brimonidine tartrate + brinzolamide: clinical use

Prescribing considerations

• Licensed for adults with open-angle glaucoma or ocular hypertension inadequately controlled by monotherapy.
• Not recommended for narrow-angle glaucoma because it has not been studied in this population.
• Use caution with hepatic impairment, cardiovascular disease, orthostatic hypotension, depression, impaired cerebral or coronary circulation, Raynaud’s phenomenon, renal-risk states, dry eye or compromised corneas.
• Eyelid closure and nasolacrimal occlusion can reduce systemic absorption.
• Safety and efficacy are not established from age 2 to 17 years; the product is intended for adults.

Contraindications and cautions

• Hypersensitivity to either active ingredient or an excipient
• Sulphonamide hypersensitivity
• Monoamine oxidase inhibitor treatment
• Antidepressants affecting noradrenergic transmission, including tricyclic antidepressants and mianserin
• Severe renal impairment
• Hyperchloraemic acidosis
• Neonates and infants younger than 2 years

Monitoring

• Review intraocular pressure, adherence, administration technique and local tolerability.
• Watch for ocular allergy, corneal effects and preservative-related irritation.
• Consider blood pressure, pulse, dizziness and alertness in susceptible patients or with interacting systemic medicines.
• Stop treatment and assess promptly if serious hypersensitivity or severe skin reactions develop.

Clinical pharmacology

Brinzolamide inhibits carbonic anhydrase II, reducing aqueous-humour formation. Brimonidine is an alpha-2 agonist that reduces aqueous production and increases uveoscleral outflow. Both undergo some systemic absorption after ocular administration.

Formulation and product differences

• The white-to-off-white suspension requires shaking before use.
• The preserved multidose formulation contains benzalkonium chloride, which can irritate the ocular surface and discolour soft contact lenses.
• Boric acid is present; age restrictions and paediatric safety warnings must be observed.

Eye drops

Route: Ophthalmic

Strengths: 10 mg/mL + 2 mg/mL