timolol/brimonidine (Rx)

Brand and Other Names:Combigan
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

timolol/brimonidine

ophthalmic solution

  • (5mg/2mg)/mL (0.5%/0.2%)

Elevated IOP in Patients with Glaucoma or Ocular Hypertension

1 gtt in affected eye(s) BID approximately 12 hours apart

Dosage Forms & Strengths

timolol/brimonidine

ophthalmic solution

  • (5mg/2mg)/mL (0.5%/0.2%)

Elevated IOP in Patients with Glaucoma or Ocular Hypertension

<2 years: Contraindicated

≥2 years old: 1 gtt in affected eye(s) BID approximately 12 hours apart

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Interactions

Interaction Checker

and timolol/brimonidine

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            Contraindicated (8)

            • isocarboxazid

              isocarboxazid, brimonidine. Mechanism: unknown. Contraindicated. Contraindicated in mfr prescribing info.

            • linezolid

              linezolid, brimonidine. Mechanism: unknown. Contraindicated. Contraindicated in mfr prescribing info.

            • phenelzine

              phenelzine, brimonidine. Mechanism: unknown. Contraindicated. Contraindicated in mfr prescribing info.

            • procarbazine

              procarbazine, brimonidine. Mechanism: unknown. Contraindicated.

            • rasagiline

              rasagiline, brimonidine. Mechanism: unknown. Contraindicated. Brimonidine should not be used in patients receiving MAO inhibitors.

            • selegiline

              selegiline, brimonidine. Mechanism: unknown. Contraindicated. Coadministration is contraindicated.

            • selegiline transdermal

              selegiline transdermal, brimonidine. Mechanism: unknown. Contraindicated. Contraindicated in mfr prescribing info.

            • tranylcypromine

              tranylcypromine, brimonidine. Mechanism: unknown. Contraindicated. Contraindicated in mfr prescribing info.

            Serious - Use Alternative (34)

            • acebutolol

              acebutolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • artemether/lumefantrine

              artemether/lumefantrine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

            • atenolol

              atenolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • betaxolol

              betaxolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • bisoprolol

              bisoprolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • carvedilol

              carvedilol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • celiprolol

              celiprolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • clonidine

              clonidine, timolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

            • dacomitinib

              dacomitinib will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

            • digoxin

              digoxin, timolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

            • diltiazem

              diltiazem, timolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

            • epinephrine

              timolol increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).

            • epinephrine racemic

              timolol increases effects of epinephrine racemic by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).

            • esmolol

              esmolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • fexinidazole

              fexinidazole, timolol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to induce bradycardia. .

            • fluoxetine

              fluoxetine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

            • givosiran

              givosiran will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

            • iobenguane I 131

              timolol will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

            • labetalol

              labetalol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • lofexidine

              lofexidine, timolol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

            • lumefantrine

              lumefantrine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

            • metoprolol

              metoprolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • nadolol

              nadolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • nebivolol

              nebivolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • paroxetine

              paroxetine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

            • penbutolol

              penbutolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • pindolol

              pindolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • propranolol

              propranolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • quinidine

              quinidine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

            • rivastigmine

              timolol increases toxicity of rivastigmine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive bradycardia effect may result in syncope.

            • sotalol

              sotalol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

            • umeclidinium bromide/vilanterol inhaled

              timolol, umeclidinium bromide/vilanterol inhaled. pharmacodynamic antagonism. Avoid or Use Alternate Drug. If a beta-blocker must be used in patients with COPD taking a beta-agonist, consider using a beta-blocker that is beta-1 selective .

            • verapamil

              verapamil, timolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

            • vilanterol/fluticasone furoate inhaled

              timolol, vilanterol/fluticasone furoate inhaled. pharmacodynamic antagonism. Avoid or Use Alternate Drug. If a beta-blocker must be used in patients with COPD taking a beta-agonist, consider using a beta-blocker that is beta-1 selective .

            Monitor Closely (220)

            • acebutolol

              acebutolol and timolol both increase serum potassium. Use Caution/Monitor.

            • aceclofenac

              timolol and aceclofenac both increase serum potassium. Use Caution/Monitor.

              aceclofenac decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • acemetacin

              timolol and acemetacin both increase serum potassium. Use Caution/Monitor.

              acemetacin decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • albuterol

              timolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              timolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • aldesleukin

              aldesleukin increases effects of timolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • alfuzosin

              alfuzosin and timolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • aluminum hydroxide

              aluminum hydroxide decreases levels of timolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • amifostine

              amifostine, brimonidine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.

              amifostine, timolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.

            • amiloride

              timolol and amiloride both increase serum potassium. Modify Therapy/Monitor Closely.

            • candesartan

              brimonidine increases effects of candesartan by pharmacodynamic synergism. Use Caution/Monitor.

            • amiodarone

              amiodarone will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              amiodarone, timolol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of cardiotoxicity with bradycardia.

            • amlodipine

              timolol and amlodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • amobarbital

              amobarbital decreases levels of timolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of amobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

            • arformoterol

              timolol increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              timolol decreases effects of arformoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • articaine

              timolol, articaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Increased effects of epinephrine in anesthetic; risk of hypertension and bradycardia. Do NOT D/C chronic beta blocker Tx prior to anesthetic administration. Consider selective beta 1 blocker (e.g., metoprolol).

