Intramol Special Precautions

Timolol ophthalmic solution may be absorbed systemically and adverse reactions seen with oral beta-blockers may occur. Patients who are receiving a beta-adrenergic blocking agent orally as well as Timolol ophthalmic solution should be observed for a potential additive effect either on the intraocular pressure or on the known systemic effects of beta blockade.
Patients should not receive two topical ophthalmic beta-adrenergic blocking agents concurrently.
Cardiac failure should be adequately controlled before beginning therapy with Timolol ophthalmic solution. Patients with a history of severe cardiac disease should be watched for signs of cardiac failure. Respiratory and cardiac reactions, including death due to bronchospasm in patients with asthma, and rarely, death associated with cardiac failure have been reported.
Timolol ophthalmic solution should be used with caution in patients with sick sinus syndrome, Prinzmetal's angina, untreated phaechromocytoma, metabolic acidosis, hypertension, and diabetes under treatment (Timolol may mask the signs of and response to hypoglycaemia).
Risk from anaphylactic reactions: While taking beta-blockers, patients with a history of atopy or a history of severe anaphylactic reaction to a variety of allergens may be more reactive to repeated challenge with such allergens, either accidental, diagnostic or therapeutic. Such patients may be unresponsive to the usual dose of adrenaline used to treat anaphylactic reactions.
This formulation of Timolol ophthalmic solution contains Benzalkonium chloride as a preservative which may be deposited in soft contact lenses. Hence, Timolol ophthalmic solution should not be used while wearing these lenses. The lenses should be removed before instillation of the drops and not re-inserted earlier than 15 minutes after use.
When Timolol ophthalmic solution is used to reduce intraocular pressure in angle-closure glaucoma, it should be used with a miotic and not alone.
A reduction in ocular hypotensive response has been reported in some patients following prolonged therapy with Timolol ophthalmic solution.
Muscle weakness: Beta-adrenergic blockade has been reported to potentiate muscle weakness consistent with certain myasthenic symptoms (e.g., diplopia, ptosis, and generalized weakness).
Timolol ophthalmic solution have been reported rarely to increase muscle weakness in some patients with myasthenia gravis or myasthenia symptoms.
Choroidal detachment has been reported with administration of aqueous suppressant therapy (e.g., Timolol, acetazolamide) after filtration procedures.
Patient should be instructed to avoid allowing the tip of the dispensing container to contact the eye surrounding structures.
Patients should also be instructed that ocular solutions, if handled improperly can become contaminated by common bacteria known to cause ocular infections. Serious damage to the eye and subsequent loss of vision may result from using contaminated solutions.
Patients should be advised that if they develop any intercurrent ocular condition (e.g., trauma, ocular surgery or infection), they should immediately seek their physician's advice concerning the continued use of present multi-dose container.
There have been reports of bacterial keratitis associated with the use of topical ophthalmic products.
Effects on ability to drive and use machines: There are currently no data available on the effects of Timolol ophthalmic solution on the ability to drive or use machinery. It has to be taken into account that dizziness, fatigue, transient ocular irritation, blurred vision and lacrimation may occur occasionally.