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Home > Drug Category > Glaucoma Medications > Combigan and Equivalent

Combigan Information

Combigan (Brimonidine/Timolol) is a prescription eye drop used primarily to lower intraocular pressure. This pressure, often called intraocular pressure, is often associated with conditions such as open-angle glaucoma or ocular hypertension. Its active ingredients are brimonidine tartrate, an alpha-2 adrenergic agonist, and timolol maleate, a non-selective beta-blocker. This medication appears to work through a dual mechanism to lower internal eye pressure. Brimonidine seems to function by reducing fluid production in the eye and increasing its outflow. Timolol, on the other hand, focuses almost entirely on decreasing the amount of fluid the eye produces.

Glaucoma is a condition in which the fluid pressure inside the eye becomes high enough to eventually damage the optic nerve, which sends visual information to the brain. You can think of the eye like a sink where the faucet (fluid production) and the drain (outflow) need to be perfectly balanced to maintain the right pressure. In ocular hypertension or glaucoma, that balance is off-either the faucet is running too fast or the drain is slightly blocked. Combigan helps by essentially turning down the faucet from two angles, improving the drain's performance. By keeping this pressure within a normal range, the medication helps prevent damage to the optic nerve, which is the main way it protects your vision over time.

Combigan Side Effects

Some possible side effects of this medication may include burning or stinging of your eye, diarrhea, dizziness, drowsiness, dry eye, dry mouth, eye pain, headache, itchy eye, nausea, red eyes, weakness, and watery eyes. Contact your doctor if these mild side effects persist or worsen.

Stop taking this medicine and contact your doctor immediately if you experience any serious side effects, including the following:
• Allergic reactions such as breathing difficulties, body itching, body rash, skin blistering, swelling of the face, mouth, tongue, lips, or throat;
• Blood pressure changes (increased or decreased blood pressure);
• Depression with symptoms such as poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide;
• Heart problems with symptoms such as fast, irregular heartbeat or pulse, chest pain, sudden weight gain, difficulty breathing, leg swelling;
• Low blood sugar with symptoms like cold sweat, cool pale skin, headache, fast heartbeat, weakness;
• Persistent vision changes

Also, inform your doctor if you notice any other side effects not listed here.

Combigan Precautions

Do not use this topical eye medication if you are allergic to brimonidine, timolol, other ingredients of Combigan, or any other medicine. Before using this medication, ensure you inform your doctor about any medical conditions you previously or currently have, including the following:
• Asthma or chronic obstructive pulmonary disease;
• Blood circulation disorders;
• Depression;
• Diabetes;
• Heart disease, such as heart block;
• Kidney disease;
• Liver disease;
• Low blood pressure;
• Myasthenia gravis;
• Raynaud's disease;
• Thromboangiitis obliterans;
• Thyroid problems, such as hyperthyroidism

If you have an upcoming surgery involving general anesthesia, the beta-blockade from timolol might impair the heart’s response to beta-adrenoceptor stimulants. Your doctor may suggest discussing a temporary pause with the surgical team. Avoid touching the dropper tip to avoid contamination. Touching the dropper tip to the eye, eyelid, or any external surface appears to be the primary route for introducing bacteria into the bottle. The preservative in these eye drops may be absorbed by soft contact lenses. You should wait at least 15 minutes after using this medication before putting in your soft contact lenses. This medicine may cause fatigue and drowsiness. Therefore, do not drive, operate machinery, or engage in any potentially hazardous activities until you determine how this medication affects you. Regarding pregnancy, Combigan is generally categorized as a drug to avoid unless the potential benefit justifies the risk to the fetus. If used during delivery, the neonate should be closely monitored for signs of beta-blockade, including bradycardia, respiratory distress, or hypoglycemia. It is also generally not recommended for use in breastfeeding women as it can pass through the breastmilk to the breastfed infants. Do not give this medication to children under 2 years of age.

Some medications, such as monoamine oxidase inhibitors, can interfere with brimonidine metabolism, leading to increased systemic effects, such as a drop in blood pressure. Therefore, it is imperative to let your doctor know about any medicines or supplements you are currently using, including other eye medications, to determine whether they can interact with Combigan. Apply one drop of this medication to your eyes in the morning and one drop in the evening (about 12 hours apart), as directed by your doctor. Check out the leaflet in the medication pack for more instructions on use. If you are using more than one type of eye drop, wait at least 10 minutes before using the second type of eye drop. Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do I need a prescription to order Combigan?

Yes, a prescription is required from your physician to order Combigan.