            • asenapine

              asenapine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              asenapine and timolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • aspirin

              timolol and aspirin both increase serum potassium. Use Caution/Monitor.

              aspirin decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • aspirin rectal

              timolol and aspirin rectal both increase serum potassium. Use Caution/Monitor.

              aspirin rectal decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              timolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

            • atazanavir

              atazanavir increases effects of timolol by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of hypotension, bradycardia, AV block, and prolonged PR interval. Consider lowering beta blocker dose.

            • atenolol

              atenolol and timolol both increase serum potassium. Use Caution/Monitor.

            • avanafil

              avanafil increases effects of timolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • bendroflumethiazide

              timolol increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • betaxolol

              betaxolol and timolol both increase serum potassium. Use Caution/Monitor.

            • bismuth subsalicylate

              bismuth subsalicylate, timolol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Blockage of renal prostaglandin synthesis; may cause severe hypertension.

            • bisoprolol

              bisoprolol and timolol both increase serum potassium. Use Caution/Monitor.

            • bretylium

              timolol, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

            • bumetanide

              timolol increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bupivacaine

              timolol, bupivacaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Use extreme caution during concomitant use of bupivacaine and antihypertensive agents.

            • bupropion

              bupropion will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • butabarbital

              butabarbital decreases levels of timolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of butabarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

            • butalbital

              butalbital decreases levels of timolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of butalbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

            • calcium acetate

              calcium acetate decreases effects of timolol by unspecified interaction mechanism. Use Caution/Monitor.

            • calcium carbonate

              calcium carbonate decreases effects of timolol by unspecified interaction mechanism. Use Caution/Monitor.

              calcium carbonate decreases levels of timolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • calcium chloride

              calcium chloride decreases effects of timolol by unspecified interaction mechanism. Use Caution/Monitor.

            • calcium citrate

              calcium citrate decreases effects of timolol by unspecified interaction mechanism. Use Caution/Monitor.

            • calcium gluconate

              calcium gluconate decreases effects of timolol by unspecified interaction mechanism. Use Caution/Monitor.

            • candesartan

              candesartan and timolol both increase serum potassium. Use Caution/Monitor.

              timolol, candesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

            • carbenoxolone

              timolol increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carbidopa

              carbidopa increases effects of timolol by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.

            • carvedilol

              carvedilol and timolol both increase serum potassium. Use Caution/Monitor.

            • celecoxib

              celecoxib will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              timolol and celecoxib both increase serum potassium. Use Caution/Monitor.

              celecoxib decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • celiprolol

              celiprolol and timolol both increase serum potassium. Use Caution/Monitor.

            • chloroprocaine

              timolol, chloroprocaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Increased effects of epinephrine in anesthetic; risk of hypertension and bradycardia. Do NOT D/C chronic beta blocker Tx prior to anesthetic administration. Consider selective beta 1 blocker (e.g., metoprolol).

            • chloroquine

              chloroquine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • chlorothiazide

              timolol increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chlorpropamide

              timolol decreases effects of chlorpropamide by pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers may also mask the symptoms of hypoglycemia.

            • chlorthalidone

              timolol increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • choline magnesium trisalicylate

              timolol and choline magnesium trisalicylate both increase serum potassium. Use Caution/Monitor.

              choline magnesium trisalicylate decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • cimetidine

              cimetidine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • citalopram

              citalopram increases levels of timolol by decreasing metabolism. Use Caution/Monitor.

            • clevidipine

              timolol and clevidipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • clonidine

              timolol, clonidine. Mechanism: pharmacodynamic synergism. Modify Therapy/Monitor Closely. Non selective beta blocker administration during withdrawal from centrally acting alpha agonists may result in rebound hypertension.

            • cobicistat

              cobicistat will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • cyclopenthiazide

              timolol increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • darifenacin

              darifenacin will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • dasiglucagon

              timolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

            • desflurane

              desflurane, timolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • desvenlafaxine

              desvenlafaxine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mg

            • diclofenac

              timolol and diclofenac both increase serum potassium. Use Caution/Monitor.

              diclofenac decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • diflunisal

              timolol and diflunisal both increase serum potassium. Use Caution/Monitor.

              diflunisal decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • digoxin

              timolol and digoxin both increase serum potassium. Use Caution/Monitor.

              timolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

              brimonidine increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

            • diltiazem

              timolol and diltiazem both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • eprosartan

              brimonidine increases effects of eprosartan by pharmacodynamic synergism. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • dobutamine

              timolol increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              timolol decreases effects of dobutamine by pharmacodynamic antagonism. Use Caution/Monitor.

            • dopexamine

              timolol increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              timolol decreases effects of dopexamine by pharmacodynamic antagonism. Use Caution/Monitor.

            • doxazosin

              doxazosin and timolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • dronedarone

              dronedarone will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • drospirenone

              timolol and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.

            • duloxetine

              duloxetine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • eliglustat

              eliglustat increases levels of timolol by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of timolol by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

            • ephedrine

              timolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              timolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • epinephrine

              timolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              timolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • epinephrine inhaled

              timolol decreases effects of epinephrine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. Beta2-adrenergic blockers may may inhibit bronchodilatory effects of epinephrine.

            • epinephrine racemic

              timolol increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              timolol decreases effects of epinephrine racemic by pharmacodynamic antagonism. Use Caution/Monitor.

            • eprosartan

              eprosartan and timolol both increase serum potassium. Use Caution/Monitor.

              timolol, eprosartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

            • esketamine intranasal

              esketamine intranasal, brimonidine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

            • esmolol

              esmolol and timolol both increase serum potassium. Use Caution/Monitor.

