[snip]

The same is true of BETAGAN (levobunolol) which has an even longer
half life than timolol.  And I realize that a lot of other eye doctors
are prescribing it on a qd basis.  I am also aware this happens a lot
in managed care situations such as HMOs where there is huge pressure
to keep costs down because of the cost difference between generic
timoptic and TIMOPTIC-XE.

I *personally* don't trust that once a day regular timoptic or
levobunolol will keep the IOP down consistently over the full 24
hours.  It may or it may not, and patients/myself don't like
performing diurnal/serial IOP checks over a 24 hour period
confirm/deny this.

So for the times when an once-a-day dosage of a topical beta blocker
is prescribed by me for my glaucoma patients, it is always a drug that
has FDA approval for qd dosage, such as TIMOPTIC-XE.  

On 6/21/06 10:34 AM, in article qvui92h16rq6i1mbbgdc2sng8lu4cmd5cn@4ax.com,

BTW, timolol can often be used once a day and do just fine. It depends on
the individual case. Timolol does not "wear off" in 12 hours, it actually
taks more than a few days. Full washout is up to 2 weeks, I am told. Yes,
some cases do need twice a day dosing for maximal effect. In fact, many of
us have a large number of patients taking regular timolol (not Timoptic-XE)
just once a day. As mentioned above, this also leads to better compliance.

Here is what I can generically say, rather than commenting directly on
your case in particular:

ISTALOL contains the same medication as timolol.  However, it is
formulated in a unique way (as TIMOPTIC-XE is) to allow once a day
dosing.  That is, essentially, the only real difference between
timolol and ISTALOL.

IOW, ISTALOL qd is promoted and marketed as providing *the same IOP
lowering* as timolol bid provides.  But in fact, timolol bid may
provide a more steady lowering and blunting of the IOP curve than
ISTALOL.

So, in general, timolol bid and ISTALOL qd are interchangable.  The
reason doctors prescribe ISTALOL (or TIMOPTIC-XE) over standard
timolol generally is because a once a day dosage promotes compliance.
Most (but not all) of the time, there is no reason why a person *must
be* on ISTALOL versus regular timolol.

If cost is a major concern, then I would askl your eye doctor two
questions:

1.  Why did he switch you from timolol to ISTALOL?

and, depending on the answer here,

2.  Tell him cost is a "big deal" and ask him if there is any way he
could switch you back to timolol.  If not, have him explain why.

FYI, one cannot say without knowing your optic nerve status over time
whether your glaucoma is/has been "under control" if the IOP is
"consistently about 18 in both eyes."  And there is no a priori way of
knowing whether in the future your glaucoma will not progress at an
unacceptable rate if your IOPs are consistently about 18.

It is important to understand that IOP is merely a risk factor for
glaucoma, as is thinner CCTs, age, family history of glaucoma, race,
etc.  However, it is an extremely imporant risk factor, because it is
the only one that eye doctors can (attempt to) control.

My eye doc has recommended that I swith from Timolol to Istalol for my
glaucoma.
Problem is that in my drug plan Timolol costs me $3 foe 90 day supply,
and Istalol is $76!!! It's not in their "preferred list".
Is it worth it? My pressure seems to be under control, consistently
about 18 in both eyes.