Cosopt PF Side Effects
Generic Name: dorzolamide / timolol ophthalmic
Note: This page contains information about the side effects of dorzolamide / timolol ophthalmic. Some of the dosage forms included on this document may not apply to the brand name Cosopt PF.
Not all side effects for Cosopt PF may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.
For the Consumer
Applies to dorzolamide / timolol ophthalmic: ophthalmic solution
In addition to its needed effects, some unwanted effects may be caused by dorzolamide / timolol ophthalmic. In the event that any of these side effects do occur, they may require medical attention.
You should check with your doctor immediately if any of these side effects occur when taking dorzolamide / timolol ophthalmic:More common
- Blurred vision
- burning or stinging of the eye (when medicine is applied)
- feeling of something in the eye
- itching of the eye
- redness of the eye and lining of the eyelid
- sensitivity of the eyes to light
- Back, abdominal, or stomach pain
- change in vision
- coughing, shortness of breath, troubled breathing, tightness in the chest, or wheezing
- discharge from the eye
- eye or eyelid pain, swelling, discomfort, or irritation
- increased blood pressure
- increased frequency of urination or painful urination
- itching of the eyelid
- seeing flashes or sparks of light
- seeing floating spots before the eyes
- swelling of lining of the eyelid
- tiny bumps on lining of the eyelid
- Blistering, peeling, or loosening of the skin
- blood in the urine
- blue lips, fingernails, or skin
- chest pain or discomfort
- difficult or troubled breathing
- headache or weakness, severe and sudden
- irregular, fast or slow, or shallow breathing
- joint or muscle pain
- mental depression
- nausea or vomiting
- pain, numbness, tingling, or burning feeling in the hands or feet
- red, irritated eyes
- red skin lesions, often with a purple center
- shortness of breath
- skin rash
- slow or irregular heartbeat
- sore throat
- sores, ulcers, or white spots in the mouth or on the lips
- unusual tiredness or weakness
If any of the following symptoms of overdose occur while taking dorzolamide / timolol ophthalmic, get emergency help immediately:Symptoms of overdose
- muscle cramps or pain
- numbness, tingling, pain, or weakness in the hands or feet
- weakness and heaviness of the legs
Some of the side effects that can occur with dorzolamide / timolol ophthalmic may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:More common
- Bitter, sour, or unusual taste
- Cold- or flu-like symptoms
- crusting or scales on eyelid
- dryness of the eyes
- indigestion or upset stomach
- sore throat
- stuffy or runny nose
- tearing of the eye
- Burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
- dry mouth
- stuffy nose
For Healthcare Professionals
Applies to dorzolamide / timolol ophthalmic: ophthalmic solution
The most common side effects have included taste perversion and ocular burning and stinging (up to 30%). Topically applied timolol ophthalmic drops may be absorbed systemically and side effects similar to systemically administered timolol or other beta-blockers such as severe respiratory or cardiac reactions may be experienced.[Ref]
Foreign body sensation has been reported due to formation of precipitate on the tip of the dropper bottle, which entered the eye during instillation of the eye drops.[Ref]
Ocular side effects have included burning and stinging upon instillation in up to 30% of patients. Conjunctival hyperemia, superficial punctate keratitis, blurred vision, and eye itching have been reported in 5% to 5% of patients. Blepharitis, cloudy vision, conjunctival discharge, conjunctival edema, conjunctival follicles, conjunctival injection, conjunctivitis, corneal erosion, corneal staining, cortical lens opacity, eye dryness, eye debris, eye discharge, eye pain, eye tearing, eyelid edema, eyelid erythema, eyelid tearing, eyelid exudate/scales, eyelid pain or discomfort, foreign body sensation, glaucomatous cupping, lens nucleus coloration, lens opacity, nuclear lens opacity, post-subcapsular cataract, visual field defect, and vitreous detachment have been reported in 1% to 5% of patients. Iridocyclitis and photophobia have been reported in less than 1% of patients.
Ocular side effects associated with dorzolamide have included eyelid crusting, transient myopia, and ocular allergic reactions.
Ocular side effects associated with timolol ocular have included ptosis, decreased corneal sensitivity, cystoid macular edema, refractive changes, diplopia, pseudopemphigoid, and choroidal detachment following filtration surgery.[Ref]
Respiratory side effects have included bronchitis, sinusitis, pharyngitis, cough, and upper respiratory tract infection in 1% to 5% of patients. Dyspnea, nasal congestion, and respiratory failure have been reported in less than 1% of patients.
Respiratory side effects associated with timolol ocular have included pulmonary edema, respiratory failure, dyspnea, nasal congestion, cough, and upper respiratory infections.
