Dosing & Uses
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
Dosing considerations
If more than one topical ophthalmic product is to be used, the different products should be instilled at least 5 minutes 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
Dosing considerations
If more than one topical ophthalmic product is to be used, the different products should be instilled at least 5 minutes apart
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

Contraindicated (9)
- 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.
- thalidomide
brimonidine and thalidomide both increase sedation. Contraindicated.
- tranylcypromine
tranylcypromine, brimonidine. Mechanism: unknown. Contraindicated. Contraindicated in mfr prescribing info.
Serious - Use Alternative (50)
- acebutolol
acebutolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- alfentanil
brimonidine and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- 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.
- buprenorphine
brimonidine and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- buprenorphine buccal
brimonidine and buprenorphine buccal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- buprenorphine subdermal implant
brimonidine and buprenorphine subdermal implant both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- buprenorphine transdermal
brimonidine and buprenorphine transdermal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- buprenorphine, long-acting injection
brimonidine and buprenorphine, long-acting injection both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- 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.
- codeine
brimonidine and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- 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.
- fentanyl
brimonidine and fentanyl both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fentanyl intranasal
brimonidine and fentanyl intranasal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fentanyl iontophoretic transdermal system
brimonidine and fentanyl iontophoretic transdermal system both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fentanyl transdermal
brimonidine and fentanyl transdermal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fentanyl transmucosal
brimonidine and fentanyl transmucosal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- 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.
- hydrocodone
brimonidine and hydrocodone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- hydromorphone
brimonidine and hydromorphone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- 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.
- mavacamten
timolol, mavacamten. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Expect additive negative inotropic effects of mavacamten and other drugs that reduce cardiac contractility.
- methadone
brimonidine and methadone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- metoprolol
metoprolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- morphine
brimonidine and morphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- 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.
- oxycodone
brimonidine and oxycodone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- oxymorphone
brimonidine and oxymorphone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- 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.
- remifentanil
brimonidine and remifentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- rivastigmine
timolol increases toxicity of rivastigmine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive bradycardia effect may result in syncope.
Monitor Closely (368)
- 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. - acetaminophen/phenyltoloxamine
brimonidine and acetaminophen/phenyltoloxamine both increase sedation. Use Caution/Monitor.
- acrivastine
acrivastine and brimonidine both increase sedation. Use Caution/Monitor.
- 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.
- alprazolam
brimonidine and alprazolam both increase sedation. Use Caution/Monitor.
- 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.
- amisulpride
amisulpride and brimonidine both increase sedation. 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. - amitriptyline
brimonidine and amitriptyline both increase sedation. Use Caution/Monitor.
- 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.
brimonidine and amobarbital both increase sedation. Use Caution/Monitor. - amoxapine
brimonidine and amoxapine both increase sedation. Use Caution/Monitor.
- 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. - aripiprazole
brimonidine and aripiprazole both increase sedation. 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.
asenapine and brimonidine both increase sedation. Use Caution/Monitor. - asenapine transdermal
asenapine transdermal and brimonidine both increase sedation. Use Caution/Monitor.
- 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.
- avapritinib
avapritinib and brimonidine both increase sedation. Use Caution/Monitor.
brimonidine and avapritinib both increase sedation. Use Caution/Monitor. - baclofen
brimonidine and baclofen both increase sedation. Use Caution/Monitor.
- bendroflumethiazide
timolol increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen and brimonidine both increase sedation. 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.
- brexanolone
brimonidine and brexanolone both increase sedation. Use Caution/Monitor.
- brexpiprazole
brexpiprazole and brimonidine both increase sedation. Use Caution/Monitor.
brimonidine and brexpiprazole both increase sedation. Use Caution/Monitor. - brivaracetam
brimonidine and brivaracetam both increase sedation. Use Caution/Monitor.
brivaracetam and brimonidine both increase sedation. Use Caution/Monitor. - brompheniramine
brimonidine and brompheniramine both increase sedation. Use Caution/Monitor.
- 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.
- buprenorphine subdermal implant
buprenorphine subdermal implant and brimonidine both increase sedation. Use Caution/Monitor.
- 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.
brimonidine and butabarbital both increase sedation. Use Caution/Monitor. - butalbital
brimonidine and butalbital both increase sedation. Use Caution/Monitor.
