Glaucoma Disease

Ophthalmic beta-blockers and Bradycardia

Question:

Thanks for the reply. I have now replaced Cosopt by just the Trusopt component, thus eliminating the beta-blocker (timolol). I am wondering how one measures the timolol residue in the body as alluded to in your post.Heart rate this AM was 54 instead of the previous 45-46, but we’ll see. Now, of course, I will wait and see if my pressure elevates significantly (you didn’t address that aspect in your examples). I am currently on alphagan (twice/day), xalatan (once/day) and formerly cosopt, now trusopt (twice/day). Use pilocarpine in the  right eye only at bedtime. Have had SLT (180 degree arc in both eyes). Pressure has varied from 18 to 25, depending on time of day, etc. HRT showed no significant loss in either eye….BT

Response:

Any words of wisdom on blockers as a possible cause Bradycardia? I have been using drops for 34 years for Primary Open-Angle Glaucoma, including timolol (alone and in cosopt). My heart rate has been gradually slowing up over the years and is presently as low as 45 beats per minute resting (and I am no super athelete). I am now 64. Recent searches on the internet reveal a possible connection. Specific cases are cited: http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2003;volume… Now, no ophthalmologists ever seem to inquire about non-obvious side effects, but I myself am now wondering. Any thoughts from those in the know? Benjamin Trimble

Response:

btrim…@yahoo.com wrote: > Any words of wisdom on blockers as a possible cause Bradycardia? I have > been using drops for 34 years for Primary Open-Angle Glaucoma, > including timolol (alone and in cosopt). My heart rate has been > gradually slowing up over the years and is presently as low as 45 beats > per minute resting (and I am no super athelete). I am now 64. Recent > searches on the internet reveal a possible connection. Specific cases > are cited:

http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2003;volume… > Now, no ophthalmologists ever seem to inquire about non-obvious side > effects, but I myself am now wondering. > Any thoughts from those in the know? > Benjamin Trimble

Bradycardia is certainly a possible side effect of ocular beta blocker drops.  I have had to discontinue Timoptic in a few patients over the years for just this reason.  This was usually at the request of their cardiologist.  In each case (I think there were only two), the heart rate did not climb significantly once I washed the Timoptic out of the patient’s system (this can take 4 – 6 weeks).  Both patients eventually needed pacemakers placed, and both did just fine.  Ask your ophthalmologist if there is something else you can take in place of the beta blocker, and see if your heart rate goes up.  Good luck to you…let us know what happens. –Rick Cohn, MD Glaucoma Specialist Winter Park, FL

Response:

Filed under: Glaucoma Drops

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