A1,
A2,
B,
C1,
C2,
D,
E,
F,
G-H,
I-K,
L,
M,
N,
O,
P1,
P2,
Q-R,
S,
T,
U-V,
W-Z
Timolide Overdose, Contraindications and Information - Timolol Maleate-Hydrochlorothiazide
Timolide Overdose, Contraindications and Information - Timolol Maleate-Hydrochlorothiazide
OVERDOSE
No data are available with regard to overdosage with TIMOLIDE
in humans.
Pretreatment of mice with hydrochlorothiazide (5 mg/kg) did
not alter the LD50 of timolol (1320 mg/kg compared to 1300 mg/kg
without pretreatment).
No specific information is available on the treatment of over-dosage
with TIMOLIDE, and no specific antidote is available. Treatment is symptomatic
and supportive. Therapy with TIMOLIDE should be discontinued and the patient
observed closely. Suggested measures include induction of emesis and/or gastric
lavage, and correction of dehydration, electrolyte imbalance, and hypotension
by established procedures.
Timolol Maleate
Overdosage has been reported with Tablets BLOCADREN* (timolol
maleate). A 30-year-old female ingested 650 mg of BLOCADREN (maximum recommended
daily dose _ 60 mg) and experienced second and third degree heart block. She
recovered without treatment but approximately two months later developed irregular
heartbeat, hypertension, dizziness, tinnitus, faintness, increased pulse rate
and borderline first degree heart block.
The oral LD50 of the drug is 1190 and 900 mg/kg
in female mice and female rats, respectively.
An in vitro hemodialysis study, using 14C timolol
added to human plasma or whole blood, showed that timolol was readily dialyzed
from these fluids; however, a study of patients with renal failure showed that
timolol did not dialyze readily.
The most common signs and symptoms to be expected with overdosage
with a beta-adrenergic receptor blocking agent are symptomatic bradycardia,
hypotension, bronchospasm, and acute cardiac failure. If overdosage occurs the
following therapeutic measures should be considered:
(1) Gastric lavage.
(2) Symptomatic bradycardia: Use atropine sulfate intravenously
in a dosage of 0.25 mg to 2 mg to induce vagal blockade. If bradycardia persists,
intravenous isoproterenol hydrochloride should be administered cautiously. In
refractory cases the use of a transvenous cardiac pacemaker may be considered.
(3) Hypotension: Use sympathomimetic pressor drug therapy,
such as dopamine, dobutamine or levarterenol. In refractory cases the use of
glucagon hydrochloride has been reported to be useful.
(4) Bronchospasm: Use isoproterenol hydrochloride. Additional
therapy with aminophylline may be considered.
(5) Acute cardiac failure: Conventional therapy with
digitalis, diuretics, and oxygen should be instituted immediately. In refractory
cases the use of intravenous aminophylline is suggested. This may be followed,
if necessary, by glucagon hydrochloride which has been reported to be useful.
(6) Heart block (second or third degree): Use isoproterenol
hydrochloride or a transvenous cardiac pacemaker.
Hydrochlorothiazide
The most common signs and symptoms observed with hydrochlorothiazide
overdosage are those caused by electrolyte depletion (hypokalemia, hypochloremia,
hypona-tremia) and dehydration resulting from excessive diuresis. If digitalis
has also been administered, hypokalemia may accentuate cardiac arrhythmias.
CONTRAINDICATIONS
TIMOLIDE is contraindicated in patients with bronchial asthma
or with a history of bronchial asthma, or severe chronic obstructive pulmonary
disease (see WARNINGS); sinus bradycardia;
second and third degree atrioventricular block; overt cardiac failure (see WARNINGS);
cardiogenic shock; anuria; hypersensitivity to this product or to sulfonamide-derived
drugs.
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