Ophthalmic beta-blockers and Bradycardia

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btrimble@yahoo.com - 05 Apr 2005 04:33 GMT

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=49;issue=2
;spage=186;epage=186;aulast=Calvo-Romero

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

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eyeguyrc@aol.com - 05 Apr 2005 22:48 GMT

> Any words of wisdom on blockers as a possible cause Bradycardia? I have
> been using drops for 34 years for Primary Open-Angle Glaucoma,
[quoted text clipped - 3 lines]
> searches on the internet reveal a possible connection. Specific cases
> are cited:

http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2003;volume=49;issue=2
;spage=186;epage=186;aulast=Calvo-Romero

> 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

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btrimble@yahoo.com - 07 Apr 2005 14:10 GMT

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

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