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Istalol Disease Interactions

There are 9 disease interactions with Istalol (timolol ophthalmic).

Major

Ophthalmic beta-blockers (applies to Istalol) asthma/COPD

Major Potential Hazard, High plausibility. Applicable conditions: Chronic Obstructive Pulmonary Disease

Ophthalmic beta-adrenergic receptor blocking agents (aka beta-blockers) in general should not be used in patients with a current or past history of bronchial asthma or chronic obstructive pulmonary disease. Topically applied beta-blockers are systemically absorbed, with the potential for producing clinically significant systemic effects even at low or undetectable plasma levels. In the respiratory tract, beta blockade may adversely affect pulmonary function by counteracting the bronchodilation produced by catecholamine stimulation of beta-2 receptors. Although agents with beta-1 selectivity (e.g., betaxolol) are considered safer in patients with bronchospastic diseases, cardioselectivity is not absolute and may be lost with larger doses or higher plasma levels.

References

  1. van Zyl AI, Jennings AA, Bateman ED, Opie LH "Comparison of respiratory effects of two cardioselective beta-blockers, celiprolol and atenolol, in asthmatics with mild to moderate hypertension." Chest 95 (1989): 209-13
  2. Adam WR, Meagher EJ, Barter CE "Labetalol, beta blockers, and acute deterioration of chronic airway obstruction." Clin Exp Hypertens A A4 (1982): 1419-28
  3. Falliers CJ, Vincent ME, Medakovic M "Effect of single doses of labetalol, metoprolol, and placebo on ventilatory function in patients with bronchial asthma: interaction with isoproterenol." J Asthma 23 (1986): 251-60
  4. Durant PA, Joucken K "Bronchospasm and hypotension during cardiopulmonary bypass after preoperative cimetidine and labetalol therapy." Br J Anaesth 56 (1984): 917-20
  5. Raine JM, Palazzo MG, Kerr JH, Sleight P "Near-fatal bronchospasm after oral nadolol in a young asthmatic and response to ventilation with halothane." Br Med J 282 (1981): 548-9
  6. Stephen SA "Unwanted effects of propranolol." Am J Cardiol 18 (1966): 463-72
  7. Chodosh S, Tuck J, Blasucci DJ "The effects of dilevalol, metoprolol, and placebo on ventilatory function in asthmatics." J Cardiovasc Pharmacol 11 (1988): s18-24
  8. Morris R, Bulteau P "Respiratory arrest after beta-blocker in an asthmatic patient." Med J Aust 2 (1980): 576
  9. Charan NB, Lakshminarayan S "Pulmonary effects of topical timolol." Arch Intern Med 140 (1980): 843-4
  10. Mashford ML, Coventry D, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  11. Laursen SO, Bjerrum P "Timolol eyedrop-induced severe bronchospasm." Acta Med Scand 211 (1982): 505-6
  12. Prince DS, Carliner NH "Respiratory arrest following first dose of timolol ophthalmic solution." Chest 84 (1983): 640-1
  13. Botet C, Grau J, Benito P, Coll J, Vivancos J "Timolol ophthalmic solution and respiratory arrest." Ann Intern Med 105 (1986): 306-7
  14. Dunn TL, Gerber MJ, Shen AS, Fernandez E, Iseman MD, Cherniak RM "The effect of topical ophthalmic instillation of timolol and betaxolol on lung function in asthmatic subjects." Am Rev Respir Dis 133 (1986): 264-8
  15. Odeh M, Oliven A, Bassan H "Timolol eyedrop-induced fatal bronchospasm in an asthmatic patient." J Fam Pract 32 (1991): 97-8
  16. Schoenberger JA, Croog SH, Sudilovsky A, et al. "Self-reported side effects from antihypertensive drugs: a clinical trial." Am J Hypertens 3 (1990): 123-32
  17. Horvath JS, Woolcock AJ, Tiller DJ, Donnelly P, Armstrong J, Caterson R "A comparison of metoprolol and propranolol on blood pressure and respiratory function in patients with hypertension." Aust N Z J Med 8 (1978): 1-6
  18. Benson MK, Berrill WT, Cruickshank JM, Sterling GS "A comparison of four B-adrenoceptor antagonists in patients with asthma." Br J Clin Pharmacol 5 (1978): 415-9
  19. Le Jeunne CL, Hugues FC, Dufier JL, Munera Y, Bringer L "Bronchial and cardiovascular effects of ocular topical B-antagonists in asthmatic subjects: comparison of timolol, carteolol, and metipranolol." J Clin Pharmacol 29 (1989): 97-101
  20. "Product Information. OptiPranolol (metipranolol ophthalmic)." Bausch and Lomb Americas, Inc. (2022):
  21. Uusitalo RJ, Palkama A "Efficacy and safety of timolol pilocarpine combination drops in glaucoma patients." Acta Ophthalmol (Copenh) 72 (1994): 496-504
  22. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
  23. "Product Information. Betagan (levobunolol ophthalmic)." Allergan Inc (2022):
  24. "Product Information. Betoptic (betaxolol ophthalmic)." Alcon Laboratories Inc PROD (2001):
  25. "Product Information. Timoptic (timolol ophthalmic)." Merck & Co., Inc PROD (2001):
  26. "Product Information. Betaxon (levobetaxolol ophthalmic)." Alza PROD (2001):
  27. "Product Information. Ocupress (carteolol ophthalmic)." Ciba Vision Ophthalmics PROD (2001):
View all 27 references
Major

