Brimonidine and timolol Ophthalmic

You should not use brimonidine and timolol ophthalmic if you have a history of asthma or chronic obstructive pulmonary disease (COPD), or a serious heart condition such as "AV block," severe heart failure, or slow heartbeats that have caused you to faint.

Brimonidine and timolol ophthalmic should not be given to a child younger than 2 years old.

An overdose of brimonidine and timolol ophthalmic is not expected to be dangerous. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222 if anyone has accidentally swallowed the medication.

Usual Adult Dose for Glaucoma:

1 drop in the affected eye(s) twice per day, approximately 12 hours apart

Comments:
-If more than one topical ophthalmic drug is being used, the different drugs should be instilled at least 5 minutes apart.

Use: To lower elevated intraocular pressure (IOP) in patients with glaucoma or ocular hypertension who require adjunctive or replacement therapy due to inadequately controlled IOP

Usual Adult Dose for Intraocular Hypertension:

1 drop in the affected eye(s) twice per day, approximately 12 hours apart

Comments:
-If more than one topical ophthalmic drug is being used, the different drugs should be instilled at least 5 minutes apart.

Use: To lower elevated intraocular pressure (IOP) in patients with glaucoma or ocular hypertension who require adjunctive or replacement therapy due to inadequately controlled IOP

Usual Pediatric Dose for Glaucoma:

2 years or older:
1 drop in the affected eye(s) twice per day, approximately 12 hours apart

Comments:
-If more than one topical ophthalmic drug is being used, the different drugs should be instilled at least 5 minutes apart.

Use: To lower elevated intraocular pressure (IOP) in patients with glaucoma or ocular hypertension who require adjunctive or replacement therapy due to inadequately controlled IOP

Usual Pediatric Dose for Intraocular Hypertension:

2 years or older:
1 drop in the affected eye(s) twice per day, approximately 12 hours apart

Comments:
-If more than one topical ophthalmic drug is being used, the different drugs should be instilled at least 5 minutes apart.

Use: To lower elevated intraocular pressure (IOP) in patients with glaucoma or ocular hypertension who require adjunctive or replacement therapy due to inadequately controlled IOP

Applies to brimonidine / timolol ophthalmic: ophthalmic solution

Ocular

Very common (10% or more): Conjunctival hyperemia, burning sensation
Common (1% to 10%): Stinging sensation in the eye, allergic conjunctivitis, corneal erosion, superficial punctuate keratitis, eye pruritus, conjunctival folliculosis, visual disturbance, blepharitis, epiphora, eye dryness, eye discharge, eye pain, eye irritation, foreign body sensation, eyelid edema, eyelid pruritus, eyelid erythema
Uncommon (0.1% to 1%): Worsened visual acuity, conjunctival edema, conjunctivitis, vitreous floater, asthenopia, photophobia, papillary hypertrophy, eyelid pain, conjunctival blanching, corneal edema, corneal infiltrates, vitreous detachment, allergic contact dermatitis
Postmarketing reports: Blurred vision, keratoconjunctivitis sicca

Brimonidine:
-Frequency not reported: Iritis, iridocyclitis (anterior uveitis), miosis, cataract, conjunctival blanching, hordeolum, lid crusting, lid disorder

Timolol:
-Rare (less than 0.1%): Corneal calcification (with the use of phosphate containing eye drops in some patients with significantly damaged corneas)
-Frequency not reported: Keratitis, choroidal detachment following filtration surgery, decreased corneal sensitivity, corneal erosion, ptosis, diplopia, cystoid macular edema, pseudopemphigoid, refractive changes, blepharoptosis[Ref]

Cardiovascular

Common (1% to 10%): Hypertension
Uncommon (0.1% to 1%): Congestive heart failure, palpitations
Postmarketing reports: Arrhythmia, bradycardia, tachycardia, hypotension, pallor

