Ocular hypertension
Second line
Timolol lowers IOP in ocular hypertension. EGS 2024 and PPP 2020 position it as second-line monotherapy when prostaglandins are contraindicated and as a component of fixed combinations.
Topical non-selective beta blocker for ophthalmic use
ATC code: S01ED01 (Timolol)
Brand names
Timoptic, Betimol, Istalol
Non-selective antagonist of β1- and β2-adrenergic receptors without intrinsic sympathomimetic activity. In the ciliary body it blocks β receptors and reduces aqueous humour production by 30–50%. Instillation of 0.25–0.5% solution once or twice daily lowers IOP by 20–25%. Onset at 20 minutes, peak at 1–2 hours, duration 12–24 hours. Systemic absorption is substantial: up to 80% of the dose reaches systemic circulation via the nasal mucosa, so cardiac and pulmonary effects similar to oral beta blockers are possible.
Second line
Timolol lowers IOP in ocular hypertension. EGS 2024 and PPP 2020 position it as second-line monotherapy when prostaglandins are contraindicated and as a component of fixed combinations.
First line
Timolol is a topical beta blocker, historically first line for primary open-angle glaucoma before prostaglandins, now second-line monotherapy or add-on. EGS 2024 and SEG/SEO 2023 recommend timolol as an alternative to prostaglandins, especially when these are contraindicated (history of uveitis) or in fixed combinations (Cosopt with dorzolamide, Ganfort with bimatoprost). IOP reduction of 20–25%. Use with caution in patients with COPD, asthma, bradycardia and AV block.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Timolol is registered as eye drops for IOP lowering in glaucoma; AEMPS has not authorised other indications. Off-label topical application of 0.5% solution to superficial cutaneous infantile haemangiomas is common in dermatology – small series and the Cochrane 2018 review (Novoa et al.) suggest possible benefit in small superficial haemangiomas. In Spain, however, AEMPS has formally approved only oral propranolol (Hemangiol – AEMPS 2014) for infantile haemangioma; timolol eye drops remain off-label without comparative RCTs. Occlusive use can produce systemic absorption with bradycardia and bronchospasm in infants. Timolol marketing for androgenetic alopecia rests on small open studies without RCT support; for stage-fright tremor and anxiety, ophthalmic timolol has no data. If timolol was suggested for haemangioma, hair loss or anxiety, consider seeking a second opinion.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Direct links to regulator labels. Open in a new tab.
FDA Category C. Pregnancy data are limited. Systemic absorption is substantial and may theoretically cause neonatal bradycardia, hypoglycaemia and respiratory depression. AEMPS permits use when necessary with punctal occlusion; therapy is reviewed in the third trimester.
Compatible with caution. Hale L2. Transfers into milk in small amounts. Infant bradycardia is possible, especially in preterm infants, so when systemic absorption is appreciable a selective beta blocker or alternative class is preferable. Punctal occlusion reduces systemic exposure.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Timolol is evaluated for the following indications with varying evidence strength: Open-angle glaucoma (evidence tier A), Ocular hypertension (evidence tier A), Topical eyedrop treatment of infantile haemangiomas (evidence tier C). See the full indication matrix with dosing and citations above on this page.
Common side effects of Timolol (≥ 1 in 100): Burning and stinging after instillation, Dry eyes, Superficial punctate keratitis, Blurred vision, Bradycardia and lowered BP, Fatigue and drowsiness. See the Safety section for uncommon and serious reactions.
FDA category C. FDA Category C. Pregnancy data are limited. Systemic absorption is substantial and may theoretically cause neonatal bradycardia, hypoglycaemia and respiratory depression. AEMPS permits use when necessary with punctal occlusion; therapy is reviewed in the third trimester.
Compatible with caution. Hale L2. Transfers into milk in small amounts. Infant bradycardia is possible, especially in preterm infants, so when systemic absorption is appreciable a selective beta blocker or alternative class is preferable. Punctal occlusion reduces systemic exposure.
Timolol is contraindicated in: Hypersensitivity to timolol or other components; Asthma or severe COPD; Sinus bradycardia (under 50 bpm); Second- or third-degree AV block without pacemaker; Sick sinus syndrome. Full list in the Safety section.