Brinzolamide/Brimonidine

DEA Class; Rx

Common Brand Names; Simbrinza

• Antiglaucoma, Combos

Combines a selective alpha-agonist (brimonidine) and a carbonic anhydrase inhibitor (brinzolamide) into a single ophthalmic preparation
Used for the treatment of open-angle glaucoma or ocular hypertension
Fixed-dose combination produces statistically significant greater reduction in IOP than brimonidine or brinzolamide monotherapy

Indicated for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension.

Indicated for reduction of elevated intraocular pressure in patients with primary open-angle glaucoma

Indicated for reduction of elevated intraocular pressure in patients with ocular hypertension

Hypersensitivity

Neonates and infants (younger than 2 yr)

• Somnolence in children (50-83%)
• Xerostomia (10-30%)
• Ocular hyperemia (10-30%)
• Burning and stinging (10-30%)
• Headache (10-30%)
• Blurring (10-30%)
• Foreign body sensation (10-30%)
• Fatigue/drowsiness (10-30%)
• Conjunctival follicles (10-30%)
• Ocular allergic reactions (10-30%)
• Ocular pruritus (10-30%)
• Blurred vision (5-10%)
• Dysgeusia (5-10%)
• Blepharitis (1-5%)
• Dermatitis (1-5%)
• Dry eye (1-5%)
• Foreign body sensation (1-5%)
• Headache (1-5%)
• Hyperemia (1-5%)
• Ocular discharge (1-5%)
• Ocular discomfort (1-5%)
• Ocular keratitis (1-5%)
• Ocular pain (1-5%)
• Ocular pruritus (1-5%)
• Rhinitis (1-5%)

Contains brinzolamide, a sulfonamide; caution with history of sulfonamide allergy

Carbonic anhydrase activity observed in both the cytoplasm and around the plasma membranes of the corneal endothelium, and therefore there is an increased potential for developing corneal edema in patients with low endothelial cell counts

Brinzolamide and its metabolite are excreted predominantly by the kidney and is not recommended in patients with severe renal impairment

Not studied in patients with acute angle-closure glaucoma

Contains benzalkonium chloride (preservative); remove contact lenses during instillation to avoid absorption by soft lenses (may reinsert 15 minutes after instillation)

Brimonidine elicits <5% mean decrease in blood pressure 2 hr after instillation; caution with severe cardiovascular disease

Not studied with severe hepatic impairment

Brimonidine may potentiate syndromes associated with vascular insufficiency (eg, depression, cerebral or coronary insufficiency, Raynaud’s phenomenon, orthostatic hypotension, thromboangiitis obliterans)

Bacterial keratitis reported from inadvertent contamination of multiple-dose containers of topical ophthalmics

Pregnancy Category: C

Lactation: Unknown whether distributed in human breast milk; do not breast feed

Brimonidine tartrate/brinzolamide

ophthalmic suspension

• 1%/0.2%