Timolol Dosage

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Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Hypertension

Initial dose: 10 mg orally twice a day
Maintenance dose: 10 to 20 mg orally twice a day

Usual Adult Dose for Angina Pectoris

Initial dose: 10 mg orally twice a day
Maintenance dose: 10 to 20 mg orally twice a day

Usual Adult Dose for Myocardial Infarction

Initial dose: 10 mg orally twice a day

Usual Adult Dose for Migraine Prophylaxis

Initial dose: 10 mg orally twice a day
Maintenance dose: 10 to 30 mg given in 1 to 2 divided doses

Renal Dose Adjustments

Since timolol is partially metabolized in the liver and excreted mainly by the kidneys, dosage reductions may be necessary when hepatic and/or renal insufficiency is present. Although the pharmacokinetics of timolol are not greatly altered by renal impairment, marked hypotensive responses have been seen in patients with marked renal impairment undergoing dialysis after 20 mg doses. Dosing in such patients should therefore be especially cautious.

Liver Dose Adjustments

Since timolol is partially metabolized in the liver and excreted mainly by the kidneys, dosage reductions may be necessary when hepatic and/or renal insufficiency is present.

Dose Adjustments

The dose may be titrated as needed every 7 days.

For migraine prophylaxis, a 20 mg daily dose may be administered as a single dose. Total daily dosage may be increased to a maximum of 30 mg, given in divided doses, or decreased to 10 mg once a day, depending on clinical response and tolerability. If a satisfactory response is not obtained after 6-8 weeks use of the maximum daily dosage, therapy with timolol should be discontinued.

Precautions

Gradual discontinuation of therapy is recommended to prevent rebound hypertension and/or angina pectoris.

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

Timolol is not significantly dialyzed. Limited data from 2 patients undergoing hemodialysis using a Travenol UF II standard coil dialyzer reveal no significant difference between the arterial and venous plasma concentrations during dialysis. Since timolol is not significantly removed by hemodialysis, supplemental dosing after dialysis is not necessary. Be cognizant of the increased risk of hypotension if timolol is administered immediately after dialysis sessions. Ideally, timolol should be administered at some time after dialysis when the patient is hemodynamically stable.

Other Comments

The maximum recommended daily dose is 60 mg in 2 divided doses.

Compared with Caucasian patients, Black patients have a reduced blood pressure response to monotherapy with beta blockers; however, the reduced response is largely eliminated if combination therapy that includes an adequate dose of a diuretic is instituted.

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