Timolol/Brimonidine

DEA Class;  Rx

Common Brand Names; Combigan

• Allergic conjunctivitis
• Conjunctival folliculosis
• Conjunctival hyperemia
• Eye pruritus
• Ocular burning
• Stinging
• Asthenia
• Blepharitis
• Corneal erosion
• Depression
• Epiphora
• Eye discharge
• Eye dryness
• Eye irritation
• Eye pain
• Eyelid edema
• Eyelid erythema
• Eyelid pruritus
• Foreign body sensation
• Headache
• Hypertension
• Oral dryness
• Somnolence
• Superficial punctate keratitis
• Visual disturbance

Not to be used alone for acute angle-closure glaucoma

Remove soft contact lenses; may reinsert 15 min post-instillation

May potentiate syndromes associated with vascular insufficiency; this drug combination should be used with caution in patients with depression, cerebral or coronary insufficiency, Raynaud’s phenomenon, orthostatic hypotension, or thromboangiitis obliterans

While taking beta-blockers, patients with history of atopy or history of severe anaphylactic reactions to a variety of allergens may be more reactive to repeated accidental, diagnostic, or therapeutic challenge with such allergens; such patients may be unresponsive to usual doses of epinephrine used to treat anaphylactic reactions

Beta-adrenergic blockade has been reported to potentiate muscle weakness consistent with certain myasthenic symptoms (eg, diplopia, ptosis, and generalized weakness); timolol has been reported rarely to increase muscle weakness in some patients with myasthenia gravis or myasthenic symptoms

Beta-adrenergic blocking agents should be administered with caution in patients subject to spontaneous hypoglycemia or to diabetic patients (especially those with labile diabetes) who are receiving insulin or oral hypoglycemic agents; beta-adrenergic receptor blocking agents may mask signs and symptoms of acute hypoglycemia

There are no adequate and well-controlled studies in pregnant women; however, in animal studies, brimonidine crossed the placenta and entered into the fetal circulation to a limited extent; because animal reproduction studies are not always predictive of human response, this drug combination should be used during pregnancy only if potential benefit to mother justifies potential risk to fetus

Timolol has been detected in human milk following oral and ophthalmic drug administration; it is not known whether brimonidine tartrate is excreted in human milk, although in animal studies, brimonidine tartrate has been shown to be excreted in breast milk; because of potential for serious adverse reactions from this drug combination in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother