From Eye Drops to ICU, a Case Report of Three Side Effects of Ophthalmic Timolol Maleate in the Same Patient

Abstract

Timolol Maleate (also called Timolol) is a nonselective beta-adrenergic blocker and a class II antiarrhythmic drug, which is used to treat intraocular hypertension. It has been reported to cause systemic side effects especially in elderly patients with other comorbidities. These side effects are due to systemic absorption of the drug and it is known that Timolol is measurable in the serum following ophthalmic use. Chances of life threatening side effects increase if these are coprescribed with other cardiodepressant drugs like calcium channel or systemic beta blockers. We report a case where an elderly patient was admitted with three side effects of Timolol and his condition required ICU admission with mechanical ventilation and temporary transvenous pacing. The case emphasizes the need of raising awareness among physicians of such medications about the potential side effects and drug interactions. A close liaison among patient's physicians is suggested.

Association between topical beta-blockers and risks of cardiovascular and respiratory disease in patients with glaucoma: a retrospective cohort study

“…His condition required intensive care unit admission with mechanical ventilation and temporary transvenous pacing. 21 This emphasises the need to raise awareness among clinicians regarding the potential side effects and drug interactions for timolol.…”

Postprandial Head-drops: Insight into Systemic Effects of Ocular Timolol Preparation in Elderly

“…Its topical ocular preparation is considered amongst the first-line agent for lowering the IOP in patients with POAG, raised IOP secondary to traumatic cataract, and intraocular hypertension (IOH). It was first introduced in 1978 and since then has been used in ophthalmology as a wonder drug, especially in elderly patients, to help with glaucoma [1-2].…”

“…Another study published by Rana et al showed three side-effects that were concomitantly present in the patient leading to his demise. These included low blood sugar levels, sinus bradycardia with variable heart block, and orthostatic hypotension [2]. It is also known to cause sick-sinus syndrome and third-degree heart blocks [6].…”

Daylight-Mediated, Passive, and Sustained Release of the Glaucoma Drug Timolol from a Contact Lens

“…More than 80% of the timolol delivered from an eye-drop collects in the nasolacrimal duct, where it is absorbed through nasal mucosa and enters the bloodstream, reaching a serum concentration of 0.4 ng/mL (∼1.3 nM). 10,11 Because this concentration exceeds the k i for βARs in the heart and lung, it may result in cardiac and respiratory dysfunctions. 7,10,12−15 Finally, topical application of 0.5% timolol is also known to induce migraines, burning-sensations, and blurred-vision that collectively undermine medication compliance.…”

“…10,11 Because this concentration exceeds the k i for βARs in the heart and lung, it may result in cardiac and respiratory dysfunctions. 7,10,12−15 Finally, topical application of 0.5% timolol is also known to induce migraines, burning-sensations, and blurred-vision that collectively undermine medication compliance. 8,16 Although drug-soaked contact lenses have been reported to release drugs to manage glaucoma, they offer few benefits over traditional eye-drops because the drug molecules rapidly diffuse out of the lens.…”