Combigan

Brimonidine and Timolol, also known under the trade name of Combigan, is a product which contains two medications – Brimonidine, which belongs to a group of drugs known as alpha agonists, that is considered to allow a better fluid drainage from within the eye, while at the same time it decreases the amount of fluid formed in the eye, and Timolol, which belongs to a group of drugs known as beta blockers, that is considered to decrease the amount of fluid in the eye. 

These medications, together in a combination are used in the treatment of high eye pressure, due to glaucoma or certain eye diseases. By decreasing the eye pressure, it helps prevent blindness and optic nerve damage. This medication is available in the form of a solution.

Before the decision to start the treatment with this medication is made, it is essential to get informed about the expected beneficial effects, as well as, about the potential side effects and risks. 

For this decision to be made, the beneficial effects must outweigh the potential risks. This is a decision that you and your doctor, together, will have to make. During the consultations, it is important to inform the doctor about:

• Allergic reactions – Inform the doctor about any allergic reactions to any kind of medications, prescribed or not prescribed. Also, inform the healthcare professional about any allergic reactions to any specific kind of food, dye, fabric and etc.

• Pediatric – There are no studies done that would confirm the safety of this medication to be used in pediatric patients. This medication is not recommended to be used in pediatric patients. It could be used only in cases where the beneficial effects outweigh the potential risks. However, it is confirmed that this medication must not be used in children younger than 2 years of age.

• Geriatric – Proper studies done have confirmed that this medication does not cause any age-related side effects and risks when it is used in geriatric patients. However, due to the increased sensitivity within the elderly, this medication must be used with extra caution during the treatment.

• Pregnancy – Inform the doctor if you are currently pregnant or have any plans about pregnancy in the near future. There are no studies done that would confirm the safety of this medication to be used during pregnancy. It is unknown how it will affect the fetus. This medication is not recommended to be used during pregnancy. However, it could be used only in cases where the beneficial effects outweigh the potential risks.

• Breastfeeding – Inform the doctor if you are currently breastfeeding. There are no studies done that would confirm the safety of this medication to be used in nursing mothers. It is unknown if it is extracted in the milk or how would it affect the infant. This medication is not recommended to be used in nursing mothers. However, it could be used only in cases where the beneficial effects outweigh the potential risks.

• Drug interactions – Inform the doctor if you are currently using any other medications, prescribed or not prescribed, even vitamins and herbal tea. This is important because certain medications are not recommended to be used in a combination with others, due to the possibility that certain interactions could occur. However, sometimes the doctor may decide to use a certain combination, including two or more medications, to treat your condition, if he or she considers that combination to prove as beneficial regarding your condition. 

• Other interactions – Certain medications are not recommended to be used in a combination with specific types of food, tobacco and alcohol. Because of this, it is important to get informed if there is a need for you to follow a specific diet, or discontinue your use of tobacco and alcohol during the treatment with this medication.

• Other medical problems – Inform the doctor about your medical history, any other medical problems and conditions from the past or at the moment. Especially, inform the doctor if there are any of the following condition present – asthma, bradycardia, cardiogenic shock, chronic obstructive pulmonary disease, heart block/failure, bacterial eye infection, blood vessel disorder, cornea, depression, eye surgery, heart disease, lung disease, stroke, diabetes, Myasthenia gravis, hypoglycemia, or hyperthyroidism.

For proper use, follow the directions given by your doctor. This medication is available in the form of a solution, for the ophthalmic route. Remember to wash your hands before and after every application. 

To avoid contamination, do not touch the tip of the bottle to your eye. If you are currently using contact lens, remove them before every application. The contact lens can absorb the eye drops and decrease the efficiency of the medication. 

Wait at least 10 minutes before you replace them. To apply the eye drops, tilt your head backward. Using two fingers pull down the lower lid and make a pouch. Here apply the prescribed number of eye drops. 

Close your eyes and using your fingers, gently massage the upper eyelid. Keep your eyes closed for at least 10 minutes to let the eye drops to get absorbed in the eye. The dose is individual for every patient, prescribed by the doctor and based on your condition and the prognosis of the treatment. 

The usual dose is 3 eye drops, daily. To get the most beneficial effects from its use, remember to use the medication regularly as directed by your doctor. If you forget a dose, apply it as soon as you remember. Do not double to catch up. 

This medication is harmful in case of an overdose and swallowing. If an overdose or swallowing is suspected, contact the doctor right away for further directions.

Visit your doctor regularly, at your scheduled appointments, so that he or she would be able to track your condition and make any adjustments if needed. 

These adjustments may refer to the dose – e.g. the doctor may decide to increase or decrease the dose, or to the treatment itself – the doctor may decide to discontinue the treatment, if there are any serious side effects present that would worsen your condition, or if your condition does not improve. 

Inform your doctor about any allergic reactions to any kind of medications, prescribed or not prescribed. This is important because this product may contain inactive substances that could cause certain interactions to occur. Inform the doctor if you are currently pregnant or have any plans about pregnancy in the near future. 

This medication is not recommended to be used during pregnancy, due to the lack of studies that would confirm the safety of this medication to be used during pregnancy. At least two proven forms of birth control should be used during the treatment. 

Inform the doctor if you are currently breastfeeding. This medication is not recommended to be used in nursing mothers, due to the lack of studies that would confirm the safety of this medication to be used in nursing mothers. 

This medication must not be used in children younger than 2 years of age. This medication may cause dizziness, drowsiness or temporary blurred vision to occur. Avoid driving and any other activities that require clear vision and alertness during the treatment with this medication.

Along with its needed beneficial effects, there are potential side effects that could occur. These side effects do not occur within all patients, also they could be mild or more serious. 

However, it is important to get informed about the potential side effects, so that you would be able to notice their presence and inform the doctor as soon as possible.

Common side effects:

• Temporary blurred vision
• dizziness
• drowsiness
• temporary stinging/itching/redness of the eye
• watery eyes
• dry mouth
• headache

These are common side effects that are not considered as serious. However, if their presence persists or worsens, inform the doctor as soon as possible.

Serious side effects:

• Vision changes
• increased eye sensitivity to the sun
• eye pain/swelling/discharge
• slow/irregular heartbeat
• muscle weakness
• unusual weakness/tiredness
• mood changes
• unexplained weight gain
• shortness of breath
• swelling of the ankles/feet

These are serious side effects, whose presence must be reported to the doctor as soon as possible.

A very serious allergic reaction to this medication is not common. However, if you notice any of the following symptoms, inform the doctor as soon as possible – skin rash, itching/swelling of the face/tongue/hands/feet, trouble breathing, or severe dizziness.