Cardiac safety of ophthalmic timolol.
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Maenpaa J, Pelkonen O
Cardiac safety of ophthalmic timolol.
Expert Opin Drug Saf. 2016 Nov;15(11):1549-1561. doi: 10.1080/14740338.2016.1225718. Epub 2016 Aug 31.
- PubMed ID
- 27534869 [ View in PubMed]
- Abstract
INTRODUCTION: It is generally believed that topical administration of eye drops safeguards against harmful systemic effects. However, about 80% of the drug in the ophthalmic products is systemically absorbed and the first-pass metabolism is avoided. Ophthalmic timolol is widely prescribed in the treatment of glaucoma either alone or in the combination eye drop products, many of which have been launched fairly recently. Ophthalmic timolol may cause serious adverse effects such as symptomatic bradycardia, various conduction disorders in the heart, orthostatic hypotension, syncope and falls. Areas covered: In this review we document a number of factors associated with the properties of ophthalmic timolol and specific features of a patient, which may jeopardize patient's cardiac safety even after topical treatment. Expert opinion: Plasma timolol levels are correlated with cardiovascular adverse effects in patients, since timolol is mainly metabolized by cytochrome P450 2D6 (CYP2D6) enzyme in the liver. Patients who are lacking the functional CYP2D6 or who are concomitantly using potent CYP2D6 inhibitor drugs (e.g. paroxetine or fluoxetine) or verapamil or other beta-blockers are at risk of getting serious cardiac adverse effects. Prior to treatment initiation, ECG should be always performed and CYP2D6 genotyping should be considered, if routinely available.
DrugBank Data that Cites this Article
- Drugs
- Drug Enzymes
Drug Enzyme Kind Organism Pharmacological Action Actions Timolol Cytochrome P450 2D6 Protein Humans UnknownSubstrateDetails - Drug Interactions
Drugs Interaction Integrate drug-drug
interactions in your softwareAcebutololVerapamil The risk or severity of adverse effects can be increased when Verapamil is combined with Acebutolol. AtenololVerapamil The risk or severity of adverse effects can be increased when Verapamil is combined with Atenolol. BetaxololVerapamil The risk or severity of adverse effects can be increased when Verapamil is combined with Betaxolol. BisoprololVerapamil The risk or severity of adverse effects can be increased when Verapamil is combined with Bisoprolol. CarteololVerapamil The risk or severity of adverse effects can be increased when Verapamil is combined with Carteolol.