Brimonidine Timolol

Brimonidine Timolol Brand Name– Combigan

What is Brimonidine Timolol

Brimonidine and timolol are combined in an ophthalmic solution for the reduction of intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension who require adjunctive or replacement therapy due to inadequate control of IOP.

Brimonidine is a selective alpha-agonist and timolol is a beta-blocker. The hypotensive effect of brimonidine is additive to timolol.

However, the IOP reduction observed with twice daily brimonidine; timolol (Combigan) is slightly less than that seen with separately administered timolol (0.5% twice daily) with brimonidine (0.2% three times/day).

Combigan ophthalmic solution (0.2% brimonidine; 0.5% timolol) was approved by the FDA in October 2007.

Indications

• glaucoma
• ocular hypertension

Side Effects

1. agranulocytosis
2. alopecia
3. anaphylactoid reactions
4. angina
5. angioedema
6. anorexia
7. anxiety
8. apnea
9. arthralgia
10. asthenia
11. blepharitis
12. blurred vision
13. bradycardia
14. bronchospasm
15. cardiac arrest
16. cataracts
17. chest pain (unspecified)
18. colitis
19. coma
20. confusion
21. conjunctival hyperemia
22. conjunctivitis
23. corneal erosion
24. cough
25. depression
26. diaphoresis
27. diarrhea
28. diplopia
29. dizziness
30. drowsiness
31. dysgeusia
32. dyspepsia
33. dyspnea
34. edema
35. emotional lability
36. epiphora
37. erythema
38. fatigue
39. fever
40. foreign body sensation
41. hallucinations
42. headache
43. heart failure
44. hepatomegaly
45. hypercholesterolemia
46. hyperglycemia
47. hypertension
48. hypoglycemia
49. hypotension
50. hypothermia
51. hypotonia
52. impotence (erectile dysfunction)
53. infection
54. influenza
55. insomnia
56. iritis
57. keratitis
58. keratoconjunctivitis
59. keratopathy
60. laryngospasm
61. lethargy
62. libido decrease
63. lupus-like symptoms
64. macular edema
65. memory impairment
66. miosis
67. musculoskeletal pain
68. nasal congestion
69. nasal dryness
70. nausea
71. nightmares
72. ocular discharge
73. ocular hemorrhage
74. ocular irritation
75. ocular pain
76. ocular pruritus
77. pallor
78. palpitations
79. paresthesias
80. peripheral vasodilation
81. pharyngitis
82. photophobia
83. pruritus
84. psoriaform rash
85. psoriasis
86. ptosis
87. pulmonary edema
88. purpura
89. rash
90. respiratory depression
91. retroperitoneal fibrosis
92. rhinitis
93. sinus tachycardia
94. sinusitis
95. skin hyperpigmentation
96. skin irritation
97. stroke
98. syncope
99. thrombotic thrombocytopenic purpura (TTP)
100. tinnitus
101. urticaria
102. vertigo
103. visual impairment
104. vomiting
105. weakness
106. weight loss
107. xerophthalmia
108. xerostomia

Monitoring Parameters

• intraocular pressure
• ophthalmologic exam

Contraindications

• acute bronchospasm
• asthma
• AV block
• bradycardia
• breast-feeding
• bronchitis
• cardiac disease
• cardiogenic shock
• cerebrovascular disease
• children
• chronic obstructive pulmonary disease (COPD)
• contact lenses
• corneal abrasion
• coronary artery disease
• depression
• diabetes mellitus
• emphysema
• geriatric
• heart failure
• hepatic disease
• hyperthyroidism
• hypoglycemia
• hypotension
• infants
• MAOI therapy
• myasthenia gravis
• neonates
• ocular infection
• orthostatic hypotension
• peripheral vascular disease
• pregnancy
• pulmonary disease
• Raynaud’s phenomenon
• renal impairment
• sick sinus syndrome
• surgery
• thromboangiitis obliterans (Buerger’s disease)
• thyrotoxicosis
• vasospastic angina
• ventricular dysfunction

Interactions

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