Brinzolamide - brimonidine is a combination medication used to reduce the pressure inside the eye for adult patients with open-angle Glaucoma or ocular hypertension. Fluid is constantly being produced and drained out of the eye. When this fluid does not drain out of the eye properly or too much fluid is produced, pressure inside the eye increases.

Brinzolamide belongs to the group of medications called carbonic anhydrase inhibitors. It works by reducing the amount of fluid produced by the eye.

Brimonidine belongs to the family of medications known as alpha-2-adrenergic receptor agonists. It works by reducing the amount of fluid produced by the eye and by increasing the flow of fluid out of the eye.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of Simbrinza may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of Simbrinza 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 taking Simbrinza, speak to your doctor. Do not stop taking Simbrinza without consulting your doctor.

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

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The recommended dose of Simbrinza is 1 drop instilled into the affected eye two times daily.

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 ones listed here, do not change the way that you are taking the medication without consulting your doctor.

To use the eye drops:

1. Wash your hands before using the eye drops.
2. Shake the eye drops well before using them.
3. Remove the cap and place it in a clean location. To avoid possible contamination, keep the tip of the container away from contact with any surface.
4. Tilt the head back and look towards the ceiling.
5. With your index finger, gently pull the lower eyelid down and away from the eye to form a pouch.
6. Apply one drop into the pouch by following the instructions on the eye drop container. Do not allow the tip of the container to touch the eye or areas around the eye.
7. Gently apply pressure to the inner corner of the eye (at the bridge of the nose) for about 60 seconds (this is called nasolacrimal occlusion). This prevents the medication from dripping down through the tear duct and entering the bloodstream, which could cause you to experience some side effects.
8. Repeat with the other eye, if prescribed by your physician.
9. Wash your hands again to remove any medication.

Do not allow the dropper tip of the bottle to touch the eye or other surrounding structures. This can contaminate the tip with common bacteria known to cause Eye Infections. Serious damage to the eye may result if you use eye drop solutions that have become contaminated.

If more than one type of eye drop is needed, wait at least 5 minutes before using the second type of eye drop.

It is important to take Simbrinza exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take 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 Simbrinza at room temperature, protect it from light and moisture, and keep it out of the reach of children. Discard any solution remaining in the dropper bottle 125 days after opening the 10 mL bottle or 32 days after opening the 5 mL bottle. If the suspension changes colour, do not use it.

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.

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 Simbrinza. If you are concerned about side effects, discuss the risks and benefits of Simbrinza 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.

• bad taste in mouth
• blurred vision
• drowsiness
• dry eyes
• Dry Mouth
• dry nose or throat
• eye pain
• eye redness
• headache
• increased tear production
• stomach ache
• tired eyes
• trouble sleeping

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:

• decreased heart rate
• unusual eye symptoms (e.g., severe eye pain, sensitivity to light, sudden decrease or loss of vision)
• signs of Low Blood Pressure (e.g., fainting, dizziness, weakness, changes in breathing)

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

• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and 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 Simbrinza.

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Each 1 mL of white-to-off-white uniform suspension, supplied in a round, white, low density polyethylene (LDPE) bottle with a natural LDPE dispensing plug and white polypropylene screw cap (DROP-TAINER®), contains 10 mg brinzolamide and 2 mg brimonidine tartrate. Nonmedicinal ingredients: boric acid, carbomer 974P, mannitol, propylene glycol, purified water, sodium chloride, tyloxapol, hydrochloric acid and/or sodium hydroxide (to adjust pH), and benzalkonium chloride (0.003%) as a preservative.

Do not take this medication if you:

• are allergic to brinzolamide, brimonidine or any ingredients of the medication
• are allergic to sulfonamides
• have severely reduced kidney function
• have a condition known as hyperchloroaemic acidosis
• have taken an MAO inhibitor (e.g., Tranylcypromine, Phenelzine, Linezolid) within the last 14 days

Do not give Simbrinza to infants and children under 2 years of age.

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There may be an interaction between brinzolamide - brimonidine and any of the following:

