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Combigan (brimonidine, timolol) contains two ophthalmic solutions, used to lower intraocular pressure in treatment of ocular hypertension or open-angle glaucoma.

While Combigan lowers eye pressure slightly less than using both brimonidine and timolol separately, combining multiple medications in one dispenser bottle is convenient and medications which are easier to use are more likely to be used. Patients who have high intraocular eye pressure will likely find Combigan a simple, beneficial treatment. Those who find they need a somewhat more powerful medication may want to use brimonidine and timolol separately.

How to Use Combigan

Combigan is only available in one strength; 0.2% brimonidine and 0.5% timolol. Each bottle comes in opaque plastic containers with built-in tips for administering eye drops.

The recommended dose is one drop of Combigan in the affected eyes twice per day, as close to 12 hours apart as possible. If administering other eye medications, wait at least 5 minutes after applying Combigan to apply them. If wearing contacts, take them out prior to administration and wait at least 15 minutes before replacing them.

Combigan may be used as long as it provides benefit, often spanning years.

Ocular hypertension can lead to open-angle glaucoma, for which there is currently no cure, but with treatment the condition can be managed and further damage slowed or prevented. While anyone can develop ocular hypertension and glaucoma, certain patients are at increased risk:

• Individuals with a family history of ocular hypertension or glaucoma.
• Individuals over age 40.
• Individuals who are black or Latino.
• Individuals who have diabetes.
• Individuals who are very nearsighted.

Patients can mitigate risk with regular eye exams, especially as they get older. Catching the condition at its earliest stages offers patients the best odds at treating it and preventing permanent vision loss.

Sometimes patients are able to minimize risks of intraocular pressure by addressing underlying issues, such as making the lifestyle changes necessary to manage diabetes. However, in most cases, there is little patients can do other than treat the condition and hope for the best.

Precautions & Side Effects

Most side effects associated with Combigan are very mild and not cause for concern unless severe enough to be disruptive. In trials, 5% to 15% of patients reported:

• Lymph follicle enlargement in the eye and eyelid
• Redness in the eye
• Inflammation of the eye
• Itching, burning or stinging of the eye

The above side effects typically occur when the drops are administered and fade away after several minutes, though not always. If concerned about side effects, consult a doctor.

More rarely serious side effects can occur, which warrant immediate medical attention:

• Visual changes
• Shortness of breath
• Irregular heartbeat
• Slowed heartbeat

Combigan should not be used in patients with a history of the following:

• Bronchial asthma
• Emphysema
• Chronic bronchitis
• Heartbeat problems

This product can interact with a number of other medications, not the least of which are drugs used to stimulate the heart, such as beta-blockers or calcium channel blockers, drugs that influence the fluids of the adrenal gland, central nervous system depressants, tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs). Always speak with a doctor or pharmacist before mixing treatments while using Combigan, or any other medication.

Some patients feel very drowsy while taking Combigan; use with caution until effects are known.