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Timolol use increases due to rise of combination therapies for glaucoma
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Fixed combination glaucoma therapies have led to an increase in the use of nonselective -blockers, which may negatively impact patient safety, especially in older patients and should be studied further, researchers said.
The number of fixed-dose combination therapies for glaucoma has grown in recent years, and only the nonselective -blocker timolol is used in the -blocker function, according to researchers. However, ophthalmic timolol has been associated with severe systemic adverse events and include numerous cases resulting in death, researchers said.
“Adverse events involving the respiratory system form a major component of severe adverse outcomes,” the researchers said.
The use of combination therapies containing nonselective -blockers more than doubled in Ontario, Canada between 2001 and 2012, increasing from 11.9 dispensed prescriptions per 1,000 people in 2001 to 28.8 dispensed per 1,000 in 2012, according to the study in the Journal of Glaucoma.
Researchers utilized the IMS PharmaStat database to assess glaucoma medication prescriptions in Ontario between January 2001 and December 2012.
Timolol use grew at an average annual rate of 2.2%, whereas betaxolol use declined by 14.1% per year over the study period, according to researchers.
The use of combination therapies more than doubled between 2001 and 2012, increasing from 11.9 dispensed prescriptions per 1,000 people in 2001 to 28.8 per 1,000 in 2012.
“Despite efforts to reduce potentially dangerous prescribing, reports suggest that the prescription of ophthalmic -blockers to patients with asthma and chronic obstructive pulmonary diseases is common,” researchers said.
The sole use of nonselective -blockers in these products has resulted in wider exposure of patients to nonselective -blocking medication, researchers added. Timolol safety in older patients and in those with respiratory issues necessitates further study, they concluded. – by Abigail Sutton
Disclosure: The researchers reported no relevant financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
Fixed-combination medications have resulted in an increase in nonselective beta-blocker use, as timolol 0.5% is the beta-blocker of choice in these preparations. Makes sense.
Timolol is associated with potentially troubling side effects. Yep, just like I learned in school.
Adverse events include numerous cases resulting in death. Ok, I guess … but these cases largely occurred in the 1970s before timolol contraindications were fully understood.
This last statement reminds me of testimony I heard from organized ophthalmology during hearings on California’s first glaucoma bill. Funny, people don’t seem to be dying in the streets because optometrists have beta-blocker prescribing ability.
Maybe I’m in the minority, but I love beta-blockers and I love fixed combination medications. They have endured the test of time and, in my experience, are associated with very few side effects compared with the other classes of topical medication. Yeah, they don’t lower IOP as well over a 24-hour period, but typically they are a second-line medication. It doesn’t really bother me that we are prescribing less betaxolol (which I wouldn’t give to someone with beta-blocker contraindications either, by the way).
Understand the contraindications, discuss side effects with patients and query patients on said side effects on follow-up. Everything will be fine.
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