scholarly journals Ritka szisztémás gyógyszer-interakció: timololtartalmú szemcsepp és lerkanidipintabletta együttes alkalmazása során ismétlődően jelentkező syncope

2019 ◽  
Vol 160 (8) ◽  
pp. 309-313 ◽  
Author(s):  
Edit Kun ◽  
Lóránt Dienes ◽  
Gábor Simonyi ◽  
Ervin Finta
Keyword(s):  
Side Effects ◽  
Beta Blockers ◽  
Channel Blockers ◽  
Eye Drops ◽  
Negative Results ◽  
Blood Pressure Fall ◽  
Systemic Side Effects ◽  
Systemic Drug ◽  
Pressure Fall

Abstract: The control and planning of the treatment of hypertensive patients need specific attention. As regards concomitant diseases and treatments, glaucoma and the use of eye drops should be taken into consideration. The ingredients of the administered eye drops get through the nasolacrimal canal and can be absorbed by the nasal mucosa. Because of the lack of enterohepatic ‘first pass’ effect, they can act systemically – like after intravenous administration. This way they can cause systemic side effects. The authors present a case of a patient, too, who was examined and medically checked regularly for years with negative results because of repeated syncope. It became clear only at the Hypertension Centre that the timolol-containing combined eye drops caused the symptoms. The authors draw attention to the fact that in the case of systemic side effects which can be connected to beta-blocking agents (blood pressure fall, bradycardia, breathing disturbance, depression), the role of the eye drops should be taken into consideration. At the same time, the possibility of the systemic drug interactions should not be forgotten either. The interaction with dihydropyridine-type calcium-channel blockers can be of great importance. In these cases, after consultation with an ophthalmologist, the glaucoma treatment with eye drops containing beta-blockers should be modified. Orv Hetil. 2019; 160(8): 309–313.

scholarly journals From Eye Drops to ICU, a Case Report of Three Side Effects of Ophthalmic Timolol Maleate in the Same Patient

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Muhammad Asim Rana ◽  
Ahmed Fouad Mady ◽  
Basheer Abdel Rehman ◽  
Abdulrahman Alharthy ◽  
Basim Huwait ◽  
...  
Keyword(s):  
Elderly Patient ◽  
Side Effects ◽  
Beta Blockers ◽  
Systemic Absorption ◽  
Eye Drops ◽  
Timolol Maleate ◽  
Raising Awareness ◽  
Adrenergic Blocker ◽  
Life Threatening ◽  
Systemic Side Effects

Timolol Maleate (also called Timolol) is a nonselective beta-adrenergic blocker and a class II antiarrhythmic drug, which is used to treat intraocular hypertension. It has been reported to cause systemic side effects especially in elderly patients with other comorbidities. These side effects are due to systemic absorption of the drug and it is known that Timolol is measurable in the serum following ophthalmic use. Chances of life threatening side effects increase if these are coprescribed with other cardiodepressant drugs like calcium channel or systemic beta blockers. We report a case where an elderly patient was admitted with three side effects of Timolol and his condition required ICU admission with mechanical ventilation and temporary transvenous pacing. The case emphasizes the need of raising awareness among physicians of such medications about the potential side effects and drug interactions. A close liaison among patient’s physicians is suggested.

scholarly journals Timolol 0.1% in Glaucomatous Patients: Efficacy, Tolerance, and Quality of Life

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Letizia Negri ◽  
Antonio Ferreras ◽  
Michele Iester
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Beta Blockers ◽  
The Other ◽  
Visual Field Defects ◽  
Market Beta ◽  
Systemic Side Effects ◽  
The Impact ◽  
Preservative Free

Glaucoma is a progressive, chronic optic neuropathy characterized by a typical visual field defects. Four main classes of topical medication are actually available on the market: beta-blockers, prostaglandins, alpha2-agonists, and topical carbonic anhydrase inhibitor to treat intraocular pressure (IOP). The aim of this review is to outline the efficacy of timolol and to evaluate the impact of this treatment on patients’ quality of life. Among beta-blockers, timolol is most used at three different concentrations: 0.1%, 0.25%, and 0.5%. While the first one is a gel, the other two products are solution. Timolol has few topical side effects, while it has some important systemic side effects on the cardiac and respiratory systems. The balance between efficacy and safety is always the main aspect to care patients. Because of the less efficacy of timolol 0.1% solution, the possibility to use carbomers as vehicle in the gel drops helped timolol 0.1 to be used in clinics, extending the time contact between the active ingredient and the surface of the cornea. Using preservative-free timolol 0.1 for treatment, IOP was at the same level of the other beta-blockers at higher concentration, but it was better tolerated. Preservative-free treatment improved the quality of life reducing dry-eye like symptoms; furthermore, the presence of an artificial tear in the medication bottle could help adherence. The once daily dosing improves compliance.

