Timolol Gel for Epistaxis in Hereditary Hemorrhagic Telangiectasia

Exclusion Criteria

• •1. Contraindications for systemic β adrenergic blocker administration
• •1. Hypersensitivity to β adrenergic blockers
• •2. Asthma or bronchospasm
• •3. Congestive heart failure with LVEF \<40%
• •4. Hereditary pulmonary arterial hypertension
• •5. Baseline bradycardia (HR \<55 beats per minute)
• •6. Sick Sinus Syndrome
• •7. 2nd or 3rd degree heart block, left or right bundle branch block, or bifasicular block
• •8. Uncontrolled diabetes mellitus (most recent HbA1c \>9%) or diabetic ketoacidosis within last 6 months
• •9. Hypotension (systolic blood pressure \< 90)
• •2. Known hypersensitivity to timolol
• •3. Severe peripheral circulatory disturbances (Raynaud phenomenon)
• •4. Known intermediate or poor metabolizer variant of the liver enzyme CYP2D6
• •5. Current use of any of the following known strong CYP2D6 inhibitors: fluoxetine (Prozac), paroxetine (Paxil), bupropion (Welbutrin), quinidine, quinine, ritonavir (Norvir), and terbinafine (Lamisil)
• •6. Current use of the following other drugs known to pharmacodynamically interact with timolol: diltiazem, verapamil, digoxin, digitalis, propafenone, disopyramide, clonidine, flecainide, or lidocaine
• •7. Patients currently treated or who plan to initiate treatment with β-blockers
• •8. Use of any anti-angiogenic medication in the last month prior to recruitment, including bevacizumab, pazopanib, thalidomide, or lenalidomide
• •9. Illicit drug use, except marijuana
• •10. Known pheochromocytoma
• •11. Use of anticoagulants, antiplatelet, or fibrinolytic therapies within the last month prior to recruitment, except for low-dose (81 mg or less) of aspirin
• •12. Pregnancy or planned pregnancy in the next 6 months or currently breastfeeding
• •13. Inability to read or understand English
• •14. Inability to complete 8 weeks of therapy for any reason