Dosing & Uses
Dosing Forms & Strengths
brinzolamide/brimonidine
ophthalmic suspension
- 1%/0.2%
Glaucoma
Indicated for reduction of elevated intraocular pressure in patients with primary open-angle glaucoma
Instill 1 gtt in affected eye(s) TID
Ocular Hypertension
Indicated for reduction of elevated intraocular pressure in patients with ocular hypertension
Instill 1 gtt in affected eye(s) TID
Administration
Shake well before use
If more than 1 ophthalmic drop is administered, the drugs should be administered at least 5 minutes apart
Dosage Forms & Strengths
brinzolamide/brimonidine
ophthalmic suspension
- 1%/0.2%
Glaucoma
Indicated for reduction of elevated intraocular pressure in patients with primary open-angle glaucoma
<2 years: Safety and efficacy not established
≥2 years: Instill 1 gtt in affected eye(s) TID
Ocular Hypertension
Indicated for reduction of elevated intraocular pressure in patients with ocular hypertension
<2 years: Safety and efficacy not established
≥2 years: Instill 1 gtt in affected eye(s) TID
Administration
Shake well before use
If more than 1 ophthalmic drop is administered, the drugs should be administered at least 5 minutes apart
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

Contraindicated (8)
- isocarboxazid
isocarboxazid, brimonidine. Mechanism: unknown. Contraindicated. Contraindicated in mfr prescribing info.
- linezolid
linezolid, brimonidine. Mechanism: unknown. Contraindicated. Contraindicated in mfr prescribing info.
- phenelzine
phenelzine, brimonidine. Mechanism: unknown. Contraindicated. Contraindicated in mfr prescribing info.
- procarbazine
procarbazine, brimonidine. Mechanism: unknown. Contraindicated.
- rasagiline
rasagiline, brimonidine. Mechanism: unknown. Contraindicated. Brimonidine should not be used in patients receiving MAO inhibitors.
- selegiline
selegiline, brimonidine. Mechanism: unknown. Contraindicated. Coadministration is contraindicated.
- selegiline transdermal
selegiline transdermal, brimonidine. Mechanism: unknown. Contraindicated. Contraindicated in mfr prescribing info.
- tranylcypromine
tranylcypromine, brimonidine. Mechanism: unknown. Contraindicated. Contraindicated in mfr prescribing info.
Serious - Use Alternative (0)
Monitor Closely (33)
- acrivastine
acrivastine and brimonidine both increase sedation. Use Caution/Monitor.
- amantadine
brinzolamide will decrease the level or effect of amantadine by Other (see comment). Modify Therapy/Monitor Closely. Excretion rate of amantadine increases rapidly when urine is acidic, administration of urine acidifying drugs may increase elimination of amantadine from the body. Monitor for efficacy of amantadine.
- 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.
- amisulpride
amisulpride and brimonidine both increase sedation. Use Caution/Monitor.
- asenapine
asenapine and brimonidine both increase sedation. Use Caution/Monitor.
- asenapine transdermal
asenapine transdermal and brimonidine both increase sedation. Use Caution/Monitor.
- aspirin
brinzolamide, aspirin. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.
- aspirin rectal
brinzolamide, aspirin rectal. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.
- aspirin/citric acid/sodium bicarbonate
brinzolamide, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.
- balsalazide
brinzolamide, balsalazide. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.
- candesartan
brimonidine increases effects of candesartan by pharmacodynamic synergism. Use Caution/Monitor.
- choline magnesium trisalicylate
brinzolamide, choline magnesium trisalicylate. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.
- diflunisal
brinzolamide, diflunisal. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.
- digoxin
brimonidine increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.
- eprosartan
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.
- irbesartan
brimonidine increases effects of irbesartan by pharmacodynamic synergism. 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.
- lisdexamfetamine
brinzolamide will increase the level or effect of lisdexamfetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.
- losartan
brimonidine increases effects of losartan by pharmacodynamic synergism. Use Caution/Monitor.
- lurasidone
lurasidone, brimonidine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased sedation.
- mesalamine
brinzolamide, mesalamine. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.
- 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. .
- olmesartan
brimonidine increases effects of olmesartan by pharmacodynamic synergism. Use Caution/Monitor.
- sacubitril/valsartan
brimonidine increases effects of sacubitril/valsartan by pharmacodynamic synergism. Use Caution/Monitor.
- salicylates (non-asa)
brinzolamide, salicylates (non-asa). Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.
- salsalate
brinzolamide, salsalate. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.
- 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.
- sulfasalazine
brinzolamide, sulfasalazine. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.
- telmisartan
brimonidine increases effects of telmisartan by pharmacodynamic synergism. Use Caution/Monitor.
- topiramate
topiramate, brinzolamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of kidney stone formation.
- valsartan
brimonidine increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor.
- willow bark
brinzolamide, willow bark. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.
Minor (150)
- acebutolol
brimonidine increases effects of acebutolol 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.
brinzolamide, amobarbital. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of anticonvulsant induced osteomalacia. - amoxapine
amoxapine decreases effects of brimonidine by pharmacodynamic antagonism. Minor/Significance Unknown.
- butabarbital
brinzolamide, butabarbital. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of anticonvulsant induced osteomalacia.
- 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.
- 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.
brinzolamide, butalbital. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of anticonvulsant induced osteomalacia. - butorphanol
brimonidine increases effects of butorphanol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.
- ethotoin
brinzolamide, ethotoin. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of anticonvulsant induced osteomalacia.
- 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.
- 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.