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. - butorphanol
brimonidine and butorphanol both increase sedation. Use Caution/Monitor.
- 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
timolol, candesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
candesartan and timolol both increase serum potassium. Use Caution/Monitor.
brimonidine increases effects of candesartan by pharmacodynamic synergism. Use Caution/Monitor. - carbenoxolone
timolol increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbinoxamine
brimonidine and carbinoxamine both increase sedation. 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.
- cariprazine
brimonidine and cariprazine both increase sedation. Use Caution/Monitor.
- carisoprodol
brimonidine and carisoprodol both increase sedation. Use Caution/Monitor.
- 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.
- cenobamate
brimonidine and cenobamate both increase sedation. Use Caution/Monitor.
- cetirizine
brimonidine and cetirizine both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
brimonidine and chlordiazepoxide both increase sedation. 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.
- chlorpheniramine
brimonidine and chlorpheniramine both increase sedation. Use Caution/Monitor.
- chlorpromazine
brimonidine and chlorpromazine both increase sedation. 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.
- chlorzoxazone
brimonidine and chlorzoxazone both increase sedation. 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.
- clemastine
brimonidine and clemastine both increase sedation. Use Caution/Monitor.
- clevidipine
timolol and clevidipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- clobazam
brimonidine and clobazam both increase sedation. Use Caution/Monitor.
- clomipramine
brimonidine and clomipramine both increase sedation. Use Caution/Monitor.
- clonazepam
brimonidine and clonazepam both increase sedation. Use Caution/Monitor.
- clonidine
brimonidine and clonidine both increase sedation. Use Caution/Monitor.
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. - clorazepate
brimonidine and clorazepate both increase sedation. Use Caution/Monitor.
- cobicistat
cobicistat will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- clozapine
brimonidine and clozapine both increase sedation. Use Caution/Monitor.
- cyclobenzaprine
brimonidine and cyclobenzaprine both increase sedation. Use Caution/Monitor.
- cyclopenthiazide
timolol increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyproheptadine
brimonidine and cyproheptadine both increase sedation. Use Caution/Monitor.
- dantrolene
brimonidine and dantrolene both increase sedation. Use Caution/Monitor.
- daridorexant
brimonidine and daridorexant both increase sedation. 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.
brimonidine and desflurane both increase sedation. Use Caution/Monitor. - desipramine
brimonidine and desipramine both increase sedation. Use Caution/Monitor.
- 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
- deutetrabenazine
brimonidine and deutetrabenazine both increase sedation. Use Caution/Monitor.
- dexbrompheniramine
brimonidine and dexbrompheniramine both increase sedation. Use Caution/Monitor.
- dexchlorpheniramine
brimonidine and dexchlorpheniramine both increase sedation. Use Caution/Monitor.
- diazepam
brimonidine and diazepam both increase sedation. Use Caution/Monitor.
- 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. - difenoxin hcl
brimonidine and difenoxin hcl both increase sedation. Use Caution/Monitor.
- 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.
- dimenhydrinate
brimonidine and dimenhydrinate both increase sedation. Use Caution/Monitor.
- diphenhydramine
brimonidine and diphenhydramine both increase sedation. Use Caution/Monitor.
diphenhydramine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. - diphenoxylate hcl
brimonidine and diphenoxylate hcl both increase sedation. 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.
- doxepin
brimonidine and doxepin both increase sedation. Use Caution/Monitor.
- doxylamine
brimonidine and doxylamine both increase sedation. Use Caution/Monitor.
- dronedarone
dronedarone will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- droperidol
brimonidine and droperidol both increase sedation. 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.
- efavirenz
brimonidine and efavirenz both increase sedation. 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.
- entacapone
brimonidine and entacapone both increase sedation. Use Caution/Monitor.
- 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
timolol, eprosartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
eprosartan and timolol both increase serum potassium. Use Caution/Monitor.
brimonidine increases effects of eprosartan by pharmacodynamic synergism. Use Caution/Monitor. - 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.
- estazolam
brimonidine and estazolam both increase sedation. Use Caution/Monitor.
- eszopiclone
brimonidine and eszopiclone both increase sedation. Use Caution/Monitor.
