Avost Plus Ophthalmic Solution

Introduction

Avost Plus Ophthalmic Solution 0.004%+0.5% is an ophthalmic combination used to treat elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. Travoprost is a prostaglandin analog that lowers IOP by increasing the outflow of aqueous humor from the eye. Timolol Maleate is a non-selective beta-blocker that reduces IOP by decreasing aqueous humor production. Together, these two medications work synergistically to effectively lower IOP and help prevent optic nerve damage and vision loss.

Uses

This combination is used for:

Treatment of elevated intraocular pressure in patients with open-angle glaucoma
Treatment of ocular hypertension
Prevention of further optic nerve damage in glaucoma patients

Brand Name	Avost Plus
Type	Ophthalmic Solution
Weight	0.004%+0.5%
Generic	Travoprost + Timolol Maleate
Manufacturer	Ibn Sina Pharmaceuticals Ltd.
Available in	English বাংলা

Mechanism of Action

Travoprost, a prostaglandin F2-alpha analog, increases uveoscleral outflow of aqueous humor, reducing IOP. Timolol Maleate is a non-selective beta-adrenergic receptor blocker that reduces aqueous humor production in the ciliary body, further lowering IOP. Together, these mechanisms decrease intraocular pressure by both reducing fluid production and increasing its drainage from the eye.

How Long Does It Take to Work?

Travoprost starts to reduce intraocular pressure within 2-4 hours after administration, with maximum effect occurring around 12 hours. Timolol also begins to reduce IOP within 20 minutes of administration, with a peak effect reached in 1-2 hours. The combination of Travoprost and Timolol provides sustained IOP reduction over 24 hours.

Absorption

Travoprost is absorbed through the cornea and hydrolyzed to its active form, travoprost free acid, in the eye. Timolol Maleate is absorbed through the cornea and enters systemic circulation in small amounts. Both medications exhibit high ocular bioavailability and exert their effects locally in the eye.

Route of Elimination

Travoprost and its metabolites are primarily eliminated through the kidneys and bile after local metabolism in the eye. Timolol is metabolized in the liver and excreted through the kidneys, with a small fraction eliminated unchanged in the urine.

Dosage

Instill one drop in the conjunctival sac of the affected eye(s) once daily at about the same time each day, preferably in the evening.

The typical dosage of Avost Plus Ophthalmic Solution 0.004%+0.5% is:

One drop in the affected eye(s) once daily in the evening

It is important not to exceed one drop daily, as more frequent administration may reduce the efficacy of IOP reduction.

Administration

Avost Plus Ophthalmic Solution 0.004%+0.5% is administered topically as an eye drop. The patient should tilt their head back, pull down the lower eyelid to create a small pocket, and instill one drop into the affected eye(s). To avoid contamination, the dropper tip should not touch the eye or surrounding areas. After administration, the patient should close their eye and apply pressure to the inner corner of the eye (near the nose) for about one minute to reduce systemic absorption of the medication.

Side Effects

Common side effects include:

Ocular hyperemia (eye redness)
Burning or stinging sensation in the eye
Blurred vision
Eyelash growth or darkening
Changes in iris color (with prolonged use of Travoprost)

Serious side effects may include bradycardia, hypotension, or bronchospasm due to the systemic absorption of Timolol.

Toxicity

Overdose of Avost Plus Ophthalmic Solution 0.004%+0.5% may result in excessive reduction of intraocular pressure, ocular discomfort, and systemic side effects such as bradycardia, hypotension, and bronchospasm. If an overdose is suspected, appropriate measures should be taken, including rinsing the eye with water and seeking medical attention.

Precautions

Precautions should be taken for patients with:

Respiratory disorders such as asthma or chronic obstructive pulmonary disease (COPD) due to Timolol’s potential to cause bronchospasm
Cardiovascular disorders such as bradycardia, heart block, or heart failure
Patients with pigmentary changes in the iris, as Travoprost may cause further darkening

Interaction

Avost Plus Ophthalmic Solution 0.004%+0.5% may interact with:

Beta-blockers (systemic): Can potentiate the systemic effects of Timolol, leading to bradycardia or hypotension
Calcium channel blockers: May increase the risk of cardiovascular side effects
Prostaglandin analogs: Additional use may reduce the effectiveness of Travoprost

Disease Interaction

Patients with the following conditions should use this combination with caution:

Asthma or COPD (risk of bronchospasm)
Bradycardia or heart block
Hypotension
Diabetes mellitus (beta-blockers can mask hypoglycemia symptoms)

Drug Interaction

Drug interactions include:

Systemic beta-blockers: Can exacerbate systemic effects such as bradycardia or hypotension
Calcium channel blockers: May increase the risk of cardiovascular effects
Other ocular hypotensive agents: Caution is advised when using multiple drugs for IOP reduction

Food Interactions

No significant food interactions are known with Avost Plus Ophthalmic Solution 0.004%+0.5%. Patients can use these eye drops without regard to food intake.

Pregnancy Use

Avost Plus Ophthalmic Solution 0.004%+0.5% should be used during pregnancy only if the potential benefit justifies the risk to the fetus. Timolol crosses the placenta and may cause fetal harm, including bradycardia, respiratory distress, and hypoglycemia. Therefore, this combination is not typically recommended during pregnancy unless absolutely necessary.

Lactation Use

Timolol is excreted in breast milk and may cause adverse effects in nursing infants. Therefore, breastfeeding women should either avoid using Avost Plus Ophthalmic Solution 0.004%+0.5% or discontinue breastfeeding while on this medication.

Acute Overdose

Acute overdose may lead to significant ocular and systemic effects, including excessive reduction in intraocular pressure, bradycardia, hypotension, bronchospasm, and respiratory distress. If overdose occurs, the patient should flush the eye(s) with water, and supportive medical treatment should be sought, including the use of atropine for bradycardia or bronchodilators for bronchospasm.

Contraindication

Contraindications for this combination include:

Patients with a history of asthma or severe COPD
Patients with bradycardia, heart block, or heart failure
Hypersensitivity to Travoprost, Timolol, or any other component of the formulation

Use Direction

The recommended use direction for Avost Plus Ophthalmic Solution 0.004%+0.5% is to instill one drop in the affected eye(s) once daily, preferably in the evening. The dropper should be handled carefully to avoid contamination, and the patient should close their eyes and apply gentle pressure to the tear duct after instillation to minimize systemic absorption.

Storage Conditions

Store Avost Plus Ophthalmic Solution 0.004%+0.5% eye drops at room temperature, between 15°C and 25°C (59°F to 77°F), and protect from light. Do not freeze the medication. Keep the bottle tightly closed when not in use and discard any unused solution after 4 weeks from opening.

Volume of Distribution

The volume of distribution for Timolol is about 1.6 L/kg, and it is widely distributed throughout the body. Travoprost, however, has a limited systemic distribution as it is primarily active within the eye and undergoes local metabolism.

Half-Life

The half-life of Timolol in plasma is approximately 4-6 hours. Travoprost has a short half-life of less than an hour in the aqueous humor, as it is rapidly metabolized to its active form and then further broken down.

Clearance

Travoprost is rapidly cleared from the aqueous humor, primarily through local ocular tissues and excreted in the urine. Timolol is cleared through hepatic metabolism and renal excretion, with about 80% of the drug eliminated via the kidneys, either unchanged or as metabolites.

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