Indications for: COMBIGAN
To reduce elevated intraocular pressure (IOP) in glaucoma or ocular hypertension where adjunctive or replacement therapy is warranted.
Clinical studies were conducted to compare the IOP-lowering effect over the course of the day of Combigan administered twice a day (BID) to individually-administered brimonidine tartrate ophthalmic solution, 0.2% administered three times per day (TID) and timolol maleate ophthalmic solution, 0.5% BID in patients with glaucoma or ocular hypertension. Combigan BID provided an additional 1 to 3 mm Hg decrease in IOP over brimonidine treatment TID and an additional 1 to 2 mm Hg decrease over timolol treatment BID during the first 7 hours post dosing. However, the IOP-lowering of Combigan BID was less (approximately 1-2 mm Hg) than that seen with the concomitant administration of 0.5% timolol BID and 0.2% brimonidine tartrate TID. Combigan administered BID had a favorable safety profile versus concurrently administered brimonidine TID and timolol BID in the self-reported level of severity of sleepiness for patients over age 40.
Adults and Children:
<2yrs: contraindicated. ≥2yrs: 1 drop every 12 hours.
Bronchial asthma or history of. Severe COPD. 2nd- or 3rd-degree AV block. Overt cardiac failure. Cardiogenic shock. Sinus bradycardia. Neonates and infants <2yrs of age.
Potential for severe respiratory or cardiac reactions. Discontinue at 1st sign of cardiac failure and before surgery. Mild to moderate COPD, bronchospastic disease: not recommended. Depression. Cerebral or coronary insufficiency. Raynaud's phenomenon. Orthostatic hypotension. Thromboangiitis obliterans. Myasthenia gravis. Renal or hepatic impairment. May mask hypoglycemia, thyrotoxicosis. Soft contact lenses (remove; may reinsert 15 minutes after instillation). Separate dosing of other oph drugs by ≥5 minutes. Pregnancy (Cat.C). Nursing mothers: not recommended.
Alpha-2 agonist + noncardioselective beta-blocker.
Avoid other topical β-blockers. May potentiate, or be potentiated by, other CNS depressants, systemic β-blockers, reserpine, quinidine, SSRIs, other CYP2D6 inhibitors. Caution with antihypertensives, systemic β-blockers, MAOIs, tricyclics. May cause conduction defects (eg, prolonged AV conduction) with digoxin, calcium channel blockers (avoid concomitant use in impaired cardiac function). May block systemic epinephrine.
Allergic conjunctivitis, conjunctival folliculosis, conjunctival hyperemia, pruritus, ocular burning/stinging, asthenia, corneal erosion, depression, epiphora, visual disturbance, headache, hypertension, dry mouth, somnolence, blepharitis, ocular hypersensitivity.
Renal. Half-life: ~3 hours (brimonidine), ~7 hours (timolol).
Soln—5mL, 10mL, 15mL