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Brimonidine / timolol ophthalmic Disease Interactions

There are 12 disease interactions with brimonidine / timolol ophthalmic:

Major

Ophthalmic beta-blockers (applies to brimonidine/timolol ophthalmic) 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. 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
  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. Prince DS, Carliner NH "Respiratory arrest following first dose of timolol ophthalmic solution." Chest 84 (1983): 640-1
  4. 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
  5. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
  6. "Product Information. Timoptic (timolol ophthalmic)." Merck & Co, Inc, West Point, PA.
  7. Odeh M, Oliven A, Bassan H "Timolol eyedrop-induced fatal bronchospasm in an asthmatic patient." J Fam Pract 32 (1991): 97-8
  8. "Product Information. Betagan Liquifilm (levobunolol)." Allergan Inc, Irvine, CA.
  9. Stephen SA "Unwanted effects of propranolol." Am J Cardiol 18 (1966): 463-72
  10. Charan NB, Lakshminarayan S "Pulmonary effects of topical timolol." Arch Intern Med 140 (1980): 843-4
  11. "Product Information. OptiPranolol (metipranolol)." Bausch and Lomb, Tampa, FL.
  12. 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
  13. Mashford ML, Coventry D, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  14. Uusitalo RJ, Palkama A "Efficacy and safety of timolol pilocarpine combination drops in glaucoma patients." Acta Ophthalmol (Copenh) 72 (1994): 496-504
  15. 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
  16. Botet C, Grau J, Benito P, Coll J, Vivancos J "Timolol ophthalmic solution and respiratory arrest." Ann Intern Med 105 (1986): 306-7
  17. Morris R, Bulteau P "Respiratory arrest after beta-blocker in an asthmatic patient." Med J Aust 2 (1980): 576
  18. "Product Information. Betoptic (betaxolol ophthalmic)." Alcon Laboratories Inc, Fort Worth, TX.
  19. 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
  20. "Product Information. Ocupress (carteolol ophthalmic)" Ciba Vision Ophthalmics, Duluth, GA.
  21. "Product Information. Betaxon (levobetaxolol ophthalmic)" Alza, Palo Alto, CA.
  22. Durant PA, Joucken K "Bronchospasm and hypotension during cardiopulmonary bypass after preoperative cimetidine and labetalol therapy." Br J Anaesth 56 (1984): 917-20
  23. 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
  24. 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
  25. 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
  26. 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
  27. Laursen SO, Bjerrum P "Timolol eyedrop-induced severe bronchospasm." Acta Med Scand 211 (1982): 505-6
View all 27 references
Major

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

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

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

Ophthalmic beta-blockers (applies to brimonidine/timolol ophthalmic) 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. "Product Information. Betoptic (betaxolol ophthalmic)." Alcon Laboratories Inc, Fort Worth, TX.
  2. "Product Information. Betaxon (levobetaxolol ophthalmic)" Alza, Palo Alto, CA.
  3. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
  4. Velde TM, Kaiser FE "Ophthalmic timolol treatment causing altered hypoglycemic response in a diabetic patient." Arch Intern Med 143 (1983): 1627
  5. "Product Information. Betagan Liquifilm (levobunolol)." Allergan Inc, Irvine, CA.
  6. 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
  7. "Product Information. OptiPranolol (metipranolol)." Bausch and Lomb, Tampa, FL.
  8. "Product Information. Timoptic (timolol ophthalmic)." Merck & Co, Inc, West Point, PA.
  9. 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
  10. "Product Information. Ocupress (carteolol ophthalmic)" Ciba Vision Ophthalmics, Duluth, GA.
  11. 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
  12. Uusitupa M, Aro A, Pietikainen M "Severe hypoglycaemia caused by physical strain and pindolol therapy." Ann Clin Res 12 (1980): 25-7
View all 12 references
Major

Ophthalmic beta-blockers (applies to brimonidine/timolol ophthalmic) 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. Ocupress (carteolol ophthalmic)" Ciba Vision Ophthalmics, Duluth, GA.
  2. "Product Information. Timoptic (timolol ophthalmic)." Merck & Co, Inc, West Point, PA.
  3. "Product Information. OptiPranolol (metipranolol)." Bausch and Lomb, Tampa, FL.
  4. "Product Information. Betaxon (levobetaxolol ophthalmic)" Alza, Palo Alto, CA.
  5. "Product Information. Betagan Liquifilm (levobunolol)." Allergan Inc, Irvine, CA.
  6. "Product Information. Betoptic (betaxolol ophthalmic)." Alcon Laboratories Inc, Fort Worth, TX.
View all 6 references
Major

Ophthalmic beta-blockers (applies to brimonidine/timolol ophthalmic) 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. Betoptic (betaxolol ophthalmic)." Alcon Laboratories Inc, Fort Worth, TX.
  2. "Product Information. Betaxon (levobetaxolol ophthalmic)" Alza, Palo Alto, CA.
  3. "Product Information. OptiPranolol (metipranolol)." Bausch and Lomb, Tampa, FL.
  4. "Product Information. Timoptic (timolol ophthalmic)." Merck & Co, Inc, West Point, PA.
  5. "Product Information. Betagan Liquifilm (levobunolol)." Allergan Inc, Irvine, CA.
  6. "Product Information. Ocupress (carteolol ophthalmic)" Ciba Vision Ophthalmics, Duluth, GA.
View all 6 references
Major

Ophthalmic beta-blockers (applies to brimonidine/timolol ophthalmic) 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. "Product Information. Timoptic (timolol ophthalmic)." Merck & Co, Inc, West Point, PA.
  4. 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
  5. Lepantalo M "Beta blockade and intermittent claudication." Acta Med Scand 700 (1985): 1-48
  6. Uusitalo RJ, Palkama A "Efficacy and safety of timolol pilocarpine combination drops in glaucoma patients." Acta Ophthalmol (Copenh) 72 (1994): 496-504
  7. Mashford ML, Coventry D, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  8. 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
  9. "Product Information. Betaxon (levobetaxolol ophthalmic)" Alza, Palo Alto, CA.
  10. "Product Information. Betoptic (betaxolol ophthalmic)." Alcon Laboratories Inc, Fort Worth, TX.
  11. Coppeto JR "Transient ischemic attacks and amaurosis fugax from timolol." Ann Ophthalmol 17 (1985): 64-5
  12. "Product Information. Betagan Liquifilm (levobunolol)." Allergan Inc, Irvine, CA.
  13. "Product Information. OptiPranolol (metipranolol)." Bausch and Lomb, Tampa, FL.
  14. Edeki TI, He H, Wood AJ "Pharmacogenetic explanation for excessive B-blockade following timolol eye drops." JAMA 274 (1995): 1611-3
  15. Shiuey Y, Eisenberg MJ "Cardiovascular effects of commonly used ophthalmic medications." Clin Cardiol 19 (1996): 5-8
  16. "Product Information. Ocupress (carteolol ophthalmic)" Ciba Vision Ophthalmics, Duluth, GA.
  17. 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
  18. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
View all 18 references
Moderate

Ophthalmic alpha-2 adrenergics (applies to brimonidine/timolol ophthalmic) cardiovascular

Moderate Potential Hazard, Low plausibility. Applicable conditions: Cardiovascular Disease, Cerebrovascular Insufficiency, Hypotension

Topically applied alpha-2 adrenergic receptor agonists are systemically absorbed, with the potential for producing rare but clinically significant systemic effects. In the central nervous system, alpha adrenergic stimulation causes an inhibition of sympathetic vasomotor centers, resulting in decreased peripheral resistance and bradycardia. While the commercially available agents in the U.S. (apraclonidine and brimonidine) are hydrophilic and do not readily distribute across the ocular-blood barrier into the CNS, prolonged use may increase the risk of systemic effects. There have been occasional reports of bradycardia, chest heaviness or burning, palpitation, reduced blood pressure, and orthostatic hypotension when apraclonidine 1% was administered once or twice a day for 4 weeks to individuals not undergoing laser surgery. Therapy with ophthalmic alpha-2 adrenergic agents should be administered cautiously in patients with severe, uncontrolled cardiovascular disease, including hypertension, coronary or cerebrovascular insufficiency, recent myocardial infarction, chronic renal failure, Raynaud's disease, thromboangiitis obliterans, and a predisposition for orthostatic hypotension.