            • ethacrynic acid

              timolol increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ether

              timolol, ether. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both beta blockers and ether depress the myocardium; consider lowering beta blocker dose if ether used for anesthesia.

            • etodolac

              timolol and etodolac both increase serum potassium. Use Caution/Monitor.

              etodolac decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • etomidate

              etomidate, timolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • fedratinib

              fedratinib will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

            • felodipine

              timolol and felodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • fenbufen

              timolol and fenbufen both increase serum potassium. Use Caution/Monitor.

            • fenoprofen

              timolol and fenoprofen both increase serum potassium. Use Caution/Monitor.

              fenoprofen decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • fingolimod

              timolol increases effects of fingolimod by pharmacodynamic synergism. Use Caution/Monitor. Both medications decrease heart rate. Monitor patients on concomitant therapy, particularly in the first 6 hours after fingolimod is initiated or after a treatment interruption of at least two weeks, for bradycardia and atrioventricular block. To identify underlying risk factors of bradycardia and AV block, obtain a new or recent ECG in patients using beta-blockers prior to starting fingolimod.

            • flurbiprofen

              timolol and flurbiprofen both increase serum potassium. Use Caution/Monitor.

              flurbiprofen decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • formoterol

              timolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              timolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • furosemide

              timolol increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • gentamicin

              timolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • glimepiride

              timolol decreases effects of glimepiride by pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers may also mask the symptoms of hypoglycemia.

            • glipizide

              timolol decreases effects of glipizide by pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers may also mask the symptoms of hypoglycemia.

            • glucagon

              glucagon decreases toxicity of timolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.

            • glucagon intranasal

              glucagon intranasal decreases toxicity of timolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.

            • glyburide

              timolol decreases effects of glyburide by pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers may also mask the symptoms of hypoglycemia.

            • guanfacine

              timolol, guanfacine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Non selective beta blocker administration during withdrawal from centrally acting alpha agonists may result in rebound hypertension.

            • haloperidol

              haloperidol will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • hydralazine

              hydralazine increases effects of timolol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

            • hydrochlorothiazide

              timolol increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ibuprofen

              timolol and ibuprofen both increase serum potassium. Use Caution/Monitor.

              ibuprofen decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • ibuprofen IV

              ibuprofen IV decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              timolol and ibuprofen IV both increase serum potassium. Use Caution/Monitor.

            • imatinib

              imatinib will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • indacaterol, inhaled

              indacaterol, inhaled, timolol. Other (see comment). Use Caution/Monitor. Comment: Beta-blockers and indacaterol may interfere with the effect of each other when administered concurrently. Beta-blockers may produce severe bronchospasm in COPD patients. Therefore, patients with COPD should not normally be treated with beta-blockers. However, under certain circumstances, e.g. as prophylaxis after myocardial infarction, there may be no acceptable alternatives to the use of beta-blockers in patients with COPD. In this setting, cardioselective beta-blockers could be considered, although they should be administered with caution.

            • indapamide

              timolol increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • indomethacin

              timolol and indomethacin both increase serum potassium. Use Caution/Monitor.

              indomethacin decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • insulin aspart

              timolol, insulin aspart. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.

            • insulin degludec

              timolol, insulin degludec. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

            • insulin degludec/insulin aspart

              timolol, insulin degludec/insulin aspart. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

            • insulin detemir

              timolol, insulin detemir. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.

            • insulin glargine

              timolol, insulin glargine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.

            • insulin glulisine

              timolol, insulin glulisine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.

            • insulin inhaled

              timolol, insulin inhaled. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

            • insulin lispro

              timolol, insulin lispro. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.

            • insulin NPH

              timolol, insulin NPH. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.

            • insulin regular human

              timolol, insulin regular human. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.

            • irbesartan

              timolol, irbesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              irbesartan and timolol both increase serum potassium. Use Caution/Monitor.

              brimonidine increases effects of irbesartan by pharmacodynamic synergism. Use Caution/Monitor.

            • isoproterenol

              timolol increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              timolol decreases effects of isoproterenol by pharmacodynamic antagonism. Use Caution/Monitor.

            • lasmiditan

              lasmiditan, brimonidine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

            • isradipine

              timolol and isradipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • ivabradine

              ivabradine, timolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Most patients receiving ivabradine will also be treated with a beta-blocker. The risk of bradycardia increases with coadministration of drugs that slow heart rate (eg, digoxin, amiodarone, beta-blockers). Monitor heart rate in patients taking ivabradine with other negative chronotropes.

            • ketamine

              ketamine, timolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • ketoprofen

              timolol and ketoprofen both increase serum potassium. Use Caution/Monitor.

              ketoprofen decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • ketorolac

              timolol and ketorolac both increase serum potassium. Use Caution/Monitor.

              ketorolac decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • ketorolac intranasal

              timolol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

              ketorolac intranasal decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • labetalol

              labetalol and timolol both increase serum potassium. Use Caution/Monitor.

            • lasmiditan

              timolol increases effects of lasmiditan by pharmacodynamic synergism. Use Caution/Monitor. Lasmiditan has been associated with a lowering of heart rate (HR). In a drug interaction study, addition of a single 200-mg dose of lasmiditan to propranolol decreased HR by an additional 5 bpm compared to propranolol alone, for a mean maximum of 19 bpm.

            • levalbuterol

              timolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              timolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • levodopa

              levodopa increases effects of timolol by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.

