobarbital anaesthetised cats with coronary ligation were divided into eight controls and eight cats treated with timolol intravenously just before ligation. Biopsy specimens were collected from ischaemic, borderline, and normally perfused myocardium, defined by an in vivo injection of fluorescein and verified by regional myocardial blood flow measurements with 15 microns radiolabelled microspheres. During a 3 h occlusion period timolol treated cats had a lower heart rate, left ventricular dP/dt, and plasma free fatty acid concentration. In control cats the cytosolic volume fraction of lipids was 0.71 X 10(-3) in non-ischaemic myocardium, 2.63 X 10(-3) in central ischaemic tissue, and 6.53 X 10(-3) in borderline tissue. Timolol reduced the appreciable lipid accumulation in borderline tissue by 24% (to 4.97 X 10(-3)) compared with controls, whereas accumulation in central ischaemic tissue was not affected. Thus timolol diminished lipid accumulation in borderline myocardial tissue. The mechanism is most likely related to reduced ischaemic intensity and better preserved metabolic function.

Animals↗

Effect of continued treatment with timolol maleate on corneal endothelium: a fluorophotometric study.

PURPOSE: To verify whether the long-term use of timolol maleate is toxic for the corneal endothelium and whether the treatment time is a predisposing factor. METHODS: We used fluorophotometry to study 40 eyes that had been treated with timolol maleate uninterruptedly during a prolonged time (from 6 months to 14 years). The results obtained were compared with a sample of 40 hypertensive eyes that had not received any treatment. RESULTS: No statistically significant differences were found between the coefficient values of endothelial permeability between the treated and nontreated subjects. In addition, no differences were found in the coefficient of endothelial permeability between subjects treated with timolol in different treatment periods (between 6 and 12 months, between 1 and 5 years, and for > 5 years). CONCLUSION: These results suggest that long-term treatment with timolol has little effect on the integrity of the corneal endothelium.

Aged↗

Effects of timolol on action potential characteristics and automaticity in barium-depolarized canine cardiac Purkinje fibers.

To evaluate timolol's ability to antagonize the "slow response" in cardiac tissues, isolated canine cardiac Purkinje fibers were exposed to 0.25 mM barium chloride to induce membrane depolarization, spontaneous automaticity, and slow response action potentials. The effects of timolol on action potential parameters and the cycle length of spontaneous automaticity were tested at concentrations of 10, 100, and 500 micrograms/ml. Timolol significantly depressed the action potential and slowed automaticity only at 100 and 500 micrograms/ml but not at 10 micrograms/ml. Since verapamil and nifedipine have been reported to completely suppress activity in this model at concentrations of 0.2-2.0 micrograms/ml, we conclude that timolol has little direct slow response blocking potency.

Action Potentials↗