References

  1. Sridharrao B, Badrinath SS "Efficacy and safety of apraclonidine in patients undergoing anterior segment laser surgery." Br J Ophthalmol 73 (1989): 884-7
  2. Nordlund JR, Pasquale LR, Robin AL, Rudikoff MT, Ordman J, Chen KS, Walt J "The cardiovascular, pulmonary, and ocular hypotensive effects of 0.2% brimonidine." Arch Ophthalmol 113 (1995): 77-83
  3. Coleman AL, Robin AL, Pollack IP, Rudikoff MT, Enger C, Mayer PR "Cardiovascular and intraocular pressure effects and plasma concentrations of apraclonidine." Arch Ophthalmol 108 (1990): 1264-7
  4. "Product Information. Alphagan (brimonidine ophthalmic)." Allergan Inc, Irvine, CA.
  5. King MH, Richards DW "Near syncope and chest tightness after administration of apraclonidine before argon laser iridotomy." Am J Ophthalmol 110 (1990): 308-9
  6. "Product Information. Iopidine (apraclonidine)." Alcon Laboratories Inc, Fort Worth, TX.
View all 6 references
Moderate

Ophthalmic alpha-2 adrenergics (applies to brimonidine/timolol ophthalmic) depression

Moderate Potential Hazard, Low plausibility.

Topically applied alpha-2 adrenergic receptor agonists are systemically absorbed, with the potential for producing rare but clinically significant systemic effects. Depression has infrequently been associated with the ocular use of these drugs due to their inhibiting effect on the sympathetic nervous system. Depressed patients should be monitored for exacerbation of their condition during therapy with ophthalmic alpha-2 adrenergic agents.

References

  1. "Product Information. Iopidine (apraclonidine)." Alcon Laboratories Inc, Fort Worth, TX.
  2. "Product Information. Alphagan (brimonidine ophthalmic)." Allergan Inc, Irvine, CA.
Moderate

Ophthalmic alpha-2 adrenergics (applies to brimonidine/timolol ophthalmic) renal/liver

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction, Liver Disease

Topically applied alpha-2 adrenergic receptor agonists are systemically absorbed, with the potential for producing rare but clinically significant systemic effects. There are limited data concerning the pharmacokinetic disposition or the clinical use of these drugs in patients with renal and/or liver disease. Therapy with ophthalmic alpha-2 adrenergic agents should be administered cautiously in patients with significantly impaired renal or hepatic function.

References

  1. "Product Information. Iopidine (apraclonidine)." Alcon Laboratories Inc, Fort Worth, TX.
  2. "Product Information. Alphagan (brimonidine ophthalmic)." Allergan Inc, Irvine, CA.
Moderate

Ophthalmic beta-blockers (applies to brimonidine/timolol ophthalmic) 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. Coppeto JR "Timolol-associated myasthenia gravis." Am J Ophthalmol 98 (1984): 244-5
  2. "Product Information. OptiPranolol (metipranolol)." Bausch and Lomb, Tampa, FL.
  3. Confavreux C, Charles N, Aimard G "Fulminant myasthenia gravis soon after initiation of acebutolol therapy." Eur Neurol 30 (1990): 279-81
  4. "Product Information. Betagan Liquifilm (levobunolol)." Allergan Inc, Irvine, CA.
  5. "Product Information. Timoptic (timolol ophthalmic)." Merck & Co, Inc, West Point, PA.
  6. Herishanu Y, Rosenberg P "Beta-blockers and myasthenia gravis." Ann Intern Med 83 (1975): 834-5
  7. "Product Information. Ocupress (carteolol ophthalmic)" Ciba Vision Ophthalmics, Duluth, GA.
  8. Verkijk A "Worsening of myasthenia gravis with timolol maleate eyedrops." Ann Neurol 17 (1985): 211-2
  9. Berstein LP, Henkind P "Additional information on adverse reactions to timolol." Am J Ophthalmol 92 (1981): 295-6
  10. 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
  11. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
  12. "Product Information. Betoptic (betaxolol ophthalmic)." Alcon Laboratories Inc, Fort Worth, TX.
  13. "Product Information. Betaxon (levobetaxolol ophthalmic)" Alza, Palo Alto, CA.
View all 13 references

Brimonidine / timolol ophthalmic drug interactions

There are 521 drug interactions with brimonidine / timolol ophthalmic

Brimonidine / timolol ophthalmic alcohol/food interactions

There is 1 alcohol/food interaction with brimonidine / timolol ophthalmic

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.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.