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Timoptic and Twinject Auto-Injector

Determining the interaction of Timoptic and Twinject Auto-Injector and the possibility of their joint administration.

Check result:

Timoptic <> Twinject Auto-Injector

Relevance: 22.11.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Beta-blockers like timolol ophthalmic may reduce the effects of epinephrine. If you have been using timolol ophthalmic, you may not respond as well to epinephrine when it is given to treat an emergency such as shock or a severe allergic reaction. In addition, the combination may cause severe high blood pressure and reduced heart rate. Your healthcare provider should always be told if you are receiving, or have recently received, beta-blocker therapy. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR CLOSELY: Noncardioselective beta-blockers can significantly enhance the pressor response to epinephrine. The mechanism involves blockade of beta-2 adrenergic receptors in the peripheral vasculature, resulting in unopposed alpha-adrenergic effect of epinephrine that is responsible for vasoconstriction. Severe hypertension accompanied by bradycardia has been reported in patients who were treated with a noncardioselective beta-blocker like propranolol or nadolol prior to receiving epinephrine. In rare cases, cardiac arrest and stroke have occurred. This interaction has not been reported with cardioselective beta-blockers, which generally have little effect on beta-2 adrenergic receptors at therapeutic dosages. In studies of hypertensive patients, treatment with propranolol was associated with significant increases in blood pressure and peripheral vascular resistance and decreases in heart rate and forearm blood flow in response to epinephrine administration, while metoprolol had only minor effects on epinephrine-induced cardiovascular changes compared to placebo. Similarly, in 24 healthy subjects treated with nadolol, atenolol, or placebo for one week prior to epinephrine administration, mean arterial pressure and calf vascular resistance increased significantly in the nadolol group but not in the atenolol group, and marked bradycardia also occurred in the former but not latter group. Theoretically, the interaction may also occur with noncardioselective beta-blocker ophthalmic preparations, since they may be systemically absorbed and can produce clinically significant systemic effects even at low or undetectable plasma levels.

MONITOR CLOSELY: Beta-blockers may attenuate the response to epinephrine in the treatment of anaphylactic reactions. Noncardioselective beta-blockers, in particular, can antagonize the bronchodilating effects of epinephrine by blocking beta-2 adrenergic receptors in smooth muscles of the bronchial tree. All beta-blockers can antagonize the cardiostimulatory effects of epinephrine by blocking beta-1 adrenergic receptors in the heart. Some investigators have suggested that the use of beta-blockers in itself is associated with an increased incidence and severity of anaphylaxis due to modulation of adenylate cyclase, which can influence release of anaphylactogenic mediators. However, data are limited and conflicting.

MANAGEMENT: Extreme caution and close monitoring of cardiovascular status are indicated when epinephrine is administered to patients treated with noncardioselective beta-blockers. A dosage reduction of epinephrine may be necessary. Withdrawal of beta-blockers before anesthesia may increase the risk of myocardial ischemia and is not recommended. The interaction is not expected to occur with local anesthetics used in dental surgery that contain very low concentrations of epinephrine.

References

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Richards DA, Prichard BN, Hernandez R "Circulatory effects of noradrenaline and adrenaline before and after labetalol." Br J Clin Pharmacol 7 (1979): 371-8
O'Grady J, Oh V, Turner P "Effects of propranolol and oxprenolol on the vasoconstrictor response to noradrenaline in the superficial hand vein in man." Eur J Clin Pharmacol 14 (1978): 83-5
Gandy W "Severe epinephrine-propanolol interaction." Ann Emerg Med 18 (1989): 98-9
Larsen LS, Larsen A "Labetalol in the treatment of epinephrine overdose." Ann Emerg Med 19 (1990): 680-2
Houben H, Thien TH, De Boo TH, et al "Influence of selective and non-selective beta-adrenoceptor blockade on the haemodynamic effect of adrenaline during combined antihypertensive drug therapy." Clin Sci 57 (1979): s397-9
van Herwaarden CL, Fennis JF, Binkhorst RA, van 't Laar A "Haemodynamic effects of adrenaline during treatment of hypertensive patients with propranolol and metoprolol." Eur J Clin Pharmacol 12 (1977): 397-402
Whelan TV "Propranolol, epinephrine, and accelerated hypertension during hemodialysis." Ann Intern Med 106 (1987): 327
Centeno RF, Yu YL "The propanolol-epinephrine interaction revisited: a serious and potentially catastrophic adverse drug interaction in facial plastic surgery." Plast Reconstr Surg 111 (2003): 944-5
Ponten J, Biber B, Bjuro T, Henriksson BA, Hjalmarson A, Lundberg D "Beta-receptor blockade and spinal anaesthesia. Withdrawal versus continuation of long-term therapy." Acta Anaesthesiol Scand Suppl 76 (1982): 62-9
Goldberg I, Ashburn FS Jr, Palmberg PF, Kass MA, Becker B "Timolol and epinephrine: a clinical study of ocular interactions." Arch Ophthalmol 98 (1980): 484-6
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Alexander GD "Dangers of propranolol withdrawal prior to local anesthesia with epinephrine." Arch Otolaryngol 111 (1985): 280
van Herwaarden CL, Binkhorst RA, Fennis JF, van 't Laar A "Effects of adrenaline during treatment with propranolol and metoprolol." Br Med J 2 (1977): 1029
Fisher DA "Interaction of epinephrine and B-blockers." JAMA 274 (1995): 1830
Catalano PM "Possible interaction of epinephrine with propranolol." J Am Acad Dermatol 10 (1984): 839
Chu D, Cocco G, Schweda E, Haeusler G, Strozzi C "Influence of propranolol and pindolol on the haemodynamic effects of papaverine, isoprenaline and noradrenaline in hypertensive patients." Eur J Clin Pharmacol 18 (1980): 141-6
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Dzubow LM "The interaction between propranolol and epinephrine as observed in patients undergoing Mohs' surgery." J Am Acad Dermatol 15 (1986): 71-5
Saff R, Nahhas A, Fink JN "Myocardial infarction induced by coronary vasospasm after self- administration of epinephrine." Ann Allergy 70 (1993): 396-8
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Foster CA, Aston SJ "Propranolol-epinephrine interaction: a potential disaster." Plast Reconstr Surg 72 (1983): 74-8
Cryer PE, Rizza RA, Haymond MW, Gerich JE "Epinephrine and norepinephrine are cleared through beta-adrenergic, but not alpha-adrenergic, mechanisms in man." Metabolism 29 (1980): 1114-8

Timoptic

Generic Name: timolol ophthalmic

Brand name: Betimol, Istalol, Timoptic Ocudose, Timoptic Ocumeter, Timoptic Ocumeter Plus, Timoptic-XE, Timoptic

Synonyms: Timoptic Ocumeter

What is Timoptic?

Twinject Auto-Injector

Generic Name: epinephrine

Brand name: EpiPen, Symjepi, Twinject, Adrenalin, Auvi-Q, Epinephrinesnap-EMS, EpiPen 2-Pak, EpiPen JR 2-Pak, EPIsnap, Auvi-Q Auto-injector, Primatene Mist Inhaler, Adrenaclick, Primatene Mist

Synonyms: Twinject

What is Twinject Auto-Injector?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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