Timolol Eye Drops — NZ Medication Guide

What is Timolol Eye Drops?

Timolol Eye Drops (generic name: timolol maleate (ophthalmic)) is a medication used primarily for lowering intraocular pressure in glaucoma and ocular hypertension. Timolol eye drops 0.25% and 0.5% (Timoptol and generics) are funded by Pharmac. Timolol gel-forming solution (Timoptol-XE) is also funded for once-daily dosing.

What is Timolol Eye Drops Used For?

Timolol Eye Drops is prescribed by healthcare professionals in New Zealand for the following indications:

• Open-angle glaucoma
• Ocular hypertension
• Adjunct therapy when prostaglandin analogues are insufficient
• Secondary glaucoma

How Does Timolol Eye Drops Work?

Timolol eye drops are a non-selective beta-adrenoceptor blocker that reduces aqueous humour production by the ciliary body, thereby lowering intraocular pressure. Beta-blockers were the standard first-line glaucoma treatment for decades before prostaglandin analogues became available. They remain widely used and are very effective as monotherapy or in combination with other glaucoma drops.

How to Take Timolol Eye Drops

Apply one drop of timolol 0.25% or 0.5% eye drops into the affected eye(s) twice daily (or once daily with gel-forming solution). Space doses approximately 12 hours apart. Wait at least 10 minutes between different eye drop medications. Remove soft contacts before instillation and wait 15 minutes. Use punctal occlusion to reduce systemic absorption, particularly important for patients with heart or lung conditions.

Common Side Effects

• Mild ocular burning or stinging on instillation
• Dry eye symptoms
• Blurred vision
• Systemic bradycardia (slowed heart rate) due to absorption
• Fatigue or exercise intolerance (systemic effect)
• Cold hands and feet (peripheral vasoconstriction)

Serious Side Effects — Seek Medical Attention

• Severe bronchospasm — particularly dangerous in asthma or COPD patients (CONTRAINDICATED)
• Severe bradycardia or heart block
• Worsening of heart failure
• Hypoglycaemia masking in diabetic patients
• Depression or CNS effects

Drug Interactions

• Oral beta-blockers — additive systemic effects; bradycardia, heart block risk
• Calcium channel blockers (verapamil, diltiazem) — enhanced cardiac conduction depression
• Antiarrhythmic medications — additive cardiac effects
• Antidiabetic medications — may mask hypoglycaemia symptoms
• NSAIDs — may reduce IOP-lowering effect slightly

New Zealand Prescribing Information

In New Zealand, timolol eye drops are CONTRAINDICATED in patients with asthma, severe COPD, bradycardia, or heart block. This is critically important as systemic absorption through the nasolacrimal duct is significant. Prescribers and pharmacists should screen for respiratory and cardiac conditions before dispensing. The combination Cosopt (dorzolamide/timolol) and Ganfort (bimatoprost/timolol) are also funded and reduce instillation burden.

Frequently Asked Questions

I have asthma — can I use timolol eye drops?

Timolol eye drops are generally CONTRAINDICATED if you have asthma or significant COPD. Even though they are applied to the eye, enough timolol can be absorbed systemically to cause bronchospasm (airway narrowing). This can be life-threatening. Inform your ophthalmologist of your asthma history. Alternative glaucoma treatments such as latanoprost or brimonidine are preferred for patients with airways disease.

How do I reduce the systemic side effects of timolol eye drops?

Use punctal occlusion after instilling the drops — press the inner corner of your eye (the tear duct area) for 1–2 minutes with a finger. This blocks the nasolacrimal duct and significantly reduces the amount of timolol draining into your nose and throat (where it is absorbed). This simple technique can halve systemic exposure.

References & Further Information

The following New Zealand and international resources were used to inform this page:

• New Zealand Formulary — Timolol (ophthalmic)
• Pharmac — Funded Medicines Schedule
• Glaucoma NZ — Eye Drop Medications
• Medsafe — Timoptol Eye Drops Data Sheet

Reviewed by a Registered Pharmacist — KiwiMeds New Zealand