Side Effects of Betimol (timolol ophthalmic solution)

Betimol (timolol ophthalmic solution) is a beta1 and beta2 (nonselective) adrenergic receptor inhibitor used to treat elevated intraocular pressure in patients with ocular hypertension or open-angle glaucoma.

When applied topically to the eye, Betimol has the action of reducing elevated, as well as normal, intraocular pressure, whether or not accompanied by glaucoma. Elevated intraocular pressure is a major risk factor in the pathogenesis of glaucomatous visual field loss and optic nerve damage. The precise mechanism of the ocular hypotensive action of Betimol is not clearly established at this time. 

Common side effects of Betimol include:

• eye redness,
• eye discomfort,
• double vision,
• blurred vision,
• drooping/swollen eyelids,
• burning or stinging in the eyes,
• dry eyes,
• itchy eyes,
• feeling like something is in the eye,
• upset stomach,
• diarrhea,
• constipation,
• fatigue,
• insomnia,
• nausea, and
• vomiting.

Serious side effects of Betimol include:

• depression,
• vivid dreams,
• memory loss,
• fever,
• impotence,
• lightheadedness,
• slow heart rate,
• low blood pressure,
• numbness and tingling,
• cramps,
• blue hands or feet,
• sore throat,
• shortness of breath, and
• wheezing.

Drug interactions of Betimol include clonidine, which may cause rebound hypertension upon abrupt discontinuation of clonidine. 

Fenoldopam should not be taken with Betimol as the combination may increase the risk of low blood pressure (hypotension). 

Betimol and reserpine taken together may have additive effects and result in hypotension and/or a markedly slow heartbeat, which may produce dizziness, lightheadedness/fainting, or dizziness on standing). 

Concurrent use of nonsteroidal anti-inflammatory drugs (NSAIDs) with Betimol may cause the antihypertensive action of beta-blockers to be decreased. 

There are no adequate studies of Betimol in pregnant women. Betimol should be used during pregnancy only if the potential benefit justifies the potential risk. 

Betimol has been detected in human milk and has a potential for adverse events in infants. Consult your doctor before breastfeeding. 

Minor side effects of timolol include:

• abdominal cramps,
• diarrhea,
• constipation,
• fatigue,
• insomnia,
• nausea, and
• vomiting.

Major side effects include:

• depression,
• vivid dreams,
• memory loss,
• fever,
• impotence,
• lightheadedness,
• slow heart rate,
• low blood pressure,
• numbness,
• tingling,
• cramps,
• blueness of the hands or feet,
• sore throat,
• shortness of breath, or
• wheezing.

The most frequently reported ocular event in clinical trials was burning/stinging on instillation and was comparable between Betimol and timolol maleate (approximately one in eight patients).

The following adverse events were associated with use of Betimol in frequencies of more than 5% in two controlled, double-masked clinical studies in which 184 patients received 0.25% or 0.5% Betimol:

OCULAR: Dry eyes, itching, foreign body sensation, discomfort in the eye, eyelid erythema, conjunctival injection, and headache.

BODY AS A WHOLE: Headache.

The following side effects were reported in frequencies of 1 to 5%:

OCULAR: Eye pain, epiphora, photophobia, blurred or abnormal vision, corneal fluorescein staining, keratitis, blepharitis and cataract.

BODY AS A WHOLE: Allergic reaction, asthenia, common cold and pain in extremities.

CARDIOVASCULAR: Hypertension.

DIGESTIVE: Nausea.

METABOLIC/NUTRITIONAL: Peripheral edema.

NERVOUS SYSTEM/PSYCHIATRY: Dizziness and dry mouth.

RESPIRATORY: Respiratory infection and sinusitis.

In addition, the following adverse reactions have been reported with ophthalmic use of beta blockers:

OCULAR: Conjunctivitis, blepharoptosis, decreased corneal sensitivity, visual disturbances including refractive changes, diplopia and retinal vascular disorder.

BODY AS A WHOLE: Chest pain.

CARDIOVASCULAR: Arrhythmia, palpitation, bradycardia, hypotension, syncope, heart block, cerebral vascular accident, cerebral ischemia, cardiac failure and cardiac arrest.

DIGESTIVE: Diarrhea.

ENDOCRINE: Masked symptoms of hypoglycemia in insulin-dependent diabetics.

NERVOUS SYSTEM/PSYCHIATRY: Depression, impotence, increase in signs and symptoms of myasthenia gravis and paresthesia.

RESPIRATORY: Dyspnea, bronchospasm, respiratory failure and nasal congestion.

SKIN: Alopecia, hypersensitivity including localized and generalized rash, urticaria.

Beta-adrenergic blocking agents: Patients who are receiving a beta-adrenergic blocking agent orally and Betimol should be observed for a potential additive effect either on the intraocular pressure or on the known systemic effects of beta-blockade.

Patients should not usually receive two topical ophthalmic beta-adrenergic blocking agents concurrently.

Catecholamine-depleting drugs: Close observation of the patient is recommended when a beta-blocker is administered to patients receiving catecholamine-depleting drugs such as reserpine, because of possible additive effects and the production of hypotension and/or marked bradycardia, which may produce vertigo, syncope, or postural hypotension.

Calcium Antagonists

Caution should be used in the co-administration of beta-adrenergic blocking agents and oral or intravenous calcium antagonists, because of possible atrioventricular conduction disturbances, left ventricular failure, and hypotension. In patients with impaired cardiac function, co-administration should be avoided.

Digitalis and Calcium Antagonists

The concomitant use of beta-adrenergic blocking agents with digitalis and calcium antagonists may have additive effects in prolonging atrioventricular conduction time.

Injectable Epinephrine

See more information in the product labeling.