            • lidocaine

              timolol, lidocaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Increased effects of epinephrine in anesthetic; risk of hypertension and bradycardia. Do NOT D/C chronic beta blocker Tx prior to anesthetic administration. Consider selective beta 1 blocker (e.g., metoprolol).

              timolol increases levels of lidocaine by decreasing elimination. Use Caution/Monitor. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).

            • lopinavir

              lopinavir increases levels of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of PR prolongation and cardiac arrhythmias. .

            • lorcaserin

              lorcaserin will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • lornoxicam

              timolol and lornoxicam both increase serum potassium. Use Caution/Monitor.

              lornoxicam decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • losartan

              losartan and timolol both increase serum potassium. Use Caution/Monitor.

              timolol, losartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              brimonidine increases effects of losartan by pharmacodynamic synergism. Use Caution/Monitor.

            • lurasidone

              lurasidone, brimonidine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased sedation.

              lurasidone increases effects of timolol by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.

            • maraviroc

              maraviroc will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • nitroglycerin rectal

              nitroglycerin rectal, brimonidine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Observe for possible additive hypotensive effects during concomitant use. .

            • marijuana

              marijuana will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • meclofenamate

              meclofenamate decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              timolol and meclofenamate both increase serum potassium. Use Caution/Monitor.

            • mefenamic acid

              timolol and mefenamic acid both increase serum potassium. Use Caution/Monitor.

              mefenamic acid decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • mefloquine

              mefloquine increases levels of timolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • meloxicam

              timolol and meloxicam both increase serum potassium. Use Caution/Monitor.

              meloxicam decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • mepivacaine

              timolol, mepivacaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Use extreme caution during concomitant use of bupivacaine and antihypertensive agents.

            • metaproterenol

              timolol increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              timolol decreases effects of metaproterenol by pharmacodynamic antagonism. Use Caution/Monitor.

            • methyclothiazide

              timolol increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • methyldopa

              timolol, methyldopa. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Non selective beta blocker administration during withdrawal from methyldopa may result in rebound hypertension.

            • methylphenidate

              methylphenidate will decrease the level or effect of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • metolazone

              timolol increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metoprolol

              metoprolol and timolol both increase serum potassium. Use Caution/Monitor.

            • mirabegron

              mirabegron will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • moxisylyte

              moxisylyte and timolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • nabumetone

              timolol and nabumetone both increase serum potassium. Use Caution/Monitor.

              nabumetone decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • nadolol

              nadolol and timolol both increase serum potassium. Use Caution/Monitor.

            • naproxen

              timolol and naproxen both increase serum potassium. Use Caution/Monitor.

              naproxen decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • nebivolol

              nebivolol and timolol both increase serum potassium. Use Caution/Monitor.

            • nicardipine

              timolol and nicardipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • nifedipine

              timolol and nifedipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • nilotinib

              nilotinib will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • nisoldipine

              timolol and nisoldipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • nitroglycerin rectal

              nitroglycerin rectal, timolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers blunt the reflex tachycardia produced by nitroglycerin without preventing its hypotensive effects. If beta-blockers are used with nitroglycerin in patients with angina pectoris, additional hypotensive effects may occur.

            • norepinephrine

              timolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              timolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • olmesartan

              timolol, olmesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              brimonidine increases effects of olmesartan by pharmacodynamic synergism. Use Caution/Monitor.

              olmesartan and timolol both increase serum potassium. Use Caution/Monitor.

            • olodaterol inhaled

              timolol, olodaterol inhaled. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor. Beta-blockers and olodaterol may interfere with the effect of each other when administered concurrently. Beta-blockers may produce severe bronchospasm in COPD patients. Therefore, patients with COPD should not normally be treated with beta-blockers. However, under certain circumstances, e.g. as prophylaxis after myocardial infarction, there may be no acceptable alternatives to the use of beta-blockers in patients with COPD. In this setting, cardioselective beta-blockers could be considered, although they should be administered with caution.

            • sacubitril/valsartan

              brimonidine increases effects of sacubitril/valsartan by pharmacodynamic synergism. Use Caution/Monitor.

            • oxaprozin

              timolol and oxaprozin both increase serum potassium. Use Caution/Monitor.

              oxaprozin decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • oxymetazoline intranasal

              timolol increases effects of oxymetazoline intranasal by pharmacodynamic synergism. Use Caution/Monitor. When beta-2 receptors are antagonized by nonselective beta blockers, alpha1 vasoconstriction may be unopposed, thus increasing hypertensive effect. When oxymetazoline is combined with intranasal tetracaine for dental anesthesia, avoid or use an alternant anesthetic in patients taking nonselective beta blockers.

            • oxymetazoline topical

              oxymetazoline topical increases and timolol decreases sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • parecoxib

              parecoxib will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              timolol and parecoxib both increase serum potassium. Use Caution/Monitor.

              parecoxib decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • peginterferon alfa 2b

              peginterferon alfa 2b, timolol. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.

            • penbutolol

              penbutolol and timolol both increase serum potassium. Use Caution/Monitor.

            • pentobarbital

              pentobarbital decreases levels of timolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of pentobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

            • perphenazine

              perphenazine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • phenobarbital

              phenobarbital decreases levels of timolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of phenobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

            • phenoxybenzamine

              phenoxybenzamine and timolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • phentolamine

              phentolamine and timolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • phenylephrine

              timolol increases effects of phenylephrine by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode (rare).

            • phenylephrine PO

              timolol increases effects of phenylephrine PO by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode (rare).