- 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.
- codeine
brimonidine increases effects of codeine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.
- 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.
- 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.
- 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.
- 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
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.
- 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.
- fosphenytoin
brinzolamide, fosphenytoin. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of anticonvulsant induced osteomalacia.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- nortriptyline
nortriptyline decreases effects of brimonidine by pharmacodynamic antagonism. 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
brinzolamide, pentobarbital. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of anticonvulsant induced osteomalacia.
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.
- phenobarbital
brinzolamide, phenobarbital. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of anticonvulsant induced osteomalacia.
- 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.
- phenytoin
brinzolamide, phenytoin. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of anticonvulsant induced osteomalacia.
- 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
brinzolamide, primidone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of anticonvulsant induced osteomalacia.
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.
- secobarbital
brinzolamide, secobarbital. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of anticonvulsant induced osteomalacia.
Adverse Effects
>10% (brimonidine)
Somnolence in children (50-83%)
Xerostomia (10-30%)
Ocular hyperemia (10-30%)
Burning and stinging (10-30%)
Headache (10-30%)
Blurring (10-30%)
Foreign body sensation (10-30%)
Fatigue/drowsiness (10-30%)
Conjunctival follicles (10-30%)
Ocular allergic reactions (10-30%)
Ocular pruritus (10-30%)
1-10% (brinzolamide)
Blurred vision (5-10%)
Dysgeusia (5-10%)
Blepharitis (1-5%)
Dermatitis (1-5%)
Dry eye (1-5%)
Foreign body sensation (1-5%)
Headache (1-5%)
Hyperemia (1-5%)
Ocular discharge (1-5%)
Ocular discomfort (1-5%)
Ocular keratitis (1-5%)
Ocular pain (1-5%)
Ocular pruritus (1-5%)
Rhinitis (1-5%)
1-10% (brimonidine)
Corneal staining/erosion (3-9%)
Photophobia (3-9%)
Eyelid erythema (3-9%)
Ocular ache/pain (3-9%)
Ocular dryness (3-9%)
Tearing (3-9%)
Upper respiratory symptoms (3-9%)
Eyelid edema (3-9%)
Conjunctival edema (3-9%)
Dizziness (3-9%)
Blepharitis (3-9%)
Ocular (3-9%)
Irritation (3-9%)
Gastrointestinal symptoms (3-9%)
Asthenia (3-9%)
Conjunctival blanching (3-9%)
Abnormal vision (3-9%) Muscular pain (3-9%)
Lid crusting (<3%)
Conjunctival hemorrhage (<3%)
Abnormal taste (<3%)
Insomnia (<3%)
Conjunctival discharge (<3%)
Depression (<3%)
Hypertension (<3%)
Anxiety (<3%)
Palpitations/arrhythmias (<3%)
Nasal dryness (<3%)
Syncope (<3%)
<1% (brinzolamide)
Allergic reactions
Alopecia
Chest pain
Conjunctivitis
Diarrhea
Diplopia
Dizziness
Dry mouth
Dyspnea
Dyspepsia
Eye fatigue
Hypertonia
Keratoconjunctivitis
Keratopathy
Kidney pain
Lid margin crusting or sticky sensation
Nausea
Pharyngitis
Tearing
Urticaria
Warnings
Contraindications
Hypersensitivity
Neonates and infants (younger than 2 yr)
Cautions
Contains brinzolamide, a sulfonamide; caution with history of sulfonamide allergy
Carbonic anhydrase activity observed in both the cytoplasm and around the plasma membranes of the corneal endothelium, and therefore there is an increased potential for developing corneal edema in patients with low endothelial cell counts
Brinzolamide and its metabolite are excreted predominantly by the kidney and is not recommended in patients with severe renal impairment
Not studied in patients with acute angle-closure glaucoma
Contains benzalkonium chloride (preservative); remove contact lenses during instillation to avoid absorption by soft lenses (may reinsert 15 minutes after instillation)
Brimonidine elicits <5% mean decrease in blood pressure 2 hr after instillation; caution with severe cardiovascular disease
Not studied with severe hepatic impairment
Brimonidine may potentiate syndromes associated with vascular insufficiency (eg, depression, cerebral or coronary insufficiency, Raynaud’s phenomenon, orthostatic hypotension, thromboangiitis obliterans)
Bacterial keratitis reported from inadvertent contamination of multiple-dose containers of topical ophthalmics
Pregnancy & Lactation
Pregnancy Category: C
Lactation: Unknown whether distributed in human breast milk; do not breast feed
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.Pharmacology
Mechanism of Action
Brinzolamide: Carbonic anhydrase inhibitor; inhibition of carbonic anhydrase in ciliary processes of the eye decreases aqueous humor secretion, presumably by slowing the formation of bicarbonate ions with subsequent reduction in sodium and fluid transport
Brimonidine: Alpha2 adrenergic receptor agonist; decreases aqueous humor secretion and increases uveoscleral outflow
Absorption
Peak plasma time: 1-4 hr (brimonidine)
Peak plasma concentration: <10 ng/mL (brinzolamide)
Distribution
Protein bound: ~60% (brinzolamide)
Due to its affinity for carbonic anhydrase (CA) II, brinzolamide distributes extensively into RBCs
Metabolism
Metabolized by liver (brimonidine)
Metabolites: N-desethyl brinzolamide
Elimination
Half-life: 111 days (brinzolamide); 3 hr (brimonidine)
Excretion: Predominantly in urine (brinzolamide); 87% urine (brimonidine)
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Formulary
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