Ocular timolol as the causative agent for symptomatic bradycardia in an 89-year-old female

Efficacy and Safety of Rho Kinase Inhibitors vs. Beta-Blockers in Primary Open-Angle Glaucoma: A Systematic Review with Meta-Analysis

“…Conversely, systemic side effects were significantly more frequent in patients treated with timolol, notably bradycardia, and musculoskeletal and gastrointestinal disorders. It is well known that beta-blocker eye drops can induce serious complications which can be life threatening, especially in the elderly or those with pre-existing comorbidities [ 19 , 20 , 21 ]. Overall, the better systemic safety profile of Rho kinase inhibitors is critical, as the choice of which IOP-reducing medication to use is dictated by the compatibility between the patient’s comorbidity state and the sides effects of the target molecule.…”

“…This would diversify the therapeutic options available for glaucoma patients, because Rho kinase inhibitors have also been shown to further reduce IOP in patients previously treated with drugs from other therapeutic classes [ 18 ]. Moreover, it is beneficial to have a wide therapeutic choice in case of side effects, intolerance, or allergies with other therapeutic classes, particularly for elderly patients and/or those with co-morbidities, in whom beta-blockers can be responsible for life threatening adverse effects [ 19 , 20 , 21 ].…”

Keeping up the Pace: A Case of Complete Heart Block

“…The history should include a family history as well as a cardiovascular risk assessment, past medical history, and the frequency, severity, and duration of symptoms while the drug history should explore possible culprits, including beta blockers and antiarrhythmics [ 3 ]. The drug history must be particularly thorough with respect to ophthalmic beta blockers, which are known to cause bradycardia such as timolol [ 6 , 7 ]. The physical examination should include a search for underlying structural heart disease and systemic disorders as well as orthostatic changes in pulse and blood pressure while investigations should include an ECG, ambulatory electrocardiographic monitoring if bradycardia is intermittent and imaging to evaluate for potential structural heart disease [ 3 ].…”