Respiratory side effects associated with timolol, as with other beta-antagonists, have included bronchial constriction in susceptible patients. Alternative therapy should be considered in patients with reactive airways disease. Cases of fatal respiratory arrest have been reported in patients with asthma, even after topically-administered timolol.
Respiratory side effects associated with oral timolol or other oral beta-blockers have included laryngospasm with respiratory distress, rales and bronchial obstruction.[Ref]
Cardiovascular side effects have included hypertension in 1% to 5% of patients. Bradycardia, cardiac failure, cerebral vascular accident, chest pain, heart block, and myocardial infarction have been reported in less than 1% of patients.
Cardiovascular side effects associated with timolol ocular have included bradycardia, arrhythmia, hypotension, hypertension, syncope, heart block, cerebral vascular accident, cerebral ischemia, exacerbation of angina, palpitation, cardiac arrest, pulmonary edema, edema, claudication, Raynaud's phenomenon, and cold hands and feet.
Cardiovascular side effects associated with oral timolol or other oral beta-blockers have included worsening of arterial insufficiency and vasodilatation.[Ref]
A case of amaurosis fugax has been associated with timolol. However, the patient involved had underlying cerebrovascular disease, autonomic dysfunction, and an arrhythmia.[Ref]
Nervous system side effects have included headache in 1% to 5% of patients. Depression and paresthesia have been reported in less than 1% of patients.
Nervous system side effects have included dizziness, headache, paresthesia, anxiety, somnolence, insomnia, nightmares, nervousness, memory loss, and disorientation. Timolol may worsen myasthenia gravis.
Nervous system side effects associated with oral timolol or other oral beta-blockers have included vertigo, local weakness, diminished concentration, an acute reversible syndrome characterized by disorientation for time and place, and slightly clouded sensorium.[Ref]
Hypersensitivity reactions associated with dorzolamide or timolol ocular have included angioedema, bronchospasm, pruritus, urticaria, local ocular reaction, contact dermatitis, anaphylaxis, local and generalized skin rash, and allergic conjunctivitis.
Hypersensitivity side effects associated with oral timolol and other oral beta-blockers have included erythematous rash, fever combined with aching and sore throat, and laryngospasm with respiratory distress.[Ref]
Dermatologic side effects have included skin rashes (less than 1%).
Dermatologic side effects associated with dorzolamide have included contact dermatitis, throat irritation, alopecia, pruritus, and urticaria. Stevens-Johnson syndrome and toxic epidermal necrolysis have been reported rarely.
Dermatologic side effects associated with timolol ocular have included contact dermatitis, psoriasiform rash, exacerbation of psoriasis, urticaria and alopecia. Rare cases of psoriasis, prurigo and hyperpigmented nail beds have been reported.
Dermatologic side effects associated with oral timolol or other oral beta-blockers have included pruritus and increased pigmentation. Oral timolol has been associated with hyperpigmented nail beds and skin irritation and these may potentially occur with ocular administration, also.[Ref]
Alternative therapy should be considered in patients with diabetes mellitus who are prone to hypoglycemia.[Ref]
Endocrine side effects of timolol ocular have included masking the signs and symptoms of and blunting the normal physiologic response to hypoglycemia in patients with diabetes, and increases in serum triglycerides, LDL cholesterol, and VLDL cholesterol, and decreases in HDL cholesterol.
Endocrine side effects associated with oral timolol have included hyperglycemia, hypoglycemia, and increased sweating. These effects may potentially occur with ocular administration, also.[Ref]
Psychiatric side effects have included rare cases of depression in less than 1% of patients.
Psychiatric side effects associated with timolol ocular have rarely included depression, confusion, hallucinations, and psychosis. These effects may occur suddenly and are typically reversible upon discontinuation.
Psychiatric side effects associated with oral timolol or other oral beta-blockers have included reversible mental depression progressing to catatonia, emotional lability, and decreased performance on neuropsychometrics.[Ref]
Gastrointestinal side effects have most commonly included taste perversion in 30% of patients (bitter, sour or unusual taste). Nausea and abdominal pain has been reported in 1% to 5% of patients. Diarrhea, dyspepsia, dry mouth, and vomiting have been reported in less than 1% of patients.
Dorzolamide has been associated with throat irritation.
Timolol ocular has been associated with anorexia.
Gastrointestinal side effects associated with oral timolol or other oral beta-blockers have included gastrointestinal pain, hepatomegaly, vomiting, mesenteric arterial thrombosis, and ischemic colitis.[Ref]
Genitourinary side effects have included urinary tract infection (1% to 5%) and urolithiasis (less than 1%).