Quantifying Side-Effects of Beta-Blockers: The Role of Visual Analogue Scales

1987 ◽  
Vol 6 (3) ◽  
pp. 195-201 ◽  
Author(s):  
R.V. Lewis
Keyword(s):  
Side Effects ◽  
Muscle Fatigue ◽  
Beta Blockers ◽  
Hypertensive Patients ◽  
Visual Analogue Scales ◽  
Detailed Explanation ◽  
Nonparametric Statistical Methods ◽  
Nonparametric Statistical ◽  
Analogue Scales

Beta-blockers are often prescribed for patients who are asymptomatic and for whom the benefits of therapy are likely to be small. Side-effects are therefore of great importance. Symptoms such as muscle fatigue and peripheral coldness are commonly associated with treatment with beta-blockers but these subjective phenomena are difficult to detect and quantify so that their prevalence and severity are uncertain. Conventional symptom questionnaires may be relatively insensitive and visual analogue scales (VAS), which permit interval quantification of subjective phenomena, may have some advantages. They appear to be able to detect the presence of tiredness of the legs and peripheral coldness among hypertensive patients taking beta-blockers and are more sensitive than descriptive or 'category' questionnaires. However, some patients find VAS hard to understand and a minority of patients score erratically for all symptoms. A most detailed explanation is of paramount importance. Scores derived from VAS surveys are not normally distributed and should be examined using nonparametric statistical methods; normalising transformations do not improve the sensitivity of the method.

scholarly journals Ocular and systemic side effects of brimonidine 0.2% eye drops (Alphagan®) in children

Eye ◽  
2004 ◽  
Vol 18 (1) ◽  
pp. 24-26 ◽  
Author(s):  
R J C Bowman ◽  
J Cope ◽  
K K Nischal
Keyword(s):  
Side Effects ◽  
Eye Drops ◽  
Systemic Side Effects

scholarly journals Systemic side effects of eye drops: a pharmacokinetic perspective

2016 ◽  
Vol Volume 10 ◽  
pp. 2433-2441 ◽  
Author(s):  
Andre Farkouh ◽  
Peter Frigo ◽  
Martin Czejka
Keyword(s):  
Side Effects ◽  
Eye Drops ◽  
Systemic Side Effects

Delayed reversal of Goldblatt hypertension by angiotensin II infusion in the rat

1984 ◽  
Vol 246 (6) ◽  
pp. H811-H817 ◽  
Author(s):  
A. Kumar ◽  
R. F. Bing ◽  
J. D. Swales ◽  
H. Thurston
Keyword(s):  
Blood Pressure ◽  
Angiotensin Ii ◽  
Blood Pressure Monitoring ◽  
Plasma Renin ◽  
Pressure Monitoring ◽  
Blood Pressure Fall ◽  
Transient Rise ◽  
Pressure Fall ◽  
Goldblatt Hypertension

Reversal of early Goldblatt two-kidney, one-clip hypertension is associated with a fall in plasma renin. To define the role of this in blood pressure normalization we maintained preoperative hypertension for 12 h after unclipping or removal of the ischemic kidney, by angiotensin II or norepinephrine infusions during continuous blood pressure monitoring. High infusion rates of angiotensin II (1 microgram X kg-1 X min-1) were needed to reproduce hypertensive pressures. On stopping angiotensin II there was a rapid initial fall in blood pressure but not to normal (176 +/- 3.1 to 138 +/- 4.3 mmHg at 1 h), and a later slower fall to normal by 24 h (114 +/- 3.9). This response was identical to that of dextrose-infused animals (180 +/- 8.2 to 146 +/- 7.0 at 1 h and 113 +/- 5.6 at 24 h), apart from a transient rise in blood pressure associated with hyperreninemia in unclipped animals 12 h postinfusion. In contrast, after norepinephrine blood pressure fell immediately to normal. Similar responses were seen in normal rats after 12-h pressor infusions of angiotensin II or norepinephrine. These results show that the fast and slow components of the blood pressure fall following reversal of Goldblatt hypertension are delayed but otherwise unaltered specifically by angiotensin II. The need for pharmacologic doses, however, suggests that mechanisms in addition to the direct vasopressor action of angiotensin II are involved.

scholarly journals Stroke neuroprotection revisited: Intra-arterial verapamil is profoundly neuroprotective in experimental acute ischemic stroke

2015 ◽  
Vol 36 (4) ◽  
pp. 721-730 ◽  
Author(s):  
Michael E Maniskas ◽  
Jill M Roberts ◽  
Ishi Aron ◽  
Justin F Fraser ◽  
Gregory J Bix
Keyword(s):  
Ischemic Stroke ◽  
Side Effects ◽  
Channel Blocker ◽  
Infarct Volume ◽  
Stroke Model ◽  
Neuroprotective Effects ◽  
Injection Volume ◽  
Cellular Apoptosis ◽  
Systemic Side Effects

While clinical trials have now solidified the role of thrombectomy in emergent large vessel occlusive stroke, additional therapies are needed to optimize patient outcome. Using our previously described experimental ischemic stroke model for evaluating adjunctive intra-arterial drug therapy after vessel recanalization, we studied the potential neuroprotective effects of verapamil. A calcium channel blocker, verapamil is often infused intra-arterially by neurointerventionalists to treat cerebral vasospasm. Such a direct route of administration allows for both focused targeting of stroke-impacted brain tissue and minimizes potential systemic side effects. Intra-arterial administration of verapamil at a flow rate of 2.5 µl/min and injection volume of 10 µl immediately after middle cerebral artery recanalization in C57/Bl6 mice was shown to be profoundly neuroprotective as compared to intra-arterial vehicle-treated stroke controls. Specifically, we noted a significant (P ≤ 0.05) decrease in infarct volume, astrogliosis, and cellular apoptosis as well as a significant increase in neuronal survival and functional outcome over seven days. Furthermore, intra-arterial administration of verapamil was well tolerated with no hemorrhage, systemic side effects, or increased mortality. Thus, verapamil administered intra-arterially immediately following recanalization in experimental ischemic stroke is both safe and neuroprotective and merits further study as a potential therapeutic adjunct to thrombectomy.

scholarly journals Emerging role of ivabradine for rate control in atrial fibrillation

2016 ◽  
Vol 10 (6) ◽  
pp. 348-352 ◽  
Author(s):  
Sarah L. Turley ◽  
Kerry E. Francis ◽  
Denise K. Lowe ◽  
William D. Cahoon
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Rate Control ◽  
Beta Blockers ◽  
Control Treatment ◽  
Ventricular Rate ◽  
Channel Blockers ◽  
Target Heart Rate ◽  
Heart Failure Patients

Control of ventricular rate is recommended for patients with paroxysmal, persistent, or permanent atrial fibrillation (AF). Existing rate-control options, including beta-blockers, nondihydropyridine calcium channel blockers, and digoxin, are limited by adverse hemodynamic effects and their ability to attain target heart rate (HR). Ivabradine, a novel HR-controlling agent, decreases HR through deceleration of conduction through If (‘funny’) channels, and is approved for HR reduction in heart failure patients with ejection fraction less than 35% and elevated HR, despite optimal pharmacological treatment. Because If channels were thought to be expressed solely in sinoatrial (SA) nodal tissue, ivabradine was not investigated in heart failure patients with concomitant AF. Subsequent identification of hyperpolarization-activated cyclic nucleotide-gated cation channel 4 (HCN4), the primary gene responsible for If current expression throughout the myocardium, stimulated interest in the potential role of ivabradine for ventricular rate control in AF. Preclinical studies of ivabradine in animal models with induced AF demonstrated a reduction in HR, with no significant worsening of QT interval or mean arterial pressure. Preliminary human data suggest that ivabradine provides HR reduction without associated hemodynamic complications in patients with AF. Questions remain regarding efficacy, safety, optimal dosing, and length of therapy in these patients. Prospective, randomized studies are needed to determine if ivabradine has a role as a rate-control treatment in patients with AF.

New technique to reduce systemic side effects of timolol eye drops: The tissue press method—Cross‐over clinical trial

2019 ◽  
Vol 48 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Luzia Müller ◽  
Berit P. Jensen ◽  
Lucas M. Bachmann ◽  
Dickson Wong ◽  
Anthony P. Wells
Keyword(s):  
Clinical Trial ◽  
Side Effects ◽  
New Technique ◽  
Eye Drops ◽  
Systemic Side Effects ◽  
Press Method
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