Reactive airway disease (e.g. existing or history of bronchial asthma; severe COPD); sinus bradycardia, sick sinus syndrome, sino-atrial block, 2nd- or 3rd-degree AV block not controlled with a pacemaker, overt cardiac failure, cardiogenic shock.

Patient with severe peripheral circulatory disorders (e.g. Raynaud's disease), CV disease (e.g. coronary heart disease, Prinzmetal angina, 1st-degree AV block); mild to moderate COPD; diabetes mellitus; corneal disease, aphakia, pseudophakia with torn posterior lens capsule, risk factors for macular oedema (e.g. intraocular surgery, retinal vein occlusions, diabetic retinopathy), active intraocular inflammation (e.g. uveitis), history of severe anaphylaxis to allergens, cerebrovascular disease, myasthenia gravis or myasthenic symptoms (e.g. ptosis, diplopia, generalised weakness). May mask the signs and symptoms of hyperthyroidism and hypoglycaemia. Renal and hepatic impairment. Pregnancy and lactation.

Significant: Increased eyelash length and thickness, darkening of eyelid or periocular skin, increased brown iris pigmentation, macular oedema (including cystoid macular oedema); choroidal detachment (following filtration procedures), dry eyes.
Eye disorders: Conjunctival hyperaemia, punctuate keratitis, eye or eyelid pruritus, foreign body sensation, eyelid erythema, eye pain, photophobia, eye discharge, eyelid oedema, eyelid irritation, increased lacrimation, visual disturbance, worsening visual acuity, corneal erosion, burning or stinging sensation in the eye, conjunctival irritation.
Nervous system disorders: Headache.
Respiratory, thoracic and mediastinal disorders: Rhinitis.
Skin and subcutaneous tissue disorders: Hirsutism.

This drug may cause temporary blurred vision, if affected, do not drive or operate machinery. Remove contact lenses before administration and wait for 15 minutes before reinserting them.

Monitor IOP. Assess for ocular pigmentation changes.

Timolol: Concomitant use with systemic β-blockers may have additive effects on IOP or systemic β-blockade. Additive hypotensive and/or bradycardic effects with oral calcium channel blockers, guanethidine, parasympathomimetic agents, antiarrhythmic agents (e.g. amiodarone) and cardiac glycosides. Increased systemic β-blockade effects (e.g. reduced heart rate) with CYP2D6 inhibitors (e.g. quinidine, fluoxetine, paroxetine). Concomitant use with epinephrine may result in mydriasis.

Description:
Overview: Bimatoprost is a synthetic prostamide that is structurally related to prostaglandin F_2α (PGF_2α).
Timolol is a non-selective β₁- and β₂-adrenergic blocker that has no significant intrinsic sympathomimetic, direct myocardial depressant, or membrane-stabilising activity.
Mechanism of Action: Bimatoprost increases aqueous humour outflow through the trabecular meshwork and enhances uveoscleral outflow, thereby reducing intraocular pressure.
Timolol decreases aqueous humour production. The precise mechanism of action of timolol is not clearly established; however, it is believed to inhibit the increased cyclic adenosine monophosphate (cAMP) synthesis due to endogenous stimulation of β-adrenergic receptors.
Pharmacokinetics:
Absorption: Bimatoprost: Small amounts are absorbed after ophthalmic administration. Time to peak plasma concentration: Within 10 minutes.
Distribution: Bimatoprost: Moderately distributed into body tissues. Volume of distribution: 0.67 L/kg. Plasma protein binding: Approx 88%.
Timolol: Crosses the placenta and enters breast milk.
Metabolism: Bimatoprost: Metabolised via oxidation, N-deethylation, and glucuronidation into various metabolites.
Timolol: Extensively metabolised in the liver by CYP2D6.
Excretion: Bimatoprost: Mainly via urine (≤67%); faeces (approx 25%). Elimination half-life: 45 minutes.
Timolol: Elimination half-life: Approx 4 hours.

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 5311027, Bimatoprost. https://pubchem.ncbi.nlm.nih.gov/compound/Bimatoprost. Accessed Aug. 26, 2025.

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 33624, Timolol. https://pubchem.ncbi.nlm.nih.gov/compound/Timolol. Accessed Nov. 22, 2023.

Store below 30°C. Storage recommendations may vary between individual products. Refer to specific product guidelines.

Antiglaucoma Preparations

S01ED51 - timolol, combinations ; Belongs to the class of beta blocking agents. Used in the treatment of glaucoma.

Bimatoprost and Timolol. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 09/10/2025.

Bimatoprost. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 09/10/2025.

Bimatoprost. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 09/10/2025.

Bimatoprost/Timolol Aspire 0.3 mg/mL + 5 mg/mL Eye Drops, Solution (Aspire Pharma Limited). MHRA. https://products.mhra.gov.uk. Accessed 09/10/2025.

Bimatoprost/Timolol Zentiva 0.3 mg/mL + 5 mg/mL Eye Drops, Solution (Zentiva Pharma UK Limited). MHRA. https://products.mhra.gov.uk. Accessed 09/10/2025.

Brayfield A, Cadart C (eds). Bimatoprost. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 09/10/2025.

Brayfield A, Cadart C (eds). Timolol Maleate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 09/10/2025.

Ganfort Eye Drops, Solution (AbbVie Sdn Bhd). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 09/10/2025.

Ganfort PF Eye Drops (AbbVie Sdn Bhd). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 09/10/2025.

Joint Formulary Committee. Bimatoprost with Timolol. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 09/10/2025.

Timolol (Ophthalmic). UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 09/10/2025.