Treatment Regimens

OBBs are used once or twice daily. There exists a difference between the approved labeling and current clinical practice where once-daily use is often recommended. For the branded OBBs, all but Istalol (timolol), Timoptic-XE (timolol in gel-forming solution), and Betagan (levobunolol) are recommended initially as twice daily. Istalol and Timoptic-XE are recommended once daily. Betagan is recommended once or twice daily. For timolol maleate solution, the labeling indicates that if the IOP is controlled at a satisfactory level, dosing can be changed to once daily.

Although the large controlled clinical trial examining once-daily dosing for nonselective OBBs studied only levobunolol and timolol, it has become common to initiate therapy with nonselective beta blockers once daily rather than twice daily. If IOP control is not satisfactory, dosing frequency can be increased to twice daily. This offers the opportunity to titrate the dose while minimizing the potential for adverse effects.13

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