Systemic absorption may follow topical application; therefore eye drops containing a beta-blocker are contra-indicated in patients with bradycardia, heart block or uncontrolled heart failure. Beta-blocker eye drops should be avoided in patients receiving oral verapamil.

Beta-blockers, even those with apparent cardioselectivity, should not be used in patients with asthma or a history of obstructive airways disease unless no alternative treatment is available. In such cases the risk of inducing bronchospasm should be appreciated and appropriate precautions taken.

Timolol maleate

• Eye drops 0.25% (£3.33 = 5ml)
• Eye drops preservative-free 2.5mg/ml (£8.45 = 5ml)
• Eye gel 0.25% (long acting) (£3.12 = 2.5ml)
• Single unit dose preservative-free gel eye drops 0.1% (long acting) (£7.49 = 30 x 0.4g unit dose)

Dose

• Standard preparations: apply twice a day
• Long acting preparations: apply once daily

Notes

1. There is no evidence to show that 0.5% timolol is any more effective than 0.25% therefore it is not included in the formulary

Betaxolol hydrochloride

• Eye drops 0.25% (£2.66 = 5ml)
• Single unit dose preservative-free eye drops 0.25% (£13.77 = 50 x 0.25ml unit dose)

Dose

• Apply twice a day

Metipranolol

• Single use drops 0.3% (unlicensed preparation)

Indications

• Metipranolol may be used to control postoperative raised Intra Ocular Pressure