Brimonidine:
-Frequency not reported: Vasodilation

Timolol:
-Frequency not reported: Chest pain, atrioventricular block, cardiac arrest, cardiac failure, Raynaud's phenomenon, cold hands and feet, claudication, worsening of angina pectoris[Ref]

Gastrointestinal

Common (1% to 10%): Oral dryness
Uncommon (0.1% to 1%): Nausea, diarrhea

Brimonidine:
-Frequency not reported: Gastrointestinal symptoms

Timolol:
-Frequency not reported: Dyspepsia, abdominal pain, vomiting[Ref]

Immunologic

Brimonidine:
-Frequency not reported: Systemic allergic reactions, systemic lupus erythematosus, flu syndrome

Timolol:
-Frequency not reported: Systemic allergic reactions including angioedema, urticaria, localized and generalized rash, pruritus, anaphylactic reaction[Ref]

Nervous system

Common (1% to 10%): Somnolence, headache
Uncommon (0.1% to 1%): Dizziness, syncope, taste perversion
Postmarketing reports: Coma, lethargy

Timolol:
-Frequency not reported: Cerebrovascular accident, cerebral ischemia, increases in signs and symptoms of myasthenia gravis, paresthesia, disorientation, memory loss, tinnitus[Ref]

Psychiatric

Common (1% to 10%): Depression

Brimonidine:
-Frequency not reported: Insomnia

Timolol:
-Frequency not reported: Insomnia, nightmare, behavioral changes and psychic disturbances including confusion, hallucination[Ref]

Respiratory

Uncommon (0.1% to 1%): Rhinitis, nasal dryness
Postmarketing reports: Respiratory depression

Brimonidine:
-Frequency not reported: Upper respiratory symptoms, dyspnea, apnea

Timolol:
-Frequency not reported: Bronchospasm (predominantly in patients with pre-existing bronchospastic disease), dyspnea, cough, upper respiratory infection, nasal congestion[Ref]

Genitourinary

Timolol:
-Frequency not reported: Sexual dysfunction, decreased libido, Peyronie's disease, retroperitoneal fibrosis[Ref]

General

The commonly reported side effects were allergic conjunctivitis, conjunctival folliculosis, conjunctival hyperemia, eye pruritus, ocular burning, and stinging.[Ref]

Musculoskeletal

Postmarketing reports: Hypotonia

Timolol:
-Frequency not reported: Myalgia[Ref]

Other

Common (1% to 10%): Asthenic conditions
Postmarketing reports: Facial erythema

Timolol:
-Frequency not reported: Edema, fatigue[Ref]

Dermatologic

Brimonidine:
-Frequency not reported: Skin reaction including erythema, pruritus, rash

Timolol:
-Frequency not reported: Alopecia, psoriasiform rash or exacerbation of psoriasis, rash[Ref]

Hepatic

Common (1% to 10%): Abnormal Liver Function Tests[Ref]

Metabolic

Brimonidine:
-Frequency not reported: Masked symptoms of hypoglycemia in diabetes patients, hypercholesterolemia

Timolol:
-Frequency not reported: Hypoglycemia[Ref]

Some side effects of brimonidine / timolol ophthalmic may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

1 drop in the affected eye(s) twice per day, approximately 12 hours apart

Comments:
-If more than one topical ophthalmic drug is being used, the different drugs should be instilled at least 5 minutes apart.

Use: To lower elevated intraocular pressure (IOP) in patients with glaucoma or ocular hypertension who require adjunctive or replacement therapy due to inadequately controlled IOP

2 years or older:
1 drop in the affected eye(s) twice per day, approximately 12 hours apart

Comments:
-If more than one topical ophthalmic drug is being used, the different drugs should be instilled at least 5 minutes apart.

Use: To lower elevated intraocular pressure (IOP) in patients with glaucoma or ocular hypertension who require adjunctive or replacement therapy due to inadequately controlled IOP

Data not available

Use is not recommended. Excreted into human milk: Brimonidine: Unknown; Timolol: Yes Excreted into animal milk: Brimonidine: Unknown Comments: The effects in the nursing infant are unknown.