A REMINDER THAT TOPICAL TIMOlOl CAN HAVE CARDIAC EFFECTS

These can be troublesome in some patients Bradycardia developed and congestive heart failure worsened in a 72-year-old woman after she started using timolol maleate eye drops (Timoptic'; Merck Sharp and Dohme) 0.25 %, I drop in each eye bid. She had severe rheumatic heart disease with atrial fibrillation and chronic congestive heart failure and was marginally compensated on digoxin and diuretics. Soon after she changed from pilocarpine to timolol eye drops she began to gain weight. Increasing diuretics did not help. Three and a half weeks after starting timolol she was admitted in nodal rhythm with a ventricular rate of 40 and a diagnosis of possible digitalis toxicity. The digoxin level was well within the therapeutic range, but the drug was stopped. !3radycardia persisted, but she was discharged somewhat improved. A week later, timolol was replaced by pilocarpine. In 3 days she lost 3. 7kg and the ventricular rate increased to 104. Britman. N.A.: New England Journal of Medicine 300: 566 (8 Mar 1979)

0156-2703/79/0317-0007 $00.50/0 ©ADIS Press INPHARMA 17 Mar 1979 7