Brimonidine Tartrate-Timolol

The typical dosage of Brimonidine Tartrate-Timolol for ophthalmic use is:

• Ophthalmic Solution: One drop in the affected eye(s) twice daily, approximately 12 hours apart.

Brimonidine Tartrate-Timolol is contraindicated in patients with:

• Known hypersensitivity to Brimonidine, Timolol, or any component of the formulation.
• Bronchial asthma, a history of bronchial asthma, or severe chronic obstructive pulmonary disease (COPD).
• Sinus bradycardia, second or third-degree atrioventricular (AV) block, overt cardiac failure, or cardiogenic shock.
• Patients taking monoamine oxidase inhibitors (MAOIs) due to the risk of a hypertensive crisis.

Patients using Brimonidine Tartrate-Timolol should be advised to:

• Use the medication exactly as prescribed and do not exceed the recommended dosage.
• Avoid driving or operating heavy machinery until they know how the medication affects them, as it can cause drowsiness, dizziness, or blurred vision.
• Wait at least 5-10 minutes before using any other eye drops to ensure proper absorption of each medication.
• Inform their healthcare provider if they experience any severe side effects, such as eye pain, vision changes, shortness of breath, or signs of an allergic reaction.
• Monitor for signs of systemic beta-blocker effects, such as a slow heart rate or low blood pressure, especially if they have a history of cardiovascular disease.

• Eye redness or irritation
• Dry mouth
• Drowsiness or fatigue
• Blurred vision
• Burning or stinging in the eyes
• Headache

• Respiratory Issues: Timolol can cause bronchospasm, particularly in patients with a history of asthma or COPD.
• Cardiovascular Effects: Timolol may cause bradycardia (slow heart rate), hypotension (low blood pressure), or worsening of heart failure.
• CNS Effects: Brimonidine can cause central nervous system effects such as drowsiness, fatigue, or sedation.
• Severe Allergic Reactions: Such as rash, itching, swelling, or difficulty breathing.

Patients should seek immediate medical attention if they experience severe or persistent side effects.

Systemic Absorption: Both Brimonidine and Timolol can be absorbed systemically, which may lead to side effects such as bradycardia, hypotension, or respiratory issues. Patients with a history of cardiovascular or respiratory conditions should be closely monitored.

CNS Effects: Brimonidine can cause drowsiness or sedation, particularly in elderly patients. Caution is advised when engaging in activities that require alertness.

Respiratory Effects: Timolol can cause bronchospasm, particularly in patients with respiratory conditions like asthma or COPD. Patients with these conditions should use Brimonidine Tartrate-Timolol with caution and under close supervision.

Interaction with MAOIs: Brimonidine is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs) due to the risk of a hypertensive crisis.

Brimonidine Tartrate-Timolol may interact with other medications, including:

• Beta-blockers: Systemic or topical beta-blockers can have additive effects with Timolol, potentially leading to bradycardia or hypotension.
• Antihypertensive Agents: May enhance the hypotensive effect of Timolol.
• CNS Depressants: Such as alcohol, sedatives, or opioids, which may enhance the sedative effects of Brimonidine.
• MAOIs: Contraindicated due to the risk of hypertensive crisis with Brimonidine.

Patients should inform their healthcare provider of all medications and supplements they are taking to avoid potential interactions.

Alternative treatments for glaucoma or ocular hypertension include:

• Prostaglandin Analogs: Such as latanoprost or travoprost, which increase the outflow of aqueous humor to lower IOP.
• Carbonic Anhydrase Inhibitors: Such as dorzolamide or brinzolamide, which decrease aqueous humor production.
• Alpha Agonists: Such as apraclonidine, which works similarly to Brimonidine but may be used in different clinical situations.
• Combination Eye Drops: That include other combinations of medications, such as Cosopt (dorzolamide/timolol) or Combigan (brimonidine/timolol).

The choice of treatment depends on the specific condition, the patient’s response to previous treatments, and any underlying medical conditions.