- ethacrynic acid
timolol increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ethanol
brimonidine and ethanol both increase sedation. 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.
- ethosuximide
brimonidine and ethosuximide both increase sedation. Use Caution/Monitor.
- ethotoin
brimonidine and ethotoin both increase sedation. Use Caution/Monitor.
- 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.
- felbamate
brimonidine and felbamate both increase sedation. Use Caution/Monitor.
- 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.
- fenfluramine
brimonidine and fenfluramine both increase sedation. 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. - fexofenadine
brimonidine and fexofenadine both increase sedation. Use Caution/Monitor.
- 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.
- flibanserin
brimonidine and flibanserin both increase sedation. Use Caution/Monitor.
- fluphenazine
brimonidine and fluphenazine both increase sedation. Use Caution/Monitor.
- flurazepam
brimonidine and flurazepam both increase sedation. Use Caution/Monitor.
- 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.
- gabapentin
brimonidine and gabapentin both increase sedation. Use Caution/Monitor.
- ganaxolone
brimonidine and ganaxolone both increase sedation. 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
brimonidine and guanfacine both increase sedation. Use Caution/Monitor.
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
brimonidine and haloperidol both increase sedation. Use Caution/Monitor.
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.
- hydroxyzine
brimonidine and hydroxyzine both increase sedation. Use Caution/Monitor.
- 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. - iloperidone
brimonidine and iloperidone both increase sedation. Use Caution/Monitor.
- imatinib
imatinib will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- imipramine
brimonidine and imipramine both increase sedation. 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. - isoflurane
brimonidine and isoflurane both increase sedation. 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. - 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
brimonidine and ketamine both increase sedation. Use Caution/Monitor.
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. - ketotifen, drug-eluting contact lens
brimonidine and ketotifen, drug-eluting contact lens both increase sedation. Use Caution/Monitor.
- 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.
- lamotrigine
brimonidine and lamotrigine both increase sedation. 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.
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. - lemborexant
brimonidine and lemborexant both increase sedation. Use Caution/Monitor.
- 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. - levetiracetam
brimonidine and levetiracetam both increase sedation. Use Caution/Monitor.
- levocetirizine
brimonidine and levocetirizine both increase sedation. Use Caution/Monitor.
- levodopa
levodopa increases effects of timolol by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.
- levorphanol
brimonidine and levorphanol both increase sedation. Use Caution/Monitor.
- 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. .
- loratadine
brimonidine and loratadine both increase sedation. Use Caution/Monitor.
- lorazepam
brimonidine and lorazepam both increase sedation. Use Caution/Monitor.
- 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. - loxapine
brimonidine and loxapine both increase sedation. Use Caution/Monitor.
- lurasidone
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.
- lumateperone
brimonidine and lumateperone both increase sedation. 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.
brimonidine and lurasidone both increase sedation. Use Caution/Monitor. - maprotiline
brimonidine and maprotiline both increase sedation. Use Caution/Monitor.
- maraviroc
maraviroc will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- marijuana
marijuana will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- meclizine
brimonidine and meclizine both increase sedation. 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. - meperidine
brimonidine and meperidine both increase sedation. Use Caution/Monitor.
- mepivacaine
timolol, mepivacaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Use extreme caution during concomitant use of bupivacaine and antihypertensive agents.
- meprobamate
brimonidine and meprobamate both increase sedation. Use Caution/Monitor.
- 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. - metaxalone
brimonidine and metaxalone both increase sedation. Use Caution/Monitor.
- methocarbamol
brimonidine and methocarbamol both increase sedation. Use Caution/Monitor.
- methohexital
brimonidine and methohexital both increase sedation. Use Caution/Monitor.
- methsuximide
brimonidine and methsuximide both increase sedation. 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.
- midazolam
brimonidine and midazolam both increase sedation. Use Caution/Monitor.
- mirabegron
mirabegron will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- mirtazapine
brimonidine and mirtazapine both increase sedation. Use Caution/Monitor.
- molindone
brimonidine and molindone both increase sedation. 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.
- nalbuphine
brimonidine and nalbuphine both increase sedation. 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, brimonidine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Observe for possible additive hypotensive effects during concomitant use. .
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. - nitrous oxide
brimonidine and nitrous oxide both increase sedation. Use Caution/Monitor.
