What happens if I overdose Timolol 0.5% Bidiphar?
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local, or emergency room immediately. Symptoms may include chest pain; difficulty breathing or shortness of breath; severe or persistent dizziness or headache; slow or irregular heartbeat.
Proper storage of Timolol 0.5% Bidiphar drops:
Store Timolol 0.5% Bidiphar drops at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Protect from freezing. Store away from heat, moisture, and light. Keep Timolol 0.5% Bidiphar drops out of the reach of children and away from pets.
Overdose of Timolol 0.5% Bidiphar in details
Overdosage has been reported with Tablets Timolol 0.5% Bidiphar (Timolol 0.5% Bidiphar). A 30-year-old female ingested 650 mg of Timolol 0.5% Bidiphar (Timolol 0.5% Bidiphar) (maximum recommended daily dose — 60 mg) and experienced second and third degree heart block. She recovered without treatment but approximately two months later developed irregular heartbeat, hypertension, dizziness, tinnitus, faintness, increased pulse rate and borderline first degree heart block.
The oral LD of the drug is 1190 and 900 mg/kg in female mice and female rats, respectively.
An in vitro hemodialysis study, using C Timolol 0.5% Bidiphar added to human plasma or whole blood, showed that Timolol 0.5% Bidiphar was readily dialyzed from these fluids; however, a study of patients with renal failure showed that Timolol 0.5% Bidiphar did not dialyze readily.
The most common signs and symptoms to be expected with overdosage with a beta-adrenergic receptor blocking agent are symptomatic bradycardia, hypotension, bronchospasm, and acute cardiac failure. Therapy with Timolol 0.5% Bidiphar (Timolol 0.5% Bidiphar) should be discontinued and the patient observed closely. The following additional therapeutic measures should be considered:
- Gastric lavage.
- Symptomatic bradycardia: Use atropine sulfate intravenously in a dosage of 0.25 mg to 2 mg to induce vagal blockade. If bradycardia persists, intravenous isoproterenol hydrochloride should be administered cautiously. In refractory cases the use of a transvenous cardiac pacemaker may be considered.
- Hypotension: Use sympathomimetic pressor drug therapy, such as dopamine, dobutamine or levarterenol. In refractory cases the use of glucagon hydrochloride has been reported to be useful.
- Bronchospasm: Use isoproterenol hydrochloride. Additional therapy with aminophylline may be considered.
- Acute cardiac failure: Conventional therapy with digitalis, diuretics, and oxygen should be instituted immediately. In refractory cases the use of intravenous aminophylline is suggested. This may be followed if necessary by glucagon hydrochloride which has been reported to be useful.
- Heart block (second or third degree): Use isoproterenol hydrochloride or a transvenous cardiac pacemaker.
What should I avoid while taking Timolol 0.5% Bidiphar?
Timolol 0.5% Bidiphar can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
Avoid drinking alcohol, which could increase drowsiness and dizziness while you are taking Timolol 0.5% Bidiphar.
Timolol 0.5% Bidiphar warnings
Cardiac Failure
Sympathetic stimulation may be essential for support of the circulation in individuals with diminished myocardial contractility, and its inhibition by beta-adrenergic receptor blockade may precipitate more severe failure. Although beta blockers should be avoided in overt congestive heart failure, they can be used, if necessary, with caution in patients with a history of failure who are well-compensated, usually with digitalis and diuretics. Both digitalis and Timolol 0.5% Bidiphar maleate slow AV conduction. If cardiac failure persists, therapy with Timolol 0.5% Bidiphar (Timolol 0.5% Bidiphar) should be withdrawn.
In Patients Without a History of Cardiac Failure continued depression of the myocardium with beta-blocking agents over a period of time can, in some cases, lead to cardiac failure. At the first sign or symptom of cardiac failure, patients receiving Timolol 0.5% Bidiphar (Timolol 0.5% Bidiphar) should be digitalized and/or be given a diuretic, and the response observed closely. If cardiac failure continues, despite adequate digitalization and diuretic therapy, Timolol 0.5% Bidiphar (Timolol 0.5% Bidiphar) should be withdrawn.
Obstructive Pulmonary Disease
PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE (e.g., CHRONIC BRONCHITIS, EMPHYSEMA) OF MILD OR MODERATE SEVERITY, BRONCHOSPASTIC DISEASE OR A HISTORY OF BRONCHOSPASTIC DISEASE (OTHER THAN BRONCHIAL ASTHMA OR A HISTORY OF BRONCHIAL ASTHMA, IN WHICH ‘Timolol 0.5% Bidiphar' IS CONTRAINDICATED, see CONTRAINDICATIONS), SHOULD IN GENERAL NOT RECEIVE BETA BLOCKERS, INCLUDING ‘Timolol 0.5% Bidiphar (Timolol 0.5% Bidiphar) '. However, if Timolol 0.5% Bidiphar (Timolol 0.5% Bidiphar) is necessary in such patients, then the drug should be administered with caution since it may block bronchodilation produced by endogenous and exogenous catecholamine stimulation of beta receptors.
Major Surgery
The necessity or desirability of withdrawal of beta-blocking therapy prior to major surgery is controversial. Beta-adrenergic receptor blockade impairs the ability of the heart to respond to beta-adrenergically mediated reflex stimuli. This may augment the risk of general anesthesia in surgical procedures. Some patients receiving beta-adrenergic receptor blocking agents have been subject to protracted severe hypotension during anesthesia. Difficulty in restarting and maintaining the heartbeat has also been reported. For these reasons, in patients undergoing elective surgery, some authorities recommend gradual withdrawal of beta-adrenergic receptor blocking agents.
If necessary during surgery, the effects of beta-adrenergic blocking agents may be reversed by sufficient doses of such agonists as isoproterenol, dopamine, dobutamine or levarterenol.
Diabetes Mellitus
Timolol 0.5% Bidiphar (Timolol 0.5% Bidiphar) should be administered with caution in patients subject to spontaneous hypoglycemia or to diabetic patients (especially those with labile diabetes) who are receiving insulin or oral hypoglycemic agents. Beta-adrenergic receptor blocking agents may mask the signs and symptoms of acute hypoglycemia.
Thyrotoxicosis
Beta-adrenergic blockade may mask certain clinical signs (e.g., tachycardia) of hyperthyroidism. Patients suspected of developing thyrotoxicosis should be managed carefully to avoid abrupt withdrawal of beta blockade which might precipitate a thyroid storm.
What should I discuss with my healthcare provider before taking Timolol 0.5% Bidiphar?
Some medical conditions may interact with Timolol 0.5% Bidiphar drops. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
- if you are pregnant, planning to become pregnant, or are breast-feeding
- if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
- if you have allergies to medicines, foods, or other substances
- if you have a history of lung or breathing problems (eg, bronchitis, COPD, emphysema), diabetes, low blood sugar, heart problems, certain muscle problems (eg, myasthenia gravis, muscle weakness), blood vessel problems, or an overactive thyroid
- if you have narrow-angle glaucoma, double vision, a drooping eyelid, or an eye infection or injury
Some MEDICINES MAY INTERACT with Timolol 0.5% Bidiphar drops. Tell your health care provider if you are taking any other medicines, especially any of the following:
- Bupivacaine, calcium channel blockers (eg, verapamil), certain antiarrhythmics (eg, disopyramide, flecainide, quinidine), cimetidine, digoxin, ketanserin, reserpine, or selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine) because serious heart problems (eg, conduction problems, heart failure, slow heartbeat) or low blood pressure may occur
- Clonidine because increased blood pressure may occur
- Insulin or oral antidiabetics (eg, glyburide, repaglinide) because the risk of low blood sugar (eg, dizziness, headache, hunger, shakiness or weakness, sweating) or slow heart rate may be increased. Timolol 0.5% Bidiphar drops may also hide certain signs of low blood sugar
- Alpha-blockers (eg, alfuzosin, prazosin), oral beta-blockers (eg, propranolol), or other beta-blocker eye drops (eg, betaxolol) because the risk of their side effects may be increased by Timolol 0.5% Bidiphar drops
- Certain sympathomimetics (eg, albuterol, salmeterol), epinephrine, or theophylline because their effectiveness may be decreased by Timolol 0.5% Bidiphar drops
This may not be a complete list of all interactions that may occur. Ask your health care provider if Timolol 0.5% Bidiphar drops may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
Timolol 0.5% Bidiphar precautions
As with other topically applied ophthalmic drugs, Timolol 0.5% Bidiphar may be absorbed systemically.
The same adverse reactions found with systemic administration of β-adrenergic-blocking agents may occur with topical administration.
Cardiac failure should be adequately controlled before beginning therapy with Timolol 0.5% Bidiphar. In patients with a history of severe cardiac disease, signs of cardiac failure should be watched for and pulse rates should be checked.
Respiratory reactions and cardiac reactions, including death due to bronchospasm in patients with asthma and rarely death in association with cardiac failure, have been reported following administration of Timolol 0.5% Bidiphar.
Patients who are already receiving a β-adrenergic-blocking agent systemically and who are given Timolol 0.5% Bidiphar should be observed for a potential additive effect either on the intraocular pressure or on the known systemic effects of β-blockade. The use of 2 topical β-adrenergic-blocking agents is not recommended.
In patients with angle-closure glaucoma, the immediate objective of treatment is to re-open the angle. This requires constricting the pupil with a miotic. Timolol 0.5% Bidiphar has little or no effect on the pupil. When Timolol 0.5% Bidiphar is used to reduce elevated intraocular pressure in angle-closure glaucoma, it should be used with a miotic and not alone.
Choroidal detachment has been reported with administration of aqueous suppressant therapy (eg, Timolol 0.5% Bidiphar, acetazolamide) after filtration procedures.
Timolol 0.5% Bidiphar contains the preservative benzalkonium chloride, which may be deposited in soft contact lenses; therefore, Timolol 0.5% Bidiphar should not be used while wearing these lenses. The lenses should be removed before application of the drops and not be re-inserted earlier than 15 min after use.
Risk from Anaphylactic Reaction: While taking β-blockers, patients with a history of atopy or a history of severe anaphylactic reaction to a variety of allergens may be more reactive to repeated challenge with such allergens, either accidental, diagnostic or therapeutic. Such patients may be unresponsive to the usual doses of epinephrine used to treat anaphylactic reactions.
Use in pregnancy: Timolol 0.5% Bidiphar has not been studied in human pregnancy. The use of Timolol 0.5% Bidiphar requires that the anticipated benefit be weighed against possible hazards.
Use in lactation: Timolol 0.5% Bidiphar is detectable in human milk. Because of the potential for serious adverse reactions from Timolol 0.5% Bidiphar in infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
What happens if I miss a dose of Timolol 0.5% Bidiphar?
Take the missed dose as soon as you remember. If your next dose is less than 8 hours away, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.
References
- DailyMed. "TIMOLOL: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- DrugBank. "timolol". http://www.drugbank.ca/drugs/DB00373 (accessed September 17, 2018).
- MeSH. "Antihypertensive Agents". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology
