vol2 - Page 267

 _'_; 18. There were 212 subjects classified and described
 with serious adverse effects due to Timoptic. Of the 212
 patients for whom this _nformatlon was known, 194 (92%) had
 preexisting respiratory or cardiovascular disease. Seventy _
 three patients (23%) experienced their adverse events within 24
 hours after first using topical timolol. Fifteen percent of
 the patients whose events occurred within 24 hours of first use
 died. Nine percent of the patients whose events occurred
 between days 2 and 7 of therapy died° The thirty-tWo reports
 of death were reviewed separately. Thirteen of these reports
 ....... were classified as cardiovascular deaths, twelve as respira-
 tory_ and one as a presumed drug interaction. Cause of death
 was unknown in six cases_ Therefore ophtlhalmic timolol is
 ...... , _ _ presently contraindicated for patients with brochial asthma, a
 history of bronchial asthmas severe chronic obstructive
 pulmonary disease, sinus bradycardia, second or third degree
 ....... atrioventricular block, overt cardiac faiiure_ or cardiogenic
 shock° The 1986 product labelling contains the followins
 warning in boldface type: "The same adverse reactions found
 with systemic administration of bete-adrenergic blocking agents
 may occur with topical administration."
 19_ Despite their threatening adverse effects, these
 drugs are al! deemed "safe" for use in glaucoma therapy.
 Medically speaking, the adverse consequences of using these
 drugs is generally outweighed by the reason for their use --
 the prevention of progressive sight loss_ The adverse effects,
 while acknowledged_ ate an accepted risk. Simply stated, these