Genitourinary side effects associated with timolol ocular have included retroperitoneal fibrosis, decreased libido, impotence, and Peyronie's disease.
Genitourinary side effects associated with oral timolol or other oral beta-blockers have included urination difficulties. This may potentially occur with ocular administration, also.[Ref]
Sexual dysfunction from timolol is reported from questionnaires, although the questions may have biased the data since the responses were not spontaneous.[Ref]
An 86-year-old male with a 10 year history of chronic open angle glaucoma developed fever, malaise, pleurisy and recurrent sterile pleural effusions while taking only topical ophthalmic timolol. Antinuclear antibodies were present and the patient was felt to have timolol induced systemic lupus erythematosus. The patient improved upon the discontinuation of timolol and was not rechallenged.[Ref]
Immunologic side effects associated with timolol ocular have included rare cases of systemic lupus erythematosus.[Ref]
Hematologic side effects associated with dorzolamide have included epistaxis.
Hematologic side effects associated with oral timolol or other oral beta-blockers have included nonthrombocytopenic purpura, thrombocytopenic purpura, and agranulocytosis.[Ref]
Other side effects have included back pain (1 to 5%).
Other side effects associated with timolol ocular have included asthenia/fatigue, chest pain, and tinnitus.
Other side effects associated with oral timolol or other oral beta-blockers have included extremity pain, decreased exercise tolerance, sweating, and weight loss.[Ref]
Hepatic side effects have included hepatomegaly associated with oral timolol. This may potentially occur with ocular administration also.[Ref]
Metabolic side effects associated with oral timolol have included weight loss, and this may potentially occur with ocular administration, also.[Ref]
Musculoskeletal side effects associated with oral timolol have included extremity pain and this may potentially occur with ocular administration, also.[Ref]
1. "Product Information. Trusopt (dorzolamide ophthalmic)." Merck & Co, Inc, West Point, PA.
2. "Product Information. Cosopt (dorzolamide-timolol)." Merck & Co, Inc, West Point, PA.
3. Baldone JA, Hankin JS, Zimmerman TJ "Allergic conjunctivitis associated with timolol therapy in an adult." Ann Ophthalmol 14 (1982): 364-5
4. Jones FL, Ekberg NL "Exacerbation of obstructive airway disease by timolol." JAMA 244 (1980): 2730
5. Guzman CA "Exacerbation of bronchorrea induced by topical timolol." Am Rev Respir Dis 121 (1980): 899-900
6. Charan NB, Lakshminarayan S "Pulmonary effects of topical timolol." Arch Intern Med 140 (1980): 843-4
7. Prince DS, Carliner NH "Respiratory arrest following first dose of timolol ophthalmic solution." Chest 84 (1983): 640-1
8. Shiuey Y, Eisenberg MJ "Cardiovascular effects of commonly used ophthalmic medications." Clin Cardiol 19 (1996): 5-8
9. Koch P "Allergic contact dermatitis due to timolol and levobunolol in eyedrops, with no cross-sensitivity to other ophthalmic beta-blockers." Contact Dermatitis 33 (1995): 140-1
10. Fernandez-Vozmediano JM, Blasi NA, Romero-Cabrera MA, Carracosa-Cerquero A "Allergic contact dermatitis to timolol." Contact Dermatitis 14 (1986): 252
11. Feiler-Ofry V, Godel V, Lazar M "Nail pigmentation following timolol maleate therapy." Ophthalmologica 182 (1981): 153-6
12. Fiore PM, Jacobs IH, Goldberg DB "Drug-induced pemphigoid: a spectrum of diseases." Arch Ophthalmol 105 (1987): 1660-3
13. Puig L, Goni FJ, Roque AM, Bordas FD, Morgas JM "Psoriasis induced by ophthalmic timolol preparations." Am J Ophthalmol 108 (1989): 455-6
14. Safran AB, Simona F, Sansonetti A, Pometta D, James R "Effects of ocular carteolol and timolol on plasma high-density lipoprotein cholesterol level." Am J Ophthalmol 117 (1994): 683
15. Nolan BT "Acute suicidal depression associated with use of timolol." JAMA 247 (1982): 1567
16. Shore JH, Fraunfelder FT, Meyer SM "Psychiatric side effects from topical ocular timolol, a beta-adrenergic blocker." J Clin Psychopharmacol 7 (1987): 264-7
17. Zamber RW, Starkebaum G, Rubin RL, Martens HF, Wener MH "Drug induced systemic lupus erythematosus due to ophthalmic timolol." J Rheumatol 19 (1992): 977-9
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