The chemical name for Timolol maleate is
(S)-1-[(1,1-dimethylethyl)amino]-3-[[4-(4-morpholinyl)-1,2,5-thiadiazol-3-yl]oxy]-2-propanol
(Z)-2-butenedioate (1:1) salt. It possesses an asymmetric carbon atom
in its structure and is provided as the levo isomer. Its molecular
formula is C13H24N4O3S•C4H4O4and its structural formula is:
Timolol maleate has a molecular weight of 432.50. It is a white,
odorless, crystalline powder which is soluble in water, methanol, and
alcohol.Timolol maleate is supplied as tablets containing 5 mg, 10 mg
and 20 mg Timolol maleate for oral administration. Inactive ingredients
are: colloidal silicon dioxide, croscarmellose sodium, magnesium
stearate, microcrystalline cellulose, pregelatinized maize starch,
sodium lauryl sulfate.
Timolol
CLINICAL PHARMACOLOGY
Timolol maleate is a beta1 and beta2 (nonselective) adrenergic receptor
blocking agent that does not have significant intrinsic sympathomimetic,
direct myocardial depressant, or local anesthetic activity.
Pharmacodynamics
Clinical pharmacology studies have confirmed the beta-adrenergic
blocking activity as shown by (1) changes in resting heart rate and
response of heart rate to changes in posture; (2) inhibition of
isoproterenol-induced tachycardia; (3) alteration of the response to the
Valsalva maneuver and amyl nitrite administration; and (4) reduction of
heart rate and blood pressure changes on exercise.
Timolol decreases the positive chronotropic, positive inotropic,
bronchodilator, and vasodilator responses caused by beta-adrenergic
receptor agonists. The magnitude of this decreased response is
proportional to the existing sympathetic tone and the concentration of
Timolol at receptor sites.In normal volunteers, the reduction in heart
rate response to a standard exercise was dose dependent over the test
range of 0.5 to 20 mg, with a peak reduction at 2 hours of approximately
30% at higher doses.
Beta-adrenergic receptor blockade reduces cardiac output in both healthy
subjects and patients with heart disease. In patients with severe
impairment of myocardial function beta-adrenergic receptor blockade may
inhibit the stimulatory effect of the sympathetic nervous system
necessary to maintain adequate cardiac function.
Beta-adrenergic receptor blockade in the bronchi and bronchioles results
in increased airway resistance from unopposed parasympathetic activity.
Such an effect in patients with asthma or other bronchospastic
conditions is potentially dangerous.
Clinical studies indicate that Timolol maleate at a dosage of 20 to 60
mg/day reduces blood pressure without causing postural hypotension in
most patients with essential hypertension. Administration of Timolol to
patients with hypertension results initially in a decrease in cardiac
output, little immediate change in blood pressure, and an increase in
calculated peripheral resistance. With continued administration of
Timolol, blood pressure 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 with Timolol. In the majority of patients with
hypertension Timolol also decreases plasma renin activity. Dosage
adjustment to achieve optimal antihypertensive effect may require a few
weeks. When therapy with Timolol is discontinued, the blood pressure
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 mechanism of the antihypertensive effects of beta-adrenergic
receptor blocking agents is not established at this time. Possible
mechanisms of action include reduction in cardiac output, reduction in
plasma renin activity, and a central nervous system sympatholytic
action.
A Norwegian multi-center, double-blind study, which included patients 20
to 75 years of age, compared the effects of Timolol maleate with
placebo in 1,884 patients who had survived the acute phase of a
myocardial infarction. Patients with systolic blood pressure below 100
mm Hg, sick sinus syndrome and contraindications to beta-blockers,
including uncontrolled heart failure, second- or third-degree AV block
and bradycardia (< 50 beats per minute), were excluded from the
multi-center trial. Therapy with Timolol, begun 7 to 28 days following
infarction, was shown to reduce overall mortality; this was primarily
attributable to a reduction in cardiovascular mortality. Timolol
significantly reduced the incidence of sudden deaths (deaths occurring
without symptoms or within 24 hours of the onset of symptoms), including
those occurring within one hour, and particularly instantaneous deaths
(those occurring without preceding symptoms). The protective effect of
Timolol was consistent regardless of age, sex or site of infarction. The
effect was clearest in patients with a first infarction who were
considered at a high risk of dying, defined as those with one or more of
the following characteristics during the acute phase: transient left
ventricular failure, cardiomegaly, newly appearing atrial fibrillation
or flutter, systolic hypotension, or SGOT (ASAT) levels greater than
four times the upper limit of normal. Therapy with Timolol also reduced
the incidence of nonfatal reinfarction. The mechanism of the protective
effect of Timolol is unknown.
Timolol was studied for the prophylactic treatment of migraine headache
in placebo-controlled clinical trials involving 400 patients, mostly
women between the ages of 18 and 66 years. Common migraine was the most
frequent diagnosis. All patients had at least two headaches per month at
baseline. Approximately 50 percent of patients who received Timolol had
a reduction in the frequency of migraine headache of at least 50
percent, compared to a similar decrease in frequency in 30 percent of
patients receiving placebo. The most common cardiovascular adverse
effect was bradycardia (5

.