• alcohol
• Aldesleukin
• Aliskiren
• alpha/beta agonists (e.g., Epinephrine, norepinephrine)
• alpha agonists (e.g., Clonidine, methyldopa)
• alpha blockers (e.g., Alfuzosin, Doxazosin, Tamsulosin)
• angiotensin converting enzyme inhibitors (ACEIs; Captopril, Enalapril, Ramipril)
• angiotensin receptor blockers (ARBs; e.g., candasartan, Irbesartan, Losartan)
• antihistamines (e.g., cetirizine, doxylamine, Diphenhydramine, Hydroxyzine, Loratadine)
• antipsychotics (e.g., Chlorpromazine, Clozapine, Haloperidol, Olanzapine, Quetiapine, Risperidone)
• azelastine
• “azole” antifungals (e.g., itraconazole, ketoconazole, Voriconazole)
• Baclofen
• barbiturates (e.g., butalbital, pentobarbital Phenobarbital)
• benzodiazepines (e.g., Alprazolam, Diazepam, Lorazepam)
• beta-adrenergic blockers (e.g., Atenolol, Propranolol, Sotalol)
• boceprevir
• Buprenorphine
• Buspirone
• calcium channel blockers (e.g., Amlodipine, Diltiazem, Nifedipine, Verapamil)
• carbonic anhydrase inhibitors (e.g., acetazolamide, Dorzolamide, Topiramate)
• chloral hydrate
• clarithromycin
• conivaptan
• delavirdine
• diuretics (water pills; e.g., Furosemide, Hydrochlorothiazide, triamterene)
• dronabinol
• droperidol
• efavirenz
• general anesthetics (medications used to put people to sleep before surgery)
• Guanfacine
• HIV protease inhibitors (e.g., darunavir, indinavir, lopinavir, saquinavir, tipranavir)
• levodopa
• magnesium sulfate 
• Methotrimeprazine
• metyrosine
• Minoxidil
• Mirtazapine
• monoamine oxidase inhibitors (M.O.S. e.g., Moclobemide, phenelzine, Rasagiline, Selegiline, tranylcypromine)
• muscle relaxants (e.g., Cyclobenzaprine, methocarbamol, orphenadrine)
• Nabilone
• narcotic pain relievers (e.g., Codeine, Fentanyl, Morphine, Oxycodone)
• nefazodone
• nelfinavir
• nitrates (e.g., Nitroglycerin, isosorbide dinitrate, isosorbide mononitrate)
• Olopatadine
• orphenadrine
• paraldehyde
• Perampanel
• Pramipexole
• Ropinirole
• Rotigotine
• Rufinamide
• saquinavir
• scopolamine
• seizure medications (e.g., Carbamazepine, Ethosuximide, felbamate, Levetiracetam, phenobarbital, Phenytoin, primidone, topiramate, Valproic acid, zonisamide)
• selective serotonin reuptake inhibitors (SSRIs; e.g., Citalopram, Duloxetine, Fluoxetine, Paroxetine, Sertraline)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., Desvenlafaxine, duloxetine, Venlafaxine)
• sodium oxybate
• Tapentadol
• thalidomide
• Tramadol
• tricyclic antidepressants (e.g., Amitriptyline, Clomipramine, Desipramine, Trimipramine)
• Zolpidem 
• Zopiclone

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 Simbrinza. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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 Simbrinza.

Allergy: Brinzolamide belongs to the family of medications known as sulfonamides or "sulfas." The same type of allergic reaction can occur with this medication as with other sulfonamides. Contact your doctor if you experience a skin rash while using Simbrinza. Stop using Simbrinza and get medical attention if you experience Hives; shortness of breath; peeling or blistering skin; or swelling of the mouth, lips, tongue, or throat.

Blurred vision: This medication may temporarily cause blurred vision. If you experience blurred vision, do not drive or operate machinery until your vision returns to normal.

Contact lenses: This medication contains the preservative benzalkonium chloride which may be absorbed by soft contact lenses. Contact lenses should be removed when applying these eye drops but can be reinserted 15 minutes after application.

Eye surgery, infections, and trauma: If you have had eye surgery, trauma to the eye, or  symptoms of an eye infection (e.g., eye redness, itchiness, discharge, crusts on the eyelids, or the feeling of something in the eye), talk your doctor about whether you should continue taking Simbrinza.

General: As with other topically applied eye drops, Simbrinza may be absorbed into the bloodstream. The same side effects reported with oral medications from the families known as carbonic anhydrase inhibitors (e.g., Acetazolamide, Methazolamide) or sulfonamides (e.g., sulfamethoxazole) may occur with these eye drops. The side effects may include rash and nausea.

Depression: If you have clinical depression or a history of depression, discuss with your doctor how Simbrinza may affect your medical condition and whether any special monitoring is needed. You may need to visit your doctor more often to ensure that Simbrinza is not making your condition worse.

Drowsiness/reduced alertness: Brimonidine may cause temporary fatigue and drowsiness. Do not drive, operate machinery, or engage in any potentially hazardous activities until you determine how Simbrinza affects you.

Kidney function: The use of Simbrinza by people with Kidney Disease has not been studied. If you have reduced kidney function or kidney disease, discuss with your doctor how Simbrinza may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Simbrinza, and whether any special monitoring is needed.

Liver function: The use of brinzolamide-brimonidine eye drops by people with liver disease has not been studied. If you have reduced liver function or liver disease, discuss with your doctor how Simbrinza may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Simbrinza, and whether any special monitoring is needed.

Orthostatic hypotension: Orthostatic hypotension, also known as postural hypotension, is a drop in blood pressure when getting up from a lying position. This may happen to people using brimonidine eye drops. If you experience this, rise slowly from a lying or sitting position when using brimonidine.

Raynaud's disease: Raynaud's disease is a disorder of the small blood vessels that feed the skin. If you have Raynaud's disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Simbrinza, and whether any special monitoring is needed.

Severe cardiovascular (heart) disease: Although brimonidine typically has little effect on blood pressure and heart rate, it may lower blood pressure and heart rate (pulse) if you have severe heart disease. If you have severe heart disease, discuss with your doctor how Simbrinza may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Simbrinza, and whether any special monitoring is needed.

Thromboangiitis obliterans: Thromboangiitis obliterans is a condition causing inflammation of small- and medium-sized arteries and veins. If you have thromboangiitis obliterans, discuss with your doctor how Simbrinza may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Simbrinza, and whether any special monitoring is needed.

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

Breast-feeding: It is not known if brinzolamide - brimonidine passes into breast milk. If you are a breast-feeding mother and are taking Simbrinza, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

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

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