Patients with cardiovascular diseases should be watched for signs of deterioration of these diseases and of adverse reactions.ĭue to its negative effect on conduction time, beta-blockers should only be given with caution to patients with first degree heart block. coronary heart disease, Prinzmetal's angina and cardiac failure) and hypotension therapy with beta-blockers should be critically assessed and the therapy with other active substances should be considered. In patients with cardiovascular diseases (e.g. In such patients, the immediate objective of the treatment is to reopen the angle, which requires the use of a miotic agent in order to obtain pupil constriction, since timolol maleate has little or no effect on the pupil. If TOPEX 1 mg/g is administered to reduce intraocular pressure in patients with closed-angle glaucoma, a miotic should be used in combination. To reduce the systemic absorption, see 4.2.Īs with any glaucoma treatment, regular examination of the intraocular pressure and cornea is recommended. Incidence of systemic ADRs after topical ophthalmic administration is lower than for systemic administration. Due to beta-adrenergic component, timolol maleate, the same types of cardiovascular, pulmonary and other adverse reactions seen with systemic beta-adrenergic blocking agents may occur. Like other topically applied ophthalmic agents timolol maleate is absorbed systemically. Medical prescription should be combined with the monitoring of intraocular pressure, particularly when the treatment is initiated. When TIOPEX 1 mg/g is used to replace miotic eye drops, testing of refraction may prove necessary when the effects of the miotics have disappeared. The following day, stop taking the previous drug completely. If the anti-glaucoma drug being replaced is not a beta-blocker eye drops, it should be continued and one drop of TIOPEX 1 mg/g should be instilled in the affected eye (or eyes), once a day. If TIOPEX 1 mg/g is replacing a combination of anti-glaucoma treatments, only one drug should be withdrawn at a time. When TIOPEX 1 mg/g is used to replace another anti-glaucoma eye drops, this eye drops should be discontinued after a full day of therapy, and TIOPEX 1 mg/g should be started the next day at the dosage of one drop in the affected eye (or eyes) once a day, in the morning. This may result in a decrease in systemic side effects and an increase in local activity. When using nasolacrimal occlusion or closing the eyelids for 2 minutes, the systemic absorption is reduced.
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