            • pindolol

              pindolol and timolol both increase serum potassium. Use Caution/Monitor.

            • pirbuterol

              timolol increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              timolol decreases effects of pirbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • piroxicam

              timolol and piroxicam both increase serum potassium. Use Caution/Monitor.

              piroxicam decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • ponesimod

              ponesimod and timolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

            • potassium acid phosphate

              timolol and potassium acid phosphate both increase serum potassium. Modify Therapy/Monitor Closely.

            • potassium chloride

              timolol and potassium chloride both increase serum potassium. Modify Therapy/Monitor Closely.

            • potassium citrate

              timolol and potassium citrate both increase serum potassium. Modify Therapy/Monitor Closely.

            • prazosin

              prazosin and timolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • prilocaine

              timolol, prilocaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Use extreme caution during concomitant use of bupivacaine and antihypertensive agents.

            • primidone

              primidone decreases levels of timolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of primidone. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

            • propafenone

              propafenone will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • propofol

              propofol, timolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • propranolol

              propranolol and timolol both increase serum potassium. Use Caution/Monitor.

            • quinacrine

              quinacrine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • ranolazine

              ranolazine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • ritonavir

              ritonavir increases levels of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Potential for increased toxicity. Increased risk of hypotension, bradycardia, AV block, and prolonged PR interval. Consider lowering beta blocker dose.

            • rolapitant

              rolapitant will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

            • ropivacaine

              timolol, ropivacaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Use extreme caution during concomitant use of bupivacaine and antihypertensive agents.

            • sacubitril/valsartan

              sacubitril/valsartan and timolol both increase serum potassium. Use Caution/Monitor.

              timolol, sacubitril/valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

            • salicylates (non-asa)

              timolol and salicylates (non-asa) both increase serum potassium. Use Caution/Monitor.

              salicylates (non-asa) decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • salmeterol

              timolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              timolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • salsalate

              timolol and salsalate both increase serum potassium. Use Caution/Monitor.

              salsalate decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • saquinavir

              saquinavir, timolol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Use alternatives if available. Increased risk of PR prolongation and cardiac arrhythmias.

            • secobarbital

              secobarbital decreases levels of timolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of secobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

            • sertraline

              sertraline will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • sevoflurane

              sevoflurane, timolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • sildenafil

              timolol increases effects of sildenafil by additive vasodilation. Use Caution/Monitor. Sildenafil has systemic vasodilatory properties and may further lower blood pressure in patients taking antihypertensive medications. Monitor blood pressure response to sildenafil in patients receiving concurrent blood pressure lowering therapy.

            • silodosin

              silodosin and timolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • siponimod

              siponimod, timolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Caution when siponimod is initiated in patients receiving beta-blocker treatment because of additive effects on lowering heart rate. Temporary interruption of beta-blocker may be needed before initiating siponimod. Beta-blocker treatment can be initiated in patients receiving stable doses of siponimod.

            • sodium bicarbonate

              sodium bicarbonate decreases levels of timolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • sodium citrate/citric acid

              sodium citrate/citric acid decreases levels of timolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • sotalol

              sotalol and timolol both increase serum potassium. Use Caution/Monitor.

            • spironolactone

              timolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

            • stiripentol

              stiripentol, brimonidine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

            • succinylcholine

              timolol and succinylcholine both increase serum potassium. Use Caution/Monitor.

            • sulfasalazine

              timolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.

              sulfasalazine decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • sulindac

              timolol and sulindac both increase serum potassium. Use Caution/Monitor.

              sulindac decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

            • tadalafil

              tadalafil increases effects of timolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • telmisartan

              timolol, telmisartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              telmisartan and timolol both increase serum potassium. Use Caution/Monitor.

              brimonidine increases effects of telmisartan by pharmacodynamic synergism. Use Caution/Monitor.

            • terazosin

              terazosin and timolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • valsartan

              brimonidine increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor.

            Minor (195)

            • acebutolol

              brimonidine increases effects of acebutolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • adenosine

              timolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

            • agrimony

              agrimony increases effects of timolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • alfentanil

              brimonidine increases effects of alfentanil by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • alfuzosin

              brimonidine increases effects of alfuzosin by pharmacodynamic synergism. Minor/Significance Unknown.

            • alprazolam

              brimonidine increases effects of alprazolam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • amiloride

              brimonidine increases effects of amiloride by pharmacodynamic synergism. Minor/Significance Unknown.

            • amitriptyline

              amitriptyline decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • amlodipine

              brimonidine increases effects of amlodipine by pharmacodynamic synergism. Minor/Significance Unknown.

            • amobarbital

              brimonidine increases effects of amobarbital by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • amoxapine

              amoxapine decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • aripiprazole

              brimonidine increases effects of aripiprazole by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • asenapine

              brimonidine increases effects of asenapine by pharmacodynamic synergism. Minor/Significance Unknown.

            • atenolol

              brimonidine increases effects of atenolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • azelastine

              brimonidine increases effects of azelastine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • belladonna and opium

              brimonidine increases effects of belladonna and opium by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • benazepril

              brimonidine increases effects of benazepril by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

            • bendroflumethiazide

              brimonidine increases effects of bendroflumethiazide by pharmacodynamic synergism. Minor/Significance Unknown.

            • benperidol

              brimonidine increases effects of benperidol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • betaxolol

              brimonidine increases effects of betaxolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • bisoprolol

              brimonidine increases effects of bisoprolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • bosentan

              brimonidine increases effects of bosentan by pharmacodynamic synergism. Minor/Significance Unknown.

