Avost Plus

• Primary Open-Angle Glaucoma: For patients whose intraocular pressure (IOP) is not adequately controlled with monotherapy.
• Ocular Hypertension: Reduction of elevated IOP to prevent optic nerve damage and progression to glaucoma.
• Other: Patients requiring combination therapy for better IOP control in various stages of glaucoma.

• Route: Topical ophthalmic solution (eye drops).
• Recommended Dose: One drop in the affected eye(s) once daily in the evening.
• Administration Instructions:
• Do not exceed once daily dosing to avoid reduced efficacy.
• Remove contact lenses before administration; wait 15 minutes before reinsertion.
• Avoid touching the dropper tip to the eye or other surfaces to prevent contamination.
• Special Populations:
• No dose adjustment required for elderly or mild/moderate renal/hepatic impairment.
• Safety and efficacy in pediatric patients have not been established.

Travoprost, a prostaglandin F2α analog, selectively binds to prostanoid FP receptors in ocular tissues, increasing uveoscleral outflow of aqueous humor, thereby lowering intraocular pressure. Timolol maleate, a non-selective beta-adrenergic receptor blocker, reduces aqueous humor production by blocking beta receptors in the ciliary epithelium. The combination results in additive IOP reduction through complementary mechanisms—enhanced outflow and reduced production.

• Absorption:
• Travoprost: Rapid corneal penetration; converted to active free acid in ocular tissues.
• Timolol: Absorbed through cornea; systemic absorption possible via nasolacrimal drainage.
• Distribution: Primarily localized in ocular tissues; limited systemic exposure.
• Metabolism:
• Travoprost: Hydrolyzed to active acid; metabolized in systemic circulation by β-oxidation.
• Timolol: Extensively metabolized in the liver by CYP2D6.
• Half-life:
• Travoprost active metabolite ~45 minutes plasma half-life.
• Timolol plasma half-life ~4–5 hours.
• Elimination:
• Travoprost metabolites excreted primarily in urine.
• Timolol metabolites excreted via urine and feces.

• Pregnancy: Category C — Animal studies show potential risks; use only if benefits justify potential risks.
• Lactation: Both drugs may be excreted in breast milk; caution advised and breastfeeding not recommended during treatment.

• Combination ophthalmic agent
• Prostaglandin analog (Travoprost) + non-selective beta-blocker (Timolol maleate)
• Antiglaucoma agent

• Known hypersensitivity to travoprost, timolol, or any formulation components
• Bronchial asthma or severe chronic obstructive pulmonary disease (COPD)
• Sinus bradycardia, second- or third-degree atrioventricular block, sick sinus syndrome (unless pacemaker present)
• Cardiogenic shock, overt cardiac failure, or severe cardiac failure

• Use with caution in patients with respiratory diseases (e.g., asthma, COPD) due to beta-blocker component.
• Monitor heart rate and blood pressure in patients with cardiac conditions.
• Potential for masking symptoms of hypoglycemia in diabetics.
• Risk of ocular adverse effects: iris pigmentation changes, eyelash changes, ocular inflammation.
• Avoid sudden discontinuation to prevent exacerbation of angina or hypertension.

• Common: Eye redness, burning or stinging sensation, blurred vision, eyelash changes, dry eyes.
• Systemic: Bradycardia, hypotension, fatigue, dizziness, headache.
• Rare: Bronchospasm, heart block, worsening heart failure, allergic reactions.

• Additive effects with other beta-blockers or calcium channel blockers may cause bradycardia or hypotension.
• CYP2D6 inhibitors (e.g., quinidine) may increase systemic timolol levels.
• Use caution with antiarrhythmics, digitalis glycosides, and insulin or oral hypoglycemic agents due to beta-blocker effects.
• Alcohol may enhance hypotensive effects.

• Combination therapy recommended in glaucoma management guidelines for patients inadequately controlled on monotherapy.
• New preservative-free formulations introduced to reduce ocular irritation.
• Emphasis on cardiovascular monitoring due to beta-blocker systemic absorption.

• Store at 2°C to 25°C (36°F to 77°F).
• Protect from light.
• Keep bottle tightly closed when not in use.
• Discard opened bottle after 4 weeks to prevent contamination.