Ophthalmic beta-blockers (applies to Istalol) bradycardia/AV block

Major Potential Hazard, High plausibility. Applicable conditions: Sinus Node Dysfunction, Heart Block

The use of ophthalmic beta-adrenergic receptor blocking agents (aka beta-blockers) is considered by manufacturers to be contraindicated in patients with sinus bradyarrhythmia or heart block greater than the first degree (unless a functioning pacemaker is present). Topically applied beta-blockers are systemically absorbed, with the potential for producing clinically significant systemic effects even at low or undetectable plasma levels. In cardiac tissues, beta blockade causes a reduction in inotropic as well as chronotropic activity, which may further depress cardiac function in such patients.

References

  1. Crean PA, Williams DO "Effect of intravenous and oral acebutolol in patients with bundle branch block." Int J Cardiol 10 (1986): 119-26
  2. Mashford ML, Coventry D, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  3. Treseder AS, Thomas TP "Sinus arrest due to timolol eye drops." Br J Clin Pract 40 (1986): 256-8
  4. "Product Information. OptiPranolol (metipranolol ophthalmic)." Bausch and Lomb Americas, Inc. (2022):
  5. Uusitalo RJ, Palkama A "Efficacy and safety of timolol pilocarpine combination drops in glaucoma patients." Acta Ophthalmol (Copenh) 72 (1994): 496-504
  6. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
  7. "Product Information. Betagan (levobunolol ophthalmic)." Allergan Inc (2022):
  8. Edeki TI, He H, Wood AJ "Pharmacogenetic explanation for excessive B-blockade following timolol eye drops." JAMA 274 (1995): 1611-3
  9. Shiuey Y, Eisenberg MJ "Cardiovascular effects of commonly used ophthalmic medications." Clin Cardiol 19 (1996): 5-8
  10. "Product Information. Betoptic (betaxolol ophthalmic)." Alcon Laboratories Inc PROD (2001):
  11. "Product Information. Timoptic (timolol ophthalmic)." Merck & Co., Inc PROD (2001):
  12. "Product Information. Betaxon (levobetaxolol ophthalmic)." Alza PROD (2001):
  13. "Product Information. Ocupress (carteolol ophthalmic)." Ciba Vision Ophthalmics PROD (2001):
View all 13 references
Major

Ophthalmic beta-blockers (applies to Istalol) cardiogenic shock

Major Potential Hazard, High plausibility.