            • brimonidine

              brimonidine increases effects of timolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • brompheniramine

              brimonidine increases effects of brompheniramine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • bumetanide

              brimonidine increases effects of bumetanide by pharmacodynamic synergism. Minor/Significance Unknown.

            • buprenorphine

              brimonidine increases effects of buprenorphine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • buprenorphine buccal

              brimonidine increases effects of buprenorphine buccal by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • butabarbital

              brimonidine increases effects of butabarbital by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • butalbital

              brimonidine increases effects of butalbital by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • butorphanol

              brimonidine increases effects of butorphanol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • captopril

              brimonidine increases effects of captopril by pharmacodynamic synergism. Minor/Significance Unknown. Both drugs lower blood pressure. Monitor blood pressure.

            • carbinoxamine

              brimonidine increases effects of carbinoxamine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • carvedilol

              brimonidine increases effects of carvedilol by pharmacodynamic synergism. Minor/Significance Unknown.

            • celiprolol

              brimonidine increases effects of celiprolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • cevimeline

              cevimeline increases effects of timolol by unspecified interaction mechanism. Minor/Significance Unknown.

            • chloral hydrate

              brimonidine increases effects of chloral hydrate by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • chlordiazepoxide

              brimonidine increases effects of chlordiazepoxide by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • chlorothiazide

              brimonidine increases effects of chlorothiazide by pharmacodynamic synergism. Minor/Significance Unknown.

            • chlorpheniramine

              brimonidine increases effects of chlorpheniramine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • chlorpromazine

              brimonidine increases effects of chlorpromazine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • chlorthalidone

              brimonidine increases effects of chlorthalidone by pharmacodynamic synergism. Minor/Significance Unknown.

            • cinnarizine

              brimonidine increases effects of cinnarizine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • ciprofloxacin

              ciprofloxacin increases levels of timolol by decreasing metabolism. Minor/Significance Unknown. May also rarely decrease beta blocker levels.

            • clemastine

              brimonidine increases effects of clemastine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • clevidipine

              brimonidine increases effects of clevidipine by pharmacodynamic synergism. Minor/Significance Unknown.

            • clomipramine

              clomipramine decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • clonazepam

              brimonidine increases effects of clonazepam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • clonidine

              brimonidine increases effects of clonidine by pharmacodynamic synergism. Minor/Significance Unknown.

            • clorazepate

              brimonidine increases effects of clorazepate by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • clozapine

              brimonidine increases effects of clozapine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • cocaine

              timolol increases effects of cocaine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of angina.

            • codeine

              brimonidine increases effects of codeine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • cornsilk

              cornsilk increases effects of timolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • cyclizine

              brimonidine increases effects of cyclizine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • cyclopenthiazide

              brimonidine increases effects of cyclopenthiazide by pharmacodynamic synergism. Minor/Significance Unknown.

            • cyproheptadine

              brimonidine increases effects of cyproheptadine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • desipramine

              desipramine decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • dexchlorpheniramine

              brimonidine increases effects of dexchlorpheniramine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • dexmedetomidine

              brimonidine increases effects of dexmedetomidine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • dextromoramide

              brimonidine increases effects of dextromoramide by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • diamorphine

              brimonidine increases effects of diamorphine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • diazepam

              brimonidine increases effects of diazepam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • difenoxin hcl

              brimonidine increases effects of difenoxin hcl by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • dihydroergotamine

              dihydroergotamine, timolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.

            • dihydroergotamine intranasal

              dihydroergotamine intranasal, timolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.

            • diltiazem

              brimonidine increases effects of diltiazem by pharmacodynamic synergism. Minor/Significance Unknown.

            • dimenhydrinate

              brimonidine increases effects of dimenhydrinate by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • diphenhydramine

              brimonidine increases effects of diphenhydramine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • diphenoxylate hcl

              brimonidine increases effects of diphenoxylate hcl by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • dipipanone

              brimonidine increases effects of dipipanone by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • dipyridamole

              dipyridamole, timolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

            • doxazosin

              brimonidine increases effects of doxazosin by pharmacodynamic synergism. Minor/Significance Unknown.

            • doxepin

              doxepin decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • doxylamine

              brimonidine increases effects of doxylamine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • droperidol

              brimonidine increases effects of droperidol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • drospirenone

              brimonidine increases effects of drospirenone by pharmacodynamic synergism. Minor/Significance Unknown.

            • enalapril

              brimonidine increases effects of enalapril by pharmacodynamic synergism. Minor/Significance Unknown.

            • eplerenone

              brimonidine increases effects of eplerenone by pharmacodynamic synergism. Minor/Significance Unknown.

            • epoprostenol

              brimonidine increases effects of epoprostenol by pharmacodynamic synergism. Minor/Significance Unknown.

            • escitalopram

              escitalopram increases levels of timolol by decreasing metabolism. Minor/Significance Unknown.

            • esmolol

              brimonidine increases effects of esmolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • estazolam

              brimonidine increases effects of estazolam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • ethacrynic acid

              brimonidine increases effects of ethacrynic acid by pharmacodynamic synergism. Minor/Significance Unknown.

            • ethanol

              brimonidine increases effects of ethanol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • etomidate

              brimonidine increases effects of etomidate by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • felodipine

              brimonidine increases effects of felodipine by pharmacodynamic synergism. Minor/Significance Unknown.

            • fenoldopam

              fenoldopam increases effects of timolol by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              brimonidine increases effects of fenoldopam by pharmacodynamic synergism. Minor/Significance Unknown.

            • fluphenazine

              brimonidine increases effects of fluphenazine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • forskolin

              forskolin increases effects of timolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • flurazepam

              brimonidine increases effects of flurazepam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • fosinopril

              brimonidine increases effects of fosinopril by pharmacodynamic synergism. Minor/Significance Unknown.

            • furosemide

              brimonidine increases effects of furosemide by pharmacodynamic synergism. Minor/Significance Unknown.

            • guanfacine

              brimonidine increases effects of guanfacine by pharmacodynamic synergism. Minor/Significance Unknown.

            • haloperidol

              brimonidine increases effects of haloperidol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • hydralazine

              brimonidine increases effects of hydralazine by pharmacodynamic synergism. Minor/Significance Unknown.

            • hydrochlorothiazide

              brimonidine increases effects of hydrochlorothiazide by pharmacodynamic synergism. Minor/Significance Unknown.

            • hydromorphone

              brimonidine increases effects of hydromorphone by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • hydroxyzine

              brimonidine increases effects of hydroxyzine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • iloperidone

              brimonidine increases effects of iloperidone by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • iloprost

              brimonidine increases effects of iloprost by pharmacodynamic synergism. Minor/Significance Unknown.

            • imaging agents (gadolinium)

              timolol, imaging agents (gadolinium). Mechanism: unknown. Minor/Significance Unknown. Increased risk of anaphylaxis from contrast media.

            • imidapril

              brimonidine increases effects of imidapril by pharmacodynamic synergism. Minor/Significance Unknown.

            • imipramine

              imipramine decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • indapamide

              brimonidine increases effects of indapamide by pharmacodynamic synergism. Minor/Significance Unknown.

            • isradipine

              brimonidine increases effects of isradipine by pharmacodynamic synergism. Minor/Significance Unknown.

            • ketanserin

              brimonidine increases effects of ketanserin by pharmacodynamic synergism. Minor/Significance Unknown.

            • labetalol

              brimonidine increases effects of labetalol by pharmacodynamic synergism. Minor/Significance Unknown.

            • levobetaxolol

              levobetaxolol increases effects of timolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • levorphanol

              brimonidine increases effects of levorphanol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • lisinopril

              brimonidine increases effects of lisinopril by pharmacodynamic synergism. Minor/Significance Unknown.

            • lofepramine

              lofepramine decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • loprazolam

              brimonidine increases effects of loprazolam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • lorazepam

              brimonidine increases effects of lorazepam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • lormetazepam

              brimonidine increases effects of lormetazepam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • loxapine

              brimonidine increases effects of loxapine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • loxapine inhaled

              brimonidine increases effects of loxapine inhaled by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • maitake

              maitake increases effects of timolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • maprotiline

              maprotiline decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • mecamylamine

              brimonidine increases effects of mecamylamine by pharmacodynamic synergism. Minor/Significance Unknown.

            • melatonin

              melatonin decreases toxicity of timolol by pharmacodynamic antagonism. Minor/Significance Unknown. Melatonin may correct beta blocker induced sleep disturbances.

            • meperidine

              brimonidine increases effects of meperidine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • meprobamate

              brimonidine increases effects of meprobamate by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • methadone

              brimonidine increases effects of methadone by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • methyclothiazide

              brimonidine increases effects of methyclothiazide by pharmacodynamic synergism. Minor/Significance Unknown.

            • metipranolol ophthalmic

              metipranolol ophthalmic increases effects of timolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • metolazone

              brimonidine increases effects of metolazone by pharmacodynamic synergism. Minor/Significance Unknown.

            • metoprolol

              brimonidine increases effects of metoprolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • metyrosine

              brimonidine increases effects of metyrosine by pharmacodynamic synergism. Minor/Significance Unknown.

            • midazolam

              brimonidine increases effects of midazolam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • minoxidil

              brimonidine increases effects of minoxidil by pharmacodynamic synergism. Minor/Significance Unknown.

            • moexipril

              brimonidine increases effects of moexipril by pharmacodynamic synergism. Minor/Significance Unknown.

            • morphine

              brimonidine increases effects of morphine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • moxisylyte

              brimonidine increases effects of moxisylyte by pharmacodynamic synergism. Minor/Significance Unknown.

            • moxonidine

              brimonidine increases effects of moxonidine by pharmacodynamic synergism. Minor/Significance Unknown.

            • nadolol

              brimonidine increases effects of nadolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • nalbuphine

              brimonidine increases effects of nalbuphine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • nebivolol

              brimonidine increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • neostigmine

              timolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

            • nicardipine

              brimonidine increases effects of nicardipine by pharmacodynamic synergism. Minor/Significance Unknown.

            • nifedipine

              brimonidine increases effects of nifedipine by pharmacodynamic synergism. Minor/Significance Unknown.

            • nisoldipine

              brimonidine increases effects of nisoldipine by pharmacodynamic synergism. Minor/Significance Unknown.

            • noni juice

              timolol and noni juice both increase serum potassium. Minor/Significance Unknown.

