This ophthalmic suspension is a fixed-dose combination of a carbonic anhydrase inhibitor and an alpha-2 adrenergic receptor agonist. It is indicated for lowering elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension.

This formulation contains Brinzolamide, a carbonic anhydrase inhibitor, and Brimonidine Tartrate, an alpha-2 adrenergic receptor agonist. Both components work to reduce elevated intraocular pressure, a key factor in the development of optic nerve damage and glaucomatous vision loss. Brinzolamide decreases aqueous humor production by inhibiting carbonic anhydrase in the ciliary processes of the eye. This reduces bicarbonate ion formation, leading to decreased sodium and fluid transport. Its peak intraocular pressure–lowering effect occurs approximately 2 to 3 hours after administration.

Brimonidine Tartrate works through a dual mechanism by reducing aqueous humor production and increasing uveoscleral outflow. It typically achieves peak intraocular pressure reduction about 2 hours after dosing.

Shake well before use. Instill one drop in the affected eye(s) three times daily. If more than one topical ophthalmic drug is being used, the drugs should be administered at least five (5) minutes apart.

Rare drug interactions have been reported in patients using this ophthalmic preparation, particularly with high-dose salicylates, CNS depressants, antihypertensive agents, cardiac glycosides, tricyclic antidepressants, and monoamine oxidase (MAO) inhibitors. Therefore, potential interactions should be considered when prescribing this medication.

This combination is contraindicated in patients with known hypersensitivity to Brinzolamide, Brimonidine Tartrate, or any component of the formulation. It is also contraindicated in neonates and infants below 2 years of age.

The most commonly reported side effects of this combination (observed in approximately 3–5% of patients) include blurred vision, eye irritation, altered taste (dysgeusia), dry mouth, and allergic eye reactions. Additional adverse reactions reported with individual components during clinical use include:

Brinzolamide 1%: Frequently reported effects (5–10%) include blurred vision and abnormal taste. Less common effects (1–5%) include blepharitis, dermatitis, dry eye, foreign body sensation, headache, hyperemia, ocular discharge, ocular discomfort, keratitis, eye pain, itching, and rhinitis.

Brimonidine Tartrate 0.2%: Common adverse reactions (10–30%) include dry mouth, ocular redness, burning or stinging, headache, blurred vision, foreign body sensation, fatigue or drowsiness, conjunctival follicles, allergic eye reactions, and itching.

Brinzolamide + Brimonidine Tartrate combination is classified as Pregnancy Category C. It should be used during pregnancy only when the expected benefit outweighs the potential risk to the fetus. It is not known whether this combination is excreted in human breast milk after topical ocular use. Since many drugs are excreted in breast milk and may cause serious adverse effects in nursing infants, a decision should be made whether to discontinue breastfeeding or discontinue the medication, considering the importance of therapy to the mother.

This combination contains Brinzolamide, a sulfonamide, which may be systemically absorbed even after topical use. Therefore, adverse reactions similar to systemic sulfonamides may occur, including rare but serious conditions such as Stevens–Johnson syndrome, toxic epidermal necrolysis, hepatic necrosis, agranulocytosis, aplastic anemia, and other blood disorders. Brimonidine may worsen conditions related to vascular insufficiency. Use with caution in patients with depression, cerebrovascular or coronary insufficiency, Raynaud’s phenomenon, or orthostatic hypotension. Since Brinzolamide and its metabolites are primarily eliminated through the kidneys, this combination is not recommended in patients with renal impairment. The preservative (benzalkonium chloride) may be absorbed by soft contact lenses; therefore, lenses should be removed before administration and can be reinserted after 15 minutes.

Pediatric use: Brinzolamide has been studied in children aged 4 weeks to 5 years, while Brimonidine has been studied in children aged 2 to 7 years. Increased drowsiness and reduced alertness have been observed in children aged 2 to 6 years. This combination is contraindicated in children under 2 years of age.

Geriatric use: No significant differences in safety or effectiveness have been observed between elderly and adult patients.

Although human data are limited, overdose of Brinzolamide may lead to electrolyte imbalance, metabolic acidosis, and central nervous system effects. Monitoring of serum electrolytes (especially potassium) and blood pH is recommended. Limited data on accidental ingestion of Brimonidine in adults suggest hypotension as a possible effect. In neonates and children, overdose may cause serious symptoms. Management includes supportive and symptomatic treatment, with maintenance of a clear airway.

Drugs for miotics and glaucoma

Store at room temperature in a cool, dry place and protect from light. Avoid touching the dropper tip to any surface. Do not use the product for more than one month after first opening. Shake well before use and do not freeze.