A fixed-dose combination ophthalmic solution containing a prostaglandin analogue (Bimatoprost) and a non-selective beta-adrenergic receptor blocker (Timolol). It is a first-line therapy for the reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension who require more than one medication. The combination provides additive IOP-lowering efficacy through complementary mechanisms, often improving patient adherence compared to separate bottles.
Adult: One drop in the affected eye(s) once daily, preferably in the evening.
Note: 1. Wash hands. 2. Tilt head back. 3. Gently pull lower eyelid to form a pouch. 4. Instill one drop. 5. Close eye gently and apply pressure to the nasolacrimal duct (inner corner of eye) for 1-2 minutes to minimize systemic absorption. 6. Wait at least 5 minutes before instilling any other topical ophthalmic medication. Do not touch dropper tip to eye or any surface.
The combination works via two distinct pathways to reduce intraocular pressure (IOP). Bimatoprost increases uveoscleral outflow of aqueous humor by remodeling the extracellular matrix of the ciliary muscle. Timolol decreases aqueous humor production by blocking beta-2 adrenergic receptors in the ciliary epithelium. The combined effect is additive, resulting in a greater and more sustained reduction in IOP than either component alone.
Pregnancy: Category C. Animal studies with Bimatoprost have shown embryofetal toxicity. Timolol crosses the placenta. Use only if the potential benefit justifies the potential risk to the fetus. May cause intrauterine growth retardation, neonatal bradycardia, and hypoglycemia if used near delivery.
Driving: May cause transient blurred vision, dizziness, or fatigue after instillation. Patients should not drive or use machines until their vision is clear.
| Oral Beta-Blockers (e.g., Propranolol, Metoprolol) | Additive systemic beta-blockade; increased risk of bradycardia, hypotension, heart failure, bronchospasm. | Major |
| Calcium Channel Blockers (e.g., Verapamil, Diltiazem) | Potentiates AV conduction disturbances and negative inotropic effects; risk of severe bradycardia and heart failure. | Major |
| Digoxin | Additive effects on AV conduction; increased risk of bradycardia. | Moderate |
| Insulin, Oral Hypoglycemics | Timolol may mask tachycardia (a sign of hypoglycemia) and may impair glucose recovery. May also cause hypertension. | Moderate |
| Catecholamine-depleting drugs (e.g., Reserpine) | Additive hypotensive and bradycardic effects; may produce vertigo, syncope. | Major |
| Quinidine | Potentiates beta-blocker effects (negative inotropy) and may reduce Timolol metabolism. | Moderate |
| Adrenergic Psychotropics (e.g., MAOIs, Tricyclic Antidepressants) | Potential for hypertension if Timolol is withdrawn abruptly. | Moderate |
| Other Topical Ophthalmic Agents (e.g., Pilocarpine, Dorzolamide) | Additive IOP-lowering effect. Administer at least 5 minutes apart. | Minor |
Same composition (Bimatoprost (0.3mg/ml) + Timolol (5mg/ml)), different brands: