If you use ocular beta blockers such as timolol for glaucoma, consider using coenzyme Q10 supplements (ideally in the ubiquinol form). Even with careful use (including punctal occlusion), some glaucoma patients experience serious cardiovascular side effects from timolol. However, several studies have found that coenzyme Q10 can improve cardiovascular health. And one study specifically found that coenzyme Q10 reduced those cardiovascular side effects caused by timolol eye drops. Therefore, I would not consider using timolol eye drops without also using coenzyme Q10. Below are excerpts from two published articles about the importance of coenzyme Q10 for glaucoma patients.
Effect of coenzyme Q10 on hemodynamic response to ocular timolol.
Takahashi, N, T Iwasaka, T Sugiura, H Onoyama, S Kurihara, M Inada, et al. “Effect of coenzyme Q10 on hemodynamic response to ocular timolol.” Journal of cardiovascular pharmacology 14, no. 3 (September 1989): 462-8.
Coenzyme Q10 (CoQ10) is an essential component of the mitochondrial membrane and plays an important role in the maintenance of normal cardiac function.
To evaluate the effects of ocular timolol on the cardiovascular system and determine the protective effect of CoQ10, 16 patients with glaucoma were studied using impedance cardiography. Following instillation of 1 mg timolol maleate in each eye, heart rate (HR) and stroke index (SI) decreased, and total peripheral resistance index (TPRI) increased significantly. Reexamination was performed after 6 weeks of 90 mg oral CoQ10. Despite decreases in HR, percent changes in HR were significantly less after CoQ10 at 120 min. Stroke index showed an initial increase which was not observed without CoQ10. These data suggest that CoQ10 delayed the appearance of inotropic blockade of timolol and hastened the disappearance of chronotropic blockade. Additional study of six normal volunteers with 6 weeks of oral CoQ10 showed a similar decrease of intraocular pressure after timolol instillation as compared to those without CoQ10.
Thus, administration of oral CoQ10 in patients receiving ocular timolol may be useful in mitigating cardiovascular side effects without affecting intraocular pressure in the treatment of glaucoma.
The following excerpt is from Complementary Therapy for the Treatment of Glaucoma: A Perspective by Robert Ritch, MD.
Tissues which are highly dependent on oxygen such as muscle, the central and peripheral nervous system, kidney, and insulin-producing pancreatic beta-cell are especially susceptible to defective oxidative phosphorylation, which plays an important role in atherogenesis, in the pathogenesis of Alzheimer's disease, Parkinson's disease, diabetes, and aging. Pretreatment of cultured neuronal cells and astrocytes with coenzyme Q10 inhibited cell death due to glutamate neurotoxicity. It also exhibits anti-apoptotic effects, apparently by stabilizing mitochondrial depolarization. Oral Q10 supplementation is effective in treating cardiomyopathies and in restoring plasma levels reduced by the statin type of cholesterol-lowering drugs. Supplementation with Coenzyme Q10 has been reported to slow the development of Parkinson’s disease. Patients with open-angle glaucoma have an increased prevalence of Parkinson’s disease.