- 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. - nortriptyline
brimonidine and nortriptyline both increase sedation. Use Caution/Monitor.
- olanzapine
brimonidine and olanzapine both increase sedation. Use Caution/Monitor.
- oliceridine
brimonidine and oliceridine both increase sedation. 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.
- olopatadine intranasal
brimonidine and olopatadine intranasal both increase sedation. Use Caution/Monitor.
- opicapone
brimonidine and opicapone both increase sedation. Use Caution/Monitor.
- opium tincture
brimonidine and opium tincture both increase sedation. Use Caution/Monitor.
- orphenadrine
brimonidine and orphenadrine both increase sedation. 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. - oxazepam
brimonidine and oxazepam both increase sedation. Use Caution/Monitor.
- 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.
- paliperidone
brimonidine and paliperidone both increase sedation. 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.
- pentazocine
brimonidine and pentazocine both increase sedation. Use Caution/Monitor.
- pentobarbital
brimonidine and pentobarbital both increase sedation. Use Caution/Monitor.
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. - perampanel
brimonidine and perampanel both increase sedation. Use Caution/Monitor.
- perphenazine
perphenazine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- perphenazine
brimonidine and perphenazine both increase sedation. Use Caution/Monitor.
- pheniramine
brimonidine and pheniramine both increase sedation. Use Caution/Monitor.
- phenobarbital
brimonidine and phenobarbital both increase sedation. Use Caution/Monitor.
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.
- pimozide
brimonidine and pimozide both increase sedation. Use Caution/Monitor.
- 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. - pomalidomide
brimonidine and pomalidomide both increase sedation. Use Caution/Monitor.
- 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.
- pregabalin
brimonidine and pregabalin both increase sedation. Use Caution/Monitor.
- prilocaine
timolol, prilocaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Use extreme caution during concomitant use of bupivacaine and antihypertensive agents.
- primidone
brimonidine and primidone both increase sedation. Use Caution/Monitor.
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. - prochlorperazine
brimonidine and prochlorperazine both increase sedation. Use Caution/Monitor.
- propafenone
propafenone will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- promethazine
brimonidine and promethazine both increase sedation. Use Caution/Monitor.
- propofol
propofol, timolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
brimonidine and propofol both increase sedation. Use Caution/Monitor. - propranolol
propranolol and timolol both increase serum potassium. Use Caution/Monitor.
- protriptyline
brimonidine and protriptyline both increase sedation. Use Caution/Monitor.
- pyrilamine
brimonidine and pyrilamine both increase sedation. Use Caution/Monitor.
- quazepam
brimonidine and quazepam both increase sedation. Use Caution/Monitor.
- quetiapine
brimonidine and quetiapine both increase sedation. Use Caution/Monitor.
- quinacrine
quinacrine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- ramelteon
brimonidine and ramelteon both increase sedation. Use Caution/Monitor.
- ranolazine
ranolazine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- remimazolam
brimonidine and remimazolam both increase sedation. Use Caution/Monitor.
- reserpine
brimonidine and reserpine both increase sedation. Use Caution/Monitor.
- risperidone
brimonidine and risperidone both increase sedation. 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
brimonidine increases effects of sacubitril/valsartan by pharmacodynamic synergism. Use Caution/Monitor.
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. - scopolamine
brimonidine and scopolamine both increase sedation. Use Caution/Monitor.
- 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
brimonidine and sevoflurane both increase sedation. Use Caution/Monitor.
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.
- sodium oxybate
brimonidine and sodium oxybate both increase sedation. Use Caution/Monitor.
- 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.
- sufentanil
brimonidine and sufentanil both increase sedation. Use Caution/Monitor.
- sufentanil SL
brimonidine and sufentanil SL both increase sedation. 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. - suvorexant
brimonidine and suvorexant both increase sedation. Use Caution/Monitor.
- tadalafil
tadalafil increases effects of timolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- tapentadol
brimonidine and tapentadol both increase sedation. Use Caution/Monitor.
- tasimelteon
brimonidine and tasimelteon both increase sedation. Use Caution/Monitor.
- 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. - temazepam
brimonidine and temazepam both increase sedation. Use Caution/Monitor.
