Timolol Rx

Clinical studies indicate that timolol maleate at a dosage of 20-60 mg/day reduces blood pressure (BP) without causing postural hypotension in most patients with essential hypertension. Administration of timolol results initially in a decrease in cardiac output, little immediate change in BP, and an increase in calculated peripheral resistance. 

With continued administration, BP decreases within a few days, cardiac output usually remains reduced, and peripheral resistance falls toward pretreatment levels. Plasma volume may decrease or remain unchanged during therapy. Timolol also decreases plasma renin activity in the majority of patients with hypertension. 

Dosage adjustment to achieve optimal antihypertensive effect may require a few weeks. When therapy with timolol is discontinued, BP tends to return to pretreatment levels gradually. In most patients the antihypertensive activity of timolol is maintained with long-term therapy and is well tolerated.

The efficacy of timolol for the prophylactic treatment of migraine was evaluated in a placebo-controlled clinical trial that included 400 patients (18-66 years old; mostly female). The most frequent diagnosis was common migraine with all patients having at least 2 headaches per month at baseline. 

Findings showed a greater proportion of timolol-treated patients had a reduction in the frequency of migraine headache of at least 50%, compared with those who received placebo (50% vs 30%, respectively). The most common cardiovascular adverse effect was bradycardia (5%).

Timolol maleate was compared with placebo In a double-blind study that included 1884 patients (20-75 years old) who had survived the acute phase of a myocardial infarction. Treatment with timolol, started 7 to 28 days following infarction, resulted in reduced overall mortality when compared with placebo; this effect was primarily attributable to a reduction in cardiovascular mortality.

Timolol also significantly reduced the incidence of sudden death and the incidence of nonfatal reinfarction. An analysis of data showed that the treatment effect was clearest for patients with a first infarction who were considered at a high risk of dying.