The use of ophthalmic beta-adrenergic receptor blocking agents (aka beta-blockers) is considered by manufacturers to be contraindicated in patients with cardiogenic shock. Topically applied beta-blockers are systemically absorbed, with the potential for producing clinically significant systemic effects even at low or undetectable plasma levels. In cardiac tissues, beta blockade causes a reduction in inotropic as well as chronotropic activity, which may further depress cardiac output and blood pressure in such patients.

References

  1. Kholeif M, Isles C "Profound hypotension after atenolol in severe hypertension." Br Med J 298 (1989): 161-2
  2. Tirlapur VG, Evans PJ, Jones MK "Shock syndrome after acebutolol." Br J Clin Pract 40 (1986): 33-4
  3. "Product Information. OptiPranolol (metipranolol ophthalmic)." Bausch and Lomb Americas, Inc. (2022):
  4. Uusitalo RJ, Palkama A "Efficacy and safety of timolol pilocarpine combination drops in glaucoma patients." Acta Ophthalmol (Copenh) 72 (1994): 496-504
  5. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
  6. "Product Information. Betagan (levobunolol ophthalmic)." Allergan Inc (2022):
  7. Edeki TI, He H, Wood AJ "Pharmacogenetic explanation for excessive B-blockade following timolol eye drops." JAMA 274 (1995): 1611-3
  8. Shiuey Y, Eisenberg MJ "Cardiovascular effects of commonly used ophthalmic medications." Clin Cardiol 19 (1996): 5-8
  9. "Product Information. Betoptic (betaxolol ophthalmic)." Alcon Laboratories Inc PROD (2001):
  10. "Product Information. Timoptic (timolol ophthalmic)." Merck & Co., Inc PROD (2001):
  11. "Product Information. Betaxon (levobetaxolol ophthalmic)." Alza PROD (2001):
  12. "Product Information. Ocupress (carteolol ophthalmic)." Ciba Vision Ophthalmics PROD (2001):
View all 12 references
Major

Ophthalmic beta-blockers (applies to Istalol) CHF

Major Potential Hazard, High plausibility. Applicable conditions: Congestive Heart Failure

The use of ophthalmic beta-adrenergic receptor blocking agents (aka beta-blockers) is considered by manufacturers to be contraindicated in patients with overt congestive heart failure (CHF). Topically applied beta-blockers are systemically absorbed, with the potential for producing clinically significant systemic effects even at low or undetectable plasma levels. Since sympathetic stimulation may be important in maintaining the hemodynamic function in patients with CHF, beta blockade can worsen the heart failure. However, therapy with ophthalmic beta-blockers can be administered cautiously in some CHF patients provided they are well compensated and receiving digitalis, diuretics, an ACE inhibitor, and/or nitrates. Beta-blockers should be discontinued if cardiac failure develops or worsens during therapy.

References

  1. Altus P "Timolol-induced congestive heart failure." South Med J 74 (1981): 88
  2. Mashford ML, Coventry D, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  3. "Product Information. OptiPranolol (metipranolol ophthalmic)." Bausch and Lomb Americas, Inc. (2022):
  4. Uusitalo RJ, Palkama A "Efficacy and safety of timolol pilocarpine combination drops in glaucoma patients." Acta Ophthalmol (Copenh) 72 (1994): 496-504
  5. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
  6. "Product Information. Betagan (levobunolol ophthalmic)." Allergan Inc (2022):
  7. Edeki TI, He H, Wood AJ "Pharmacogenetic explanation for excessive B-blockade following timolol eye drops." JAMA 274 (1995): 1611-3
  8. Shiuey Y, Eisenberg MJ "Cardiovascular effects of commonly used ophthalmic medications." Clin Cardiol 19 (1996): 5-8
  9. "Product Information. Betoptic (betaxolol ophthalmic)." Alcon Laboratories Inc PROD (2001):
  10. "Product Information. Timoptic (timolol ophthalmic)." Merck & Co., Inc PROD (2001):
  11. "Product Information. Betaxon (levobetaxolol ophthalmic)." Alza PROD (2001):
  12. "Product Information. Ocupress (carteolol ophthalmic)." Ciba Vision Ophthalmics PROD (2001):
View all 12 references
Major

Ophthalmic beta-blockers (applies to Istalol) diabetes

Major Potential Hazard, High plausibility. Applicable conditions: Diabetes Mellitus

Beta-adrenergic receptor blocking agents (aka beta-blockers) may mask symptoms of hypoglycemia such as tremors, tachycardia and blood pressure changes. In addition, the nonselective beta-blockers (e.g., timolol, carteolol) may inhibit catecholamine-mediated glycogenolysis, thereby potentiating insulin-induced hypoglycemia and delaying the recovery of normal blood glucose levels. Since topically applied beta-blockers are systemically absorbed and may produce clinically significant systemic effects even at low or undetectable plasma levels, therapy with ophthalmic beta-blockers should be administered cautiously in patients with diabetes or predisposed to spontaneous hypoglycemia.

References

  1. Darga LL, Hakim MJ, Lucas CP, Franklin BA "Comparison of the effects of guanadrel sulfate and propranolol on blood pressure, functional capacity, serum lipoproteins and glucose in systemic hypertension." Am J Cardiol 67 (1991): 590-6
  2. Uusitupa M, Aro A, Pietikainen M "Severe hypoglycaemia caused by physical strain and pindolol therapy." Ann Clin Res 12 (1980): 25-7
  3. Velde TM, Kaiser FE "Ophthalmic timolol treatment causing altered hypoglycemic response in a diabetic patient." Arch Intern Med 143 (1983): 1627
  4. Grimaldi A, Bennett P, Delas B, et al. "Beta-blockers and hypoglycaemia: assessment of cardioselective and intrinsic sympathomimetic properties in relation to severity of hypoglycaemia." Curr Ther Res Clin Exp 36 (1984): 361-73
  5. "Product Information. OptiPranolol (metipranolol ophthalmic)." Bausch and Lomb Americas, Inc. (2022):
  6. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
  7. "Product Information. Betagan (levobunolol ophthalmic)." Allergan Inc (2022):
  8. "Product Information. Betoptic (betaxolol ophthalmic)." Alcon Laboratories Inc PROD (2001):
  9. Giugliano D, Acampora R, Marfella R, DeRosa N, Ziccardi P, Ragone R, DeAngelis L, DOnofrio F "Metabolic and cardiovascular effects of carvedilol and atenolol in non-insulin-dependent diabetes mellitus and hypertension - A randomized, controlled trial." Ann Intern Med 126 (1997): 955-9
  10. "Product Information. Timoptic (timolol ophthalmic)." Merck & Co., Inc PROD (2001):
  11. "Product Information. Betaxon (levobetaxolol ophthalmic)." Alza PROD (2001):
  12. "Product Information. Ocupress (carteolol ophthalmic)." Ciba Vision Ophthalmics PROD (2001):
View all 12 references
Major

Ophthalmic beta-blockers (applies to Istalol) hypersensitivity

Major Potential Hazard, High plausibility. Applicable conditions: Allergies

Topically applied beta-adrenergic receptor blocking agents (aka beta-blockers) are systemically absorbed, with the potential for producing clinically significant systemic effects even at low or undetectable plasma levels. The use of beta-blockers in patients with a history of allergic reactions or anaphylaxis may be associated with heightened reactivity to culprit allergens. The frequency and/or severity of attacks may be increased during beta-blocker therapy. In addition, these patients may be refractory to the usual doses of epinephrine used to treat acute hypersensitivity reactions and may require a beta-agonist such as isoproterenol.

References

  1. "Product Information. OptiPranolol (metipranolol ophthalmic)." Bausch and Lomb Americas, Inc. (2022):
  2. "Product Information. Betagan (levobunolol ophthalmic)." Allergan Inc (2022):
  3. "Product Information. Betoptic (betaxolol ophthalmic)." Alcon Laboratories Inc PROD (2001):
  4. "Product Information. Timoptic (timolol ophthalmic)." Merck & Co., Inc PROD (2001):
  5. "Product Information. Betaxon (levobetaxolol ophthalmic)." Alza PROD (2001):
  6. "Product Information. Ocupress (carteolol ophthalmic)." Ciba Vision Ophthalmics PROD (2001):
View all 6 references
Major

Ophthalmic beta-blockers (applies to Istalol) hyperthyroidism

Major Potential Hazard, High plausibility.

Beta-adrenergic receptor blocking agents (aka beta-blockers) may mask some symptoms of hyperthyroidism such as tachycardia, anxiety, tremor, and heat intolerance. Abrupt withdrawal of beta-blocker therapy in thyrotoxic patients may exacerbate symptoms of hyperthyroidism or precipitate a thyroid storm. Since topically applied beta-blockers are systemically absorbed and may produce clinically significant systemic effects even at low or undetectable plasma levels, therapy with ophthalmic beta-blockers should be administered cautiously in patients with or suspected of having hyperthyroidism. Cessation of beta-blocker therapy, when necessary, should occur gradually over a period of 1 to 2 weeks. Patients should be advised not to discontinue treatment without first consulting with the physician. Close monitoring is recommended during and after therapy withdrawal.

References

  1. "Product Information. OptiPranolol (metipranolol ophthalmic)." Bausch and Lomb Americas, Inc. (2022):
  2. "Product Information. Betagan (levobunolol ophthalmic)." Allergan Inc (2022):
  3. "Product Information. Betoptic (betaxolol ophthalmic)." Alcon Laboratories Inc PROD (2001):
  4. "Product Information. Timoptic (timolol ophthalmic)." Merck & Co., Inc PROD (2001):
  5. "Product Information. Betaxon (levobetaxolol ophthalmic)." Alza PROD (2001):
  6. "Product Information. Ocupress (carteolol ophthalmic)." Ciba Vision Ophthalmics PROD (2001):
View all 6 references
Major

Ophthalmic beta-blockers (applies to Istalol) PVD

Major Potential Hazard, Moderate plausibility. Applicable conditions: Cerebrovascular Insufficiency, Peripheral Arterial Disease

Due to their negative inotropic and chronotropic effects on the heart, beta-adrenergic receptor blocking agents (aka beta-blockers) reduce cardiac output and may precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease. In addition, the nonselective beta-blockers (e.g., timolol, carteolol) may attenuate catecholamine-mediated vasodilation during exercise by blocking beta-2 receptors in peripheral vessels. Since topically applied beta-blockers are systemically absorbed and may produce clinically significant systemic effects even at low or undetectable plasma levels, therapy with ophthalmic beta-blockers should be administered cautiously in patients with peripheral vascular disease. Close monitoring for progression of arterial obstruction is advised.

References

  1. Eliasson K, Danielson M, Hylander B, Lindblad LE "Raynaud's phenomenon caused by beta-receptor blocking drugs." Acta Med Scand 215 (1984): 333-9
  2. Eliasson K, Lins L-E, Sundqvist K "Peripheral vasospasm during beta-receptor blockade: a comparison between metoprolol and pindolol." Acta Med Scand 665 (1982): 109-12
  3. Lepantalo M "Beta blockade and intermittent claudication." Acta Med Scand 700 (1985): 1-48
  4. Mashford ML, Coventry D, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  5. Coppeto JR "Transient ischemic attacks and amaurosis fugax from timolol." Ann Ophthalmol 17 (1985): 64-5
  6. Broeder CE, Thomas EL, Martin NB, Hofman Z, Jesek JK, Scruggs KD, Wambsgans KC, Wilmore JH "Effects of propranolol and pindolol on cardiac output during extended periods of low-intensity physical activity." Am J Cardiol 72 (1993): 1188-95
  7. Holti G "A double-blind study of the peripheral vasoconstrictor effects of the beta-blocking drug penbutolol in patients with Raynaud's phenomenon." Curr Med Res Opin 6 (1979): 267-70
  8. "Product Information. OptiPranolol (metipranolol ophthalmic)." Bausch and Lomb Americas, Inc. (2022):
  9. Uusitalo RJ, Palkama A "Efficacy and safety of timolol pilocarpine combination drops in glaucoma patients." Acta Ophthalmol (Copenh) 72 (1994): 496-504
  10. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
  11. "Product Information. Betagan (levobunolol ophthalmic)." Allergan Inc (2022):
  12. Breckenridge A, Roberts DH "Antihypertensive treatment in concomitant peripheral vascular disease: current experience and the potential of carvedilol." J Cardiovasc Pharmacol 18 Suppl 4 (1991): s78-81
  13. Edeki TI, He H, Wood AJ "Pharmacogenetic explanation for excessive B-blockade following timolol eye drops." JAMA 274 (1995): 1611-3
  14. Shiuey Y, Eisenberg MJ "Cardiovascular effects of commonly used ophthalmic medications." Clin Cardiol 19 (1996): 5-8
  15. "Product Information. Betoptic (betaxolol ophthalmic)." Alcon Laboratories Inc PROD (2001):
  16. "Product Information. Timoptic (timolol ophthalmic)." Merck & Co., Inc PROD (2001):
  17. "Product Information. Betaxon (levobetaxolol ophthalmic)." Alza PROD (2001):
  18. "Product Information. Ocupress (carteolol ophthalmic)." Ciba Vision Ophthalmics PROD (2001):
View all 18 references
Moderate

Ophthalmic beta-blockers (applies to Istalol) myasthenia gravis

Moderate Potential Hazard, Low plausibility. Applicable conditions: Myoneural Disorder

Topically applied beta-adrenergic receptor blocking agents (aka beta-blockers) are systemically absorbed, with the potential for producing clinically significant systemic effects even at low or undetectable plasma levels. In the nervous and musculoskeletal systems, beta blockade may potentiate muscle weakness consistent with certain myasthenic symptoms such as diplopia, ptosis, and generalized weakness. Several beta-blockers have been associated rarely with aggravation of muscle weakness in patients with preexisting myasthenia gravis or myasthenic symptoms.

References

  1. Confavreux C, Charles N, Aimard G "Fulminant myasthenia gravis soon after initiation of acebutolol therapy." Eur Neurol 30 (1990): 279-81
  2. Berstein LP, Henkind P "Additional information on adverse reactions to timolol." Am J Ophthalmol 92 (1981): 295-6
  3. Coppeto JR "Timolol-associated myasthenia gravis." Am J Ophthalmol 98 (1984): 244-5
  4. Verkijk A "Worsening of myasthenia gravis with timolol maleate eyedrops." Ann Neurol 17 (1985): 211-2
  5. Herishanu Y, Rosenberg P "Beta-blockers and myasthenia gravis." Ann Intern Med 83 (1975): 834-5
  6. "Product Information. OptiPranolol (metipranolol ophthalmic)." Bausch and Lomb Americas, Inc. (2022):
  7. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
  8. "Product Information. Betagan (levobunolol ophthalmic)." Allergan Inc (2022):
  9. Choi KL, Wat MS, Ip TP, Kung AWC, Lam KSL "Phaeochromocytoma associated with myasthenia gravis precipitated by propranolol treatment." Aust N Z J Med 25 (1995): 257
  10. "Product Information. Betoptic (betaxolol ophthalmic)." Alcon Laboratories Inc PROD (2001):
  11. "Product Information. Timoptic (timolol ophthalmic)." Merck & Co., Inc PROD (2001):
  12. "Product Information. Betaxon (levobetaxolol ophthalmic)." Alza PROD (2001):
  13. "Product Information. Ocupress (carteolol ophthalmic)." Ciba Vision Ophthalmics PROD (2001):
View all 13 references

Istalol drug interactions

There are 269 drug interactions with Istalol (timolol ophthalmic).

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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