Timolol/ Latanoprost

Registered South African indications:

• Increased intraocular pressure

Contraindications

• Hypersensitivity to the active ingredients or any of the excipients in this combination product
• Asthma or history thereof
• Severe chronic obstructive pulmonary disease
• Sinus bradycardia
• Sick sinus syndrome
• Sino-atrial block
• Second or third degree atrioventricular block not controlled with pacemaker
• Overt cardiac failure
• Cardiogenic shock

Cautions

• Pregnancy
• Breastfeeding
• Renal impairment
• Hepatic impairment
• Cardiovascular diseases
• First degree heart block
• Severe peripheral circulatory disorders 
• Mild to moderate chronic obstructive pulmonary disease
• Spontaneous hypoglycaemia 
• Labile diabetes mellitus
• Hyperthyroidism
• Corneal diseases
• Inflammatory, neovascular, or chronic closed angle glaucoma
• Open angle glaucoma of pseudophakic patients 
• Pigmentary glaucoma
• History of herpetic keratitis
• Active herpes simplex keratitis 
• History of recurrent herpetic keratitis
• Aphakic patients
• Pseudophakic patients with a torn posterior lens capsule
• Known risk factors for macular oedema
• Dry eye conditions
• Concomitant use of contact lenses
• May impair ability to drive and operate machinery

Forms avail. in SA and covered in this monograph: opd

Reduction of intraocular pressure in patients with open angle glaucoma and ocular hypertension insufficiently responsive to topical beta ­blockers or prostaglandin analogues

Timolol/ Latanoprost
5/0.05 (mg/ml)

• Ophthalmic (opd): 1 drop into affected eye(s), dly; Max: 1 drop/eye/24hrs

If more than one topical ophthalmic drug is being used, the drugs should be administered at least 5min apart

May cause change in iris colour

Not established for use in children

Recommendations for this combination product as per highest risk category when comparing individual active ingredients

Pregnancy

• FDA Pregnancy Category C (Timolol, Latanoprost)

Breastfeeding

• Caution; not recommended (Latanoprost)

Renal Impairment

• Caution; no information available

Hepatic Impairment

• Caution; no information available

Elderly

• No dose adjustment recommended

Central Nervous System Disorders

• Syncope
• Cerebrovascular accident
• Cerebral ischaemia
• Exacerbation of myasthenia gravis
• Dizziness
• Paraesthesia
• Headache
• Insomnia
• Depression
• Nightmares
• Memory loss
• Asthenia
• Dizziness

Cardiovascular Disorders

• Bradycardia
• Chest pain
• Palpitations
• Oedema
• Arrhythmia
• Congestive heart failure
• Atrioventricular block
• Cardiac arrest
• Cardiac failure
• Hypotension
• Raynaud's phenomenon
• Cold hands and feet
• Aggravation of angina

Respiratory Disorders

• Bronchospasm
• Dyspnoea
• Cough
• Asthma or exacerbation thereof

Gastrointestinal Disorders

• Dysgeusia
• Nausea and vomiting
• Dyspepsia
• Diarrhoea
• Dry mouth
• Abdominal pain

Genitourinary Disorders

• Sexual dysfunction
• Decreased libido

Endocrine and Metabolic Disorders

• Hypoglycaemia

Musculoskeletal Disorders

• Myalgia
• Joint pain
• Muscle pain

Skin and Subcutaneous Tissue Disorders

• Alopecia
• Psoriasiform rash 
• Exacerbation of psoriasis
• Skin rash
• Pruritus
• Darkening of palpebral skin

Immune, Blood and Lymphatic System Disorders

• Systemic allergic reactions
• Anaphylactic reaction
• Herpetic keratitis

Sensory Disorders

• Corneal calcification
• Ocular irritation 
• Blepharitis
• Keratitis
• Choroidal detachment following filtration surgery 
• Decreased corneal sensitivity
• Dry eyes
• Corneal erosion ptosis
• Diplopia
• Tinnitus
• Increased iris pigmentation
• Eye pain
• Eye hyperaemia
• Conjunctivitis
• Blurred vision 
• Increased lacrimation 
• Corneal disorders
• Eyelash and vellus hair changes 
• Punctate epithelial erosions
• Periorbital oedema
• Iritis/uveitis
• Macular oedema 
• Corneal oedema 
• Misdirected eyelashes
• Iris cyst
• Photophobia
• Periorbital and lid changes 

• Beta blockers
• Prostaglandins
• Prostaglandin analogues
• Prostaglandin derivatives
• Oral calcium channel blockers
• Antiarrhythmics 
• Digitalis glycosides
• Parasympathomimetics
• Guanethidine
• Adrenaline
• Clonidine 
• Anti-diabetic agents

None routine

Timolol
Timolol maleate is a non-selective beta-adrenergic receptor blocking agent that does not have significant intrinsic sympathomimetic, direct myocardial depressant, or local anaesthetic activity. It combines reversibly with the beta-adrenergic receptor, and this inhibits the usual biologic response that would occur with stimulation of that receptor. Timolol maleate reduces elevated and normal intraocular pressure whether or not associated with glaucoma and has little or no effect on accommodation or pupil size. 

Latanoprost
Latanoprost is a prostaglandin F2-alpha analogue. It reduces intraocular pressure by increasing aqueous humour outflow through the trabecular meshwork and uveoscleral pathways.

COMBINATION PREPARATIONS

Timolol/ Latanoprost

Eye drops (per ml) 5mg/50μg

• Co-Atana (Actor)
• Xalacom (UpJohn) originator