            • nortriptyline

              nortriptyline decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • octacosanol

              octacosanol increases effects of timolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • olanzapine

              brimonidine increases effects of olanzapine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • opium tincture

              brimonidine increases effects of opium tincture by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • oxazepam

              brimonidine increases effects of oxazepam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • oxycodone

              brimonidine increases effects of oxycodone by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • oxymorphone

              brimonidine increases effects of oxymorphone by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • paliperidone

              brimonidine increases effects of paliperidone by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • papaveretum

              brimonidine increases effects of papaveretum by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • penbutolol

              brimonidine increases effects of penbutolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • pentazocine

              brimonidine increases effects of pentazocine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • pentobarbital

              brimonidine increases effects of pentobarbital by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • perindopril

              brimonidine increases effects of perindopril by pharmacodynamic synergism. Minor/Significance Unknown.

            • perphenazine

              brimonidine increases effects of perphenazine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • phenobarbital

              brimonidine increases effects of phenobarbital by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • phenoxybenzamine

              brimonidine increases effects of phenoxybenzamine by pharmacodynamic synergism. Minor/Significance Unknown.

            • phentolamine

              brimonidine increases effects of phentolamine by pharmacodynamic synergism. Minor/Significance Unknown.

            • physostigmine

              timolol, physostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

            • pilocarpine

              pilocarpine increases effects of timolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • pimozide

              brimonidine increases effects of pimozide by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • pindolol

              brimonidine increases effects of pindolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • prazosin

              brimonidine increases effects of prazosin by pharmacodynamic synergism. Minor/Significance Unknown.

            • primidone

              brimonidine increases effects of primidone by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • prochlorperazine

              brimonidine increases effects of prochlorperazine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • promethazine

              brimonidine increases effects of promethazine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • propranolol

              brimonidine increases effects of propranolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • protriptyline

              protriptyline decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • quazepam

              brimonidine increases effects of quazepam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • quetiapine

              brimonidine increases effects of quetiapine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • quinapril

              brimonidine increases effects of quinapril by pharmacodynamic synergism. Minor/Significance Unknown.

            • ramipril

              brimonidine increases effects of ramipril by pharmacodynamic synergism. Minor/Significance Unknown.

            • reishi

              reishi increases effects of timolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • risperidone

              brimonidine increases effects of risperidone by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • secobarbital

              brimonidine increases effects of secobarbital by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • shepherd's purse

              shepherd's purse, timolol. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.

            • silodosin

              brimonidine increases effects of silodosin by pharmacodynamic synergism. Minor/Significance Unknown.

            • sotalol

              brimonidine increases effects of sotalol by pharmacodynamic synergism. Minor/Significance Unknown.

            • spironolactone

              brimonidine increases effects of spironolactone by pharmacodynamic synergism. Minor/Significance Unknown.

            • sufentanil

              brimonidine increases effects of sufentanil by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • tapentadol

              brimonidine increases effects of tapentadol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • temazepam

              brimonidine increases effects of temazepam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • terazosin

              brimonidine increases effects of terazosin by pharmacodynamic synergism. Minor/Significance Unknown.

            • thioridazine

              brimonidine increases effects of thioridazine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • thiothixene

              brimonidine increases effects of thiothixene by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • timolol

              brimonidine increases effects of timolol by pharmacodynamic synergism. Minor/Significance Unknown.

            • tizanidine

              tizanidine increases effects of timolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

            • torsemide

              brimonidine increases effects of torsemide by pharmacodynamic synergism. Minor/Significance Unknown.

            • tramadol

              brimonidine increases effects of tramadol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • trandolapril

              brimonidine increases effects of trandolapril by pharmacodynamic synergism. Minor/Significance Unknown.

            • trazodone

              trazodone decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • treprostinil

              treprostinil increases effects of timolol by pharmacodynamic synergism. Minor/Significance Unknown.

              brimonidine increases effects of treprostinil by pharmacodynamic synergism. Minor/Significance Unknown.

            • triamterene

              brimonidine increases effects of triamterene by pharmacodynamic synergism. Minor/Significance Unknown.

            • yohimbe

              timolol decreases toxicity of yohimbe by pharmacodynamic antagonism. Minor/Significance Unknown.

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            Adverse Effects

            5-15%

            Allergic conjunctivitis

            Conjunctival folliculosis

            Conjunctival hyperemia

            Eye pruritus

            Ocular burning

            Stinging

            1-5%

            Asthenia

            Blepharitis

            Corneal erosion

            Depression

            Epiphora

            Eye discharge

            Eye dryness

            Eye irritation

            Eye pain

            Eyelid edema

            Eyelid erythema

            Eyelid pruritus

            Foreign body sensation

            Headache

            Hypertension

            Oral dryness

            Somnolence

            Superficial punctate keratitis

            Visual disturbance

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            Warnings

            Contraindications

            Hypersensitivity to either product or other components

            Reactive airway disease, including severe COPD or active or history of bronchial asthma

            Sinus bradycardia, 2°/3° AV block, overt cardiac failure, cardiogenic shock

            Concurrency with MAO inhibitors

            Cautions

            Not to be used alone for acute angle-closure glaucoma

            Depression, cerebral or coronary insufficiency, Raynaud's phenomenon, orthostatic hypotension, thromboangiitis obliterans, diabetes mellitus, severe cardiovascular dz, renal/hepatic impairment, myasthenia gravis

            Ocular hypersensitivity reported with brimonidine ophthalmic solutions; including some reports with Increased IOP

            If other eye drops used, instill at least 5 min apart

            May mask hyperthyroidism/thyrotoxicosis symptoms

            Remove soft contact lenses; may reinsert 15 min post-instillation

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: use caution

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Images

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            Patient Handout

            A Patient Handout is not currently available for this monograph.
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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
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            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.