How does this medication work? What will it do for me?

This medication is an ophthalmic solution (eye drops) that combines two medications: brimonidine and timolol. Brimonidine belongs to the class of medications called alpha-2 adrenergic receptor agonists. Timolol belongs to the class of medications called beta-adrenergic receptor blockers (also known as "beta-blockers").

Brimonidine - timolol eye drops reduce the volume of liquid produced in the eye and increase the drainage of fluid from the eye. This medication is intended for use by people with chronic open-angle glaucoma or by people with ocular hypertension (high pressure in the eye) who are not responsive to treatment with only one medication and are considered appropriate candidates for combination therapy. This medication may also be used by people who have intra-ocular pressure that fluctuates over long periods of time.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are using this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if it has not been prescribed by their doctor.

What form(s) does this medication come in?

Each mL of ophthalmic solution contains brimonidine tartrate 2 mg (0.2%) and timolol maleate 5 mg (0.5 %). Nonmedicinal ingredients: benzalkonium chloride 0.005% as preservative, purified water, sodium phosphate, monobasic monohydrate, sodium phosphate, and dibasic heptahydrate. Hydrochloric acid and/or sodium hydroxide may be added to adjust pH.

How should I use this medication?

The usual dose is one drop in the morning and one drop in the evening (about 12 hours apart) in the affected eye(s). Do not let the tip of the bottle touch your eye or any other surface. If you use other eye drops, wait at least 10 minutes before using them. If you wear soft contact lenses, take them out before putting in the drops, then wait at least 15 minutes after using the drops before putting your soft contact lenses back in. Read the product leaflet for directions on proper use of the eyedrops.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the one given here, do not change the way you are using the medication without consulting your doctor.

It is important to use this medication exactly as prescribed by your doctor. If you miss a dose, use it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not use a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not use brimonidine - timolol eye drops if you:

  • are allergic to brimonidine, timolol, or any ingredients of the medication
  • are taking a monoamine oxidase (MAO) inhibitor, such as phenelzine or tranylcypromine
  • have asthma or have ever had asthma in the past
  • have severe chronic obstructive lung disease (COPD)
  • have certain heart diseases or conditions:
    • sinus bradycardia (slow heartbeat)
    • sick sinus syndrome
    • sino-atrial nodal block
    • second- or third-degree atrioventricular (AV) block (electrical problems)
    • uncontrolled heart failure (heart cannot pump effectively)
    • cardiogenic shock (heart cannot provide enough oxygen to the body)

Do not give this medication to children under 2 years of age.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • burning or stinging of your eye
  • drowsiness
  • dry eye
  • dry mouth
  • headache
  • itchy eye
  • red eyes (dilation of blood vessels in the membrane that lines the eyelid and surface of the eye, causing the eye to appear "red")

Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • vision changes
  • slow or irregular heart beat
  • low blood pressure
  • symptoms of low blood sugar (e.g., cold sweat, cool pale skin, headache, fast heart beat, weakness

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • signs of breathing problems (e.g., shortness of breath, troubled breathing, wheezing, or tightness in chest, fast or irregular breathing)
  • symptoms of a severe allergic reaction (e.g., difficulty breathing, hives, swelling of the face or throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Absorption: This medication is to be used only as a topical (surface-only) treatment for the eyes; however, as with many eye medications, it is absorbed into the bloodstream. The same side effects of systemic (oral) beta-adrenergic receptor blockers may occur with this medication. These side effects include shortness of breath, dizziness, lightheadedness, skin rash, or slow heartbeat.

Allergy: Some people who are allergic to other alpha-agonists or beta-blockers experience allergic reactions to brimonidine - timolol. Before you use this medication, inform your doctor about any previous adverse reactions you have had to medications.

Contamination: Eye drops can become contaminated with bacteria if the tip of the dropper touches any surface, including your eye. This can cause eye infections, which may lead to serious eye damage and loss of vision.

Contact lenses: The preservative in these eye drops may be absorbed by soft contact lenses. You should wait at least 15 minutes after using this medication before putting in your soft contact lenses.

Drowsiness/reduced alertness: This medication may cause fatigue and/or drowsiness. Avoid driving, using machinery, or doing hazardous activities until you determine how the medication affects you.

