brimonidine and timolol ophthalmic

Generic Name: brimonidine and timolol ophthalmic (bri MOE ni deen and TIM oh lol)Brand Names: Combigan

What is brimonidine and timolol ophthalmic?

Brimonidine reduces the amount of fluid in the eye, which decreases pressure inside the eye.

Timolol also reduces pressure inside the eye.

The combination of brimonidine and timolol ophthalmic (for the eyes) is used to treat glaucoma or ocular hypertension (high pressure inside the eye).

Brimonidine and timolol ophthalmic may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about brimonidine and timolol ophthalmic?Do not use brimonidine and timolol ophthalmic if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days.

You should not use this medication if you are allergic to brimonidine (Alphagan) or timolol (Timoptic, Cosopt), or if you have certain conditions. Be sure your doctor knows if you have asthma, or severe chronic obstructive pulmonary disease (COPD), heart disease or heart failure, slow heartbeats, or a heart condition called "AV block."

Before using this medication, tell your doctor if you have diabetes, overactive thyroid, circulation problems, allergies, low blood pressure, myasthenia gravis, or a history of depression

Do not use this medication while you are wearing contact lenses. This medication may contain a preservative that can be absorbed by soft contact lenses. Wait at least 15 minutes after using brimonidine and timolol ophthalmic before putting your contact lenses in.

Do not allow the dropper tip to touch any surface, including the eyes or hands. If the dropper becomes contaminated it could cause an infection in your eye, which can lead to vision loss or serious damage to the eye.

What should I discuss with my healthcare provider before using brimonidine and timolol ophthalmic?Do not use brimonidine and timolol ophthalmic if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days.

You should not use this medication if you are allergic to brimonidine (Alphagan) or timolol (Timoptic, Cosopt), or if you have certain conditions. Be sure your doctor knows if you have:

• asthma, or severe chronic obstructive pulmonary disease (COPD);

• heart disease or heart failure;

• slow heartbeats; or

• a heart condition called "AV block."

If you have any other conditions, you may need a dose adjustment or special tests to safely use brimonidine and timolol ophthalmic:

• depression;

• diabetes;

• overactive thyroid;

• circulation problems, such as Raynaud's syndrome or Buerger's disease;

• a history of fainting or low blood pressure;

• allergies; or

• a muscle disorder such as myasthenia gravis.

FDA pregnancy category C. It is not known whether brimonidine and timolol ophthalmic is harmful to an unborn baby. Before using this medication, tell your doctor if you are pregnant or plan to become pregnant during treatment. Brimonidine and timolol can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I use brimonidine and timolol ophthalmic?

Use this medication exactly as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Wash your hands before using the eye drops. Do not use this medication while you are wearing contact lenses. Brimonidine and timolol ophthalmic may contain a preservative that can be absorbed by soft contact lenses. Wait at least 15 minutes after using the eye drops before putting your contact lenses in.

To apply the eye drops:

• Tilt your head back slightly and pull down your lower eyelid. Hold the dropper above the eye with the dropper tip down. Look up and away from the dropper as you squeeze out a drop, then close your eye.

• Gently press your finger to the inside corner of the eye (near your nose) for about 1 minute to keep the liquid from draining into your tear duct.

• If you use any other eye medications, wait about 5 minutes after using brimonidine eye drops before using the other medication.

• Do not allow the dropper tip to touch any surface, including the eyes or hands. If the dropper becomes contaminated it could cause an infection in your eye, which can lead to vision loss or serious damage to the eye.

Do not use the eye drops if the liquid has changed colors or has particles in it. Call your doctor for a new prescription.

Tell your doctor right away if you have any eye injury or infection. If you have any type of surgery, including eye surgery, tell the surgeon ahead of time that you are using brimonidine and timolol ophthalmic. You may need to stop using the medicine for a short time.

Store the drops at room temperature away from heat and moisture. Keep the bottle tightly closed when not in use.

What happens if I miss a dose?

Use the medication as soon as you remember. If it is almost time for the next dose, skip the missed dose and wait until your next regularly scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine, or if anyone has accidentally swallowed it.

Overdose symptoms may include dizziness, headache, slow heart rate, and feeling short of breath or like you might pass out.

What should I avoid while using brimonidine and timolol ophthalmic?

This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid using any eye medications your doctor has not prescribed. Cold or allergy medicine, narcotic pain medicine, sleeping pills, sedatives, and medicine for seizures can add to sleepiness caused by brimonidine and timolol ophthalmic. Tell your doctor if you regularly use any of these medicines.

Brimonidine and timolol ophthalmic side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

• severe swelling, itching, burning, redness, pain, or discomfort in or around your eye;

• bronchospasm (wheezing, chest tightness, trouble breathing);

• pounding heartbeats or fluttering in your chest;

• slow heart rate, weak pulse, fainting, slow breathing (breathing may stop);

• feeling like you might pass out;

• numbness, tingling, or cold feeling in your hands or feet;

• muscle weakness; or

• confusion, hallucinations, unusual thoughts or behavior.

Less serious side effects may include:

• mild burning, stinging, or itching of your eyes;

• dry eyes, blurred vision;

• mildly swollen or puffy eyes;

• feeling like something is in your eye;

• weakness, tired feeling;

• cough, sore throat;

• nausea, upset stomach;

• headache;

• drowsiness;

• unusual or unpleasant taste in your mouth;

• sensitivity to light;

• dry nose;

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Brimonidine and timolol ophthalmic Dosing Information

Usual Adult Dose for Glaucoma:

One drop instilled in the affected eye(s) twice daily (every 12 hours).

Usual Adult Dose for Intraocular Hypertension:

One drop instilled in the affected eye(s) twice daily (every 12 hours).

Usual Pediatric Dose for Glaucoma:

2 years or older:One drop instilled in the affected eye(s) twice daily (every 12 hours).

Usual Pediatric Dose for Intraocular Hypertension:

2 years or older:One drop instilled in the affected eye(s) twice daily (every 12 hours).

What other drugs will affect brimonidine and timolol ophthalmic?

Before using brimonidine and timolol ophthalmic, tell your doctor if you are using any of the following medications:

• an antidepressant;

• blood pressure medications;

• cimetidine (Tagamet);

• digoxin (digitalis, Lanoxin);

• HIV /AIDS medicine such as ritonavir (Norvir);

• an antihistamine such as diphenhydramine (Benadryl);

• an antifungal antibiotic such as terbinafine (Lamisil);

• anti-malaria medication such as hydroxychloroquine (Plaquenil);

• medicine to treat psychiatric disorders, such as thioridazine (Mellaril);

• a heart rhythm medication such as propafenone (Rythmol) or quinidine (Quinidex, Quin-Release Quin-G);

• a calcium channel blocker such as amlodipine (Norvasc), diltiazem (Tiazac, Cartia, Cardizem), nifedipine (Procardia, Adalat), verapamil (Calan, Covera, Isoptin, Verelan), and others; or

• a beta-blocker such as atenolol (Tenormin), bisoprolol (Zebeta, Ziac), metoprolol (Lopressor, Toprol), propranolol (Inderal, InnoPran), timolol (Betimol, Blocadren, Cosopt, Timoptic, Istalol), and others.

This list is not complete and there may be other drugs that can interact with brimonidine and timolol ophthalmic. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about brimonidine and timolol ophthalmic.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 1.03. Revision Date: 11/17/2009 12:59:17 PM.