- terazosin
terazosin and timolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- terbinafine
terbinafine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.
- terbutaline
timolol increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
timolol decreases effects of terbutaline by pharmacodynamic antagonism. Use Caution/Monitor. - tetrabenazine
brimonidine and tetrabenazine both increase sedation. Use Caution/Monitor.
- theophylline
timolol, theophylline. Other (see comment). Use Caution/Monitor. Comment: Beta blockers (esp. non selective) antagonize theophylline effects, while at the same time increasing theophylline levels and toxicity (mechanism: decreased theophylline metabolism). Smoking increases risk of interaction.
- thioridazine
brimonidine and thioridazine both increase sedation. Use Caution/Monitor.
thioridazine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. - thiothixene
brimonidine and thiothixene both increase sedation. Use Caution/Monitor.
- tipranavir
tipranavir will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- tiagabine
brimonidine and tiagabine both increase sedation. Use Caution/Monitor.
- tizanidine
brimonidine and tizanidine both increase sedation. Use Caution/Monitor.
- tolazamide
timolol decreases effects of tolazamide by pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers may also mask the symptoms of hypoglycemia.
- tolbutamide
timolol decreases effects of tolbutamide by pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers may also mask the symptoms of hypoglycemia.
- tolcapone
brimonidine and tolcapone both increase sedation. Use Caution/Monitor.
- tolfenamic acid
timolol and tolfenamic acid both increase serum potassium. Use Caution/Monitor.
tolfenamic acid decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - tolmetin
timolol and tolmetin both increase serum potassium. Use Caution/Monitor.
tolmetin decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - tolvaptan
timolol and tolvaptan both increase serum potassium. Use Caution/Monitor.
- topiramate
brimonidine and topiramate both increase sedation. Use Caution/Monitor.
- torsemide
timolol increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tramadol
brimonidine and tramadol both increase sedation. Use Caution/Monitor.
- trazodone
brimonidine and trazodone both increase sedation. Use Caution/Monitor.
- triamterene
timolol and triamterene both increase serum potassium. Modify Therapy/Monitor Closely.
- triazolam
brimonidine and triazolam both increase sedation. Use Caution/Monitor.
- trifluoperazine
brimonidine and trifluoperazine both increase sedation. Use Caution/Monitor.
- triprolidine
brimonidine and triprolidine both increase sedation. Use Caution/Monitor.
- valproic acid
brimonidine and valproic acid both increase sedation. Use Caution/Monitor.
- valsartan
timolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
brimonidine increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor.
valsartan and timolol both increase serum potassium. Use Caution/Monitor. - venlafaxine
venlafaxine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- vigabatrin
brimonidine and vigabatrin both increase sedation. Use Caution/Monitor.
- verapamil
timolol and verapamil both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- xipamide
xipamide increases effects of timolol by pharmacodynamic synergism. Use Caution/Monitor.
- zaleplon
brimonidine and zaleplon both increase sedation. Use Caution/Monitor.
Minor (194)
- 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 topical
timolol increases effects of cocaine topical 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.
- 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.