Heart disease: People with heart conditions, such as heart block, heart failure or angina, may experience increased symptoms of their condition when using this eye drop. If you have any medical condition that may be affected by low blood pressure or reduced heart rate, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Medical conditions that may be affected include:

  • orthostatic hypotension (low blood pressure upon standing up)
  • Raynaud's disease
  • reduced blood flow to the brain or heart
  • severe cardiovascular disease or heart failure
  • thromboangiitis obliterans (inflammation and destruction of blood vessels)

Medical conditions: If you have any of the following medical conditions, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

  • allergy to other alpha-adrenergic agonists or beta-adrenergic receptor blockers
  • chronic obstructive pulmonary disease (COPD)
  • depression
  • diabetes
  • liver or kidney impairment
  • myasthenia gravis

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: Timolol passes into breast milk after being used as an eye drop. It is not known if brimonidine passes into human breast milk. If you are a breast-feeding mother and are taking brimonidine - timolol, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

What other drugs could interact with this medication?

There may be an interaction between brimonidine - timolol eye drops and any of the following:

  • abiraterone acetate
  • acetazolamide
  • alcohol
  • aldesleukin
  • aliskiren
  • alpha/beta agonists (e.g., epinephrine, norepinephrine)
  • alpha blockers (e.g., alfuzosin, doxazosin, tamsulosin)
  • alpha agonists (e.g., clonidine, methyldopa)
  • angiotensin converting enzyme inhibitors (ACEIs; captopril, enalapril, ramipril)
  • angiotensin receptor blockers (ARBS; e.g., candasartan, irbesartan, losartan)
  • antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
  • amiodarone
  • "azole" antifungals (e.g., itraconazole, ketoconazole, voriconazole)
  • barbiturates (e.g., butalbital, phenobarbital)
  • benzodiazepines (e.g., diazepam, lorazepam)
  • beta-adrenergic blockers (e.g., atenolol, metoprolol, propranolol)
  • beta 2 agonists (e.g., salbutamol, formoterol, terbutaline)
  • boceprevir
  • brimonidine
  • brinzolamide
  • bupropion
  • calcium channel blockers (e.g., nifedipine, verapamil)
  • catecholamine-depleting medications (e.g., guanethidine, reserpine)
  • celecoxib
  • ceritinib
  • chloramphenicol
  • chloroquine
  • clarithromycin
  • cimetidine
  • cinacalcet
  • clobazam
  • clomipramine
  • clonidine
  • clozapine
  • cobicistat
  • cocaine
  • conivaptan
  • crizotinib
  • delavirdine
  • desipramine
  • digoxin
  • diphenhydramine
  • dipyridamole
  • disopyramide
  • diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
  • donepezil
  • dorzolamide
  • dronedarone
  • ephedrine
  • epinephrine
  • ergot alkaloids (e.g., dihydroergotamine, ergonovine,  ergotamine, methylergonovine)
  • fingolimod
  • floctafenine
  • galantamine
  • grass pollen allergen extract (5 grass extract)
  • guanfacine
  • HIV protease inhibitors (atazanavir, darunavir, lopinavir, ritonavir)
  • hydroxychloroquine
  • imatinib
  • imipramine
  • insulin
  • isoniazid
  • levodopa
  • lidocaine
  • methadone
  • methyldopa
  • minoxidil
  • mirabegron
  • monoamine oxidase inhibitors  (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
  • nefazodone
  • nelfinavir
  • nilotinib
  • nitrates (e.g., nitroglycerin, isosorbide dinitrate, isosorbide mononitrate)
  • nonsteroidal anti-inflammatory medications (e.g., diclofenac, ibuprofen, ketorolac, naproxen)
  • octreotide
  • opioid (narcotic) pain relievers (e.g., codeine, hydrocodone, morphine)
  • pasireotide
  • pilocarpine
  • primaquine
  • pseudoephedrine
  • quinidine
  • quinine
  • rifabutin
  • rifampin
  • risperidone
  • rivastigmine
  • selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine, fluoxetine, paroxetine, sertraline)
  • sulfonylureas (e.g., gliclazide, glyburide, tolbutamide)
  • sufentanil
  • telaprevir
  • telithromycin
  • terbinafine
  • theophyllines (e.g., aminophylline, oxtriphylline, theophylline)
  • ticlopidine
  • tizanidine
  • tranylcypromine
  • topiramate
  • tricyclic antidepressants (e.g., amitriptyline, clomipramine)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, nicotine from cigarettes, and street drugs can affect the action of many medications, you should let your prescriber know if you use them.