Abstract
26 eyes of 14 patients - 8 with primary open angle glaucoma, 6 glaucoma suspects - were treated for at least 6 months with either twice daily timolol 0.25% in both eyes or twice daily timolol 0.50% in one eye. None of the patients received concomitant local or oral drugs. Special attention was paid to tachyphylaxis and to blood pressure and pulse rate.
We could detect a slight although not significant tendency to tachyphylaxis (1–2 mm Hg) after 1 week of timolol treatment. It takes at least 1 – 2 weeks to reach the initial I.O.P. level after withdrawal of timolol therapy. Blood pressure did not change significantly. The pulse rate showed a slight although not significant tendency to decrease (a few beats/minute), but we detected a reflex tachycardia (10 beats/minute) after withdrawal of timolol therapy which was very significant. This rebound phenomenon has not been referred to in the literature. It seems reasonable to conclude that one should take care in treating glaucoma patients with concomitant arrhythmias with timolol eye drops.
Similar content being viewed by others
References
Bischoff, P. Erfahrungen mit Timolol in der Glaukomtherapie. Klin. Mbl. Augenheilk. 173: 202–207 (1978).
Boger, W.P., Puliafito, C.A., Steinert, R.F. & Langston, D.P. Long-term experience with timolol ophthalmic solution in patients with open angle glaucoma. Trans. Amer. Acad. O. and O. 85: 259–267 (1978).
Boger, W. P., Steinert, R.F., Puliafito, C.A. & Pavan-Langston, D. Clinical trial comparing timolol ophthalmic solution to pilocarpine in open angle glaucoma. Amer. J. Ophthal. 86: 8–18 (1978).
Brogden, R.N., Speight, T.M. & Avery, G.S. Timolol: A preliminary report of its pharmacological properties and therapeutic efficacy in angina and hypertension. Drugs 9: 164–177 (1915).
Brenkman, R.F. Ocular hypotensive effect of atenolol 4% eye drops in glaucoma. In: Symposium on medical therapy in glaucoma. Docum. Ophthal. Proceeding Series. Vol. 12: 851–94. Dr. W. Junk, The Hague (1977).
Diaz, R.G., Somberg, J. Freeman, E. & Levitt, B. Myocardial infarction after propranolol withdrawal. Amer. Heart J. 88: 257–258 (1974).
Hall, R.A. Robson, R.D. & Share, N.N. A new potent beta-adrenergic blocking agent 3-morpholino4-(3-t-butylamino-2-hydroxyproproxy)-1, 2, 5-thiadiazole hydrogen maleate. Proc. Can. Fed. Biol. Soc. 13: 33 (1970).
Johnson, S.H., Brubaker, R.F. & Trautman, J.C. Absence of an effect of timolol on the pupil. Invest. Ophthalmol. Visual Sci. 17: 924–926 (1978).
Miller, R.R., Olson, H.G., Amsterdam, E.A. & Mason, D.T. Propranolol withdrawal rebound phenomenon. Exacerbation of coronary events after abrupt cessation of anti-anginal therapy. New England J. of Medicine 293: 416–418 (1975).
Moss, A.P., Ritch, R., Hargett, N.A., Kohn, A.N. & Podos, S.M. A comparison of the effects of timolol and epinephrine on intra ocular pressure. Amer. J. Ophthal. 86: 489–495 (1978).
Phillips, C.I., Gore, S.M., MacDonald, M.J. & Cullen, P.M. Atenolol eye drops in glaucoma. A double masked controlled study. Brit. J. Ophthal. 61: 349–353 (1977).
Radius, R.L., Diamond, G.R., Pollack, I.P. & Langham, M.E. Timolol. A new drug for management of chronic simple glaucoma. Arch. Ophthal. 96: 1003–1008 (1978).
Ritch, R., Hargett, N.A. & Podos, S.M. The effect of 1.5% timolol maleate on intraocular pressure. Acta Ophthal 56: 6–10 (1978).
Ros, F.E., Drake, C.L., Offerhaus, L. & Greve, E.L. Atenolol 4% eye drops and glaucoma. Albrecht von Graefes Arch. Min. exp. Ophthal. 205: 61–70 (1977).
Ros, F.E., Dake, C.L., Nagelkerke, N. & Greve, E.L. Metoprolol eye drops in the treatment of glaucoma. Albrecht von Graefes Arch. klin. exp. Ophthal. 206: 247–254 (1978).
Wettrell, K. & Pandolfi, M. Effect of topical atenolol on intra-ocular pressure. Brit. J. Ophthal. 61: 334–338 (1977).
Zimmerman, T.J. & Kaufman, H.E. Timolol. A beta-adrenergic blocking drug for the treatment of glaucoma. Arch. Ophthal. 95: 601–604 (1977).
Zimmerman, T.J. & Kaufman, H.E. Timolol. Dose response and duration of action. Arch. Ophthal. 95: 605–607 (1977).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ros, F.E., Dake, C.L. Timolol eye drops: Bradycardia ot tachycardia?. Doc Ophthalmol 48, 283–289 (1980). https://doi.org/10.1007/BF00141455
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF00141455