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
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
Neonates and infants (<2 years)
Cautions
Not to be used alone for acute angle-closure glaucoma
Remove soft contact lenses; may reinsert 15 min post-instillation
May potentiate syndromes associated with vascular insufficiency; this drug combination should be used with caution in patients with depression, cerebral or coronary insufficiency, Raynaud’s phenomenon, orthostatic hypotension, or thromboangiitis obliterans
While taking beta-blockers, patients with history of atopy or history of severe anaphylactic reactions to a variety of allergens may be more reactive to repeated accidental, diagnostic, or therapeutic challenge with such allergens; such patients may be unresponsive to usual doses of epinephrine used to treat anaphylactic reactions
Beta-adrenergic blockade has been reported to potentiate muscle weakness consistent with certain myasthenic symptoms (eg, diplopia, ptosis, and generalized weakness); timolol has been reported rarely to increase muscle weakness in some patients with myasthenia gravis or myasthenic symptoms
Beta-adrenergic blocking agents should be administered with caution in patients subject to spontaneous hypoglycemia or to diabetic patients (especially those with labile diabetes) who are receiving insulin or oral hypoglycemic agents; beta-adrenergic receptor blocking agents may mask signs and symptoms of acute hypoglycemia
Beta-adrenergic blocking agents may mask certain clinical signs (eg, tachycardia) of hyperthyroidism; patients suspected of developing thyrotoxicosis should be managed carefully to avoid abrupt withdrawal of beta adrenergic blocking agents that might precipitate a thyroid storm
Ocular hypersensitivity reactions reported with brimonidine tartrate ophthalmic solutions 0.2%, with some reported to be associated with increase in intraocular pressure
There have been reports of bacterial keratitis associated with use of multiple-dose containers of topical ophthalmic products; these containers had been inadvertently contaminated by patients who, in most cases, had a concurrent corneal disease or a disruption of ocular epithelial surface
Impairment of beta-adrenergically mediated reflexes
- Necessity or desirability of withdrawal of beta-adrenergic blocking agents prior to major surgery is controversial; beta-adrenergic receptor blockade impairs ability of heart to respond to betaadrenergically mediated reflex stimuli; this may augment risk of general anesthesia in surgical procedures
- Some patients receiving beta-adrenergic receptor blocking agents have experienced protracted severe hypotension during anesthesia; difficulty in restarting and maintaining heartbeat also reported; for these reasons, in patients undergoing elective surgery, some authorities recommend gradual withdrawal of beta adrenergic receptor blocking agent
- If necessary, during surgery, effects of beta-adrenergic blocking agents may be reversed by sufficient doses of adrenergic agonists
Respiratory and cardiac reactions
- Can be absorbed systemically; the same types of adverse reactions found with systemic administration of beta-adrenergic blocking agents may occur with topical administration
- Severe respiratory reactions and cardiac reactions including death due to bronchospasm in patients with asthma, and rarely death in association with cardiac failure reported with ophthalmic administration; ophthalmic beta-blockers may impair compensatory tachycardia and increase risk of hypotension
- Sympathetic stimulation may be essential for support of circulation in individuals with diminished myocardial contractility; its inhibition by beta-adrenergic receptor blockade may precipitate more severe failure
- In patients without history of cardiac failure, continued depression of myocardium with beta-blocking agents over a period of time can, in some cases, lead to cardiac failure; at first sign or symptom of cardiac failure, therapy should be discontinued
- Patients with chronic obstructive pulmonary disease (eg, chronic bronchitis, emphysema) of mild or moderate severity, bronchospastic disease, or a history of the bronchospastic disease (other than bronchial asthma or a history of bronchial asthma, in which this drug combination is contraindicated should, in general, not receive beta-blocking agents, including this product
Pregnancy & Lactation
Pregnancy
There are no adequate and well-controlled studies in pregnant women; however, in animal studies, brimonidine crossed the placenta and entered into the fetal circulation to a limited extent; because animal reproduction studies are not always predictive of human response, this drug combination should be used during pregnancy only if potential benefit to mother justifies potential risk to fetus
Teratogenicity studies have been performed in animals; brimonidine tartrate was not teratogenic when given orally during gestation days 6 through 15 in rats and days 6 through 18 in rabbits; the highest doses of brimonidine tartrate in rats (2.5 mg/kg/day) and rabbits (5 mg/kg/day) achieved AUC exposure values 580 and37-fold higher, respectively than similar values estimated in humans treated with this drug combination, 1 drop in both eyes twice daily
Teratogenicity studies with timolol in mice, rats, and rabbits at oral doses up to 50 mg/kg/day [4,200 times maximum recommended human ocular dose of 0.012 mg/kg/day on a mg/kg basis (MRHOD)] demonstrated no evidence of fetal malformations; although delayed fetal ossification was observed at this dose in rats, there were no adverse effects on postnatal development of offspring; doses of 1,000 mg/kg/day (83,000 times the MRHOD) were maternotoxic in mice and resulted in an increased number of fetal resorptions. Increased fetal resorptions were also seen in rabbits at doses 8,300 times the MRHOD without apparent maternotoxicity
Lactation
Timolol has been detected in human milk following oral and ophthalmic drug administration; it is not known whether brimonidine tartrate is excreted in human milk, although in animal studies, brimonidine tartrate has been shown to be excreted in breast milk; because of potential for serious adverse reactions from this drug combination in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother
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.Images
Formulary
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