brinzolamide/brimonidine (Rx)

Brand and Other Names:Simbrinza

Dosing & Uses

AdultPediatric

Dosing Forms & Strengths

brinzolamide/brimonidine

ophthalmic suspension

  • 1%/0.2%

Open-Angle-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

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%

Open-Angle-Glaucoma

Indicated for reduction of elevated intraocular pressure in patients with primary open-angle glaucoma

<2 years: Contraindicated

≥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: Contraindicated

≥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

Next:

Interactions

Interaction Checker

and brinzolamide/brimonidine

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    Contraindicated

      Serious - Use Alternative

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            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 (19)

            • alfentanil

              brimonidine and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • 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

            • codeine

              brimonidine and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • 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

            • 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

            • methadone

              brimonidine and methadone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • morphine

              brimonidine and morphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • 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

            • remifentanil

              brimonidine and remifentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            Monitor Closely (173)

            • acetaminophen/phenyltoloxamine

              brimonidine and acetaminophen/phenyltoloxamine both increase sedation. Use Caution/Monitor.

            • acrivastine

              acrivastine and brimonidine both increase sedation. Use Caution/Monitor.

            • alprazolam

              brimonidine and alprazolam 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.

            • amitriptyline

              brimonidine and amitriptyline both increase sedation. Use Caution/Monitor.

            • amobarbital

              brimonidine and amobarbital both increase sedation. Use Caution/Monitor.

            • amoxapine

              brimonidine and amoxapine both increase sedation. Use Caution/Monitor.

            • aripiprazole

              brimonidine and aripiprazole 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.

            • 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.

            • 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.

            • benzhydrocodone/acetaminophen

              benzhydrocodone/acetaminophen and brimonidine both increase sedation. Use Caution/Monitor.

            • 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.

            • buprenorphine subdermal implant

              buprenorphine subdermal implant and brimonidine both increase sedation. Use Caution/Monitor.

            • butabarbital

              brimonidine and butabarbital both increase sedation. Use Caution/Monitor.

            • butalbital

              brimonidine and butalbital both increase sedation. Use Caution/Monitor.

            • butorphanol

              brimonidine and butorphanol both increase sedation. Use Caution/Monitor.

            • candesartan

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

            • carbinoxamine

              brimonidine and carbinoxamine both increase sedation. Use Caution/Monitor.

            • cariprazine

              brimonidine and cariprazine both increase sedation. Use Caution/Monitor.

            • carisoprodol

              brimonidine and carisoprodol both increase sedation. 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.

            • chlorpheniramine

              brimonidine and chlorpheniramine both increase sedation. Use Caution/Monitor.

            • chlorpromazine

              brimonidine and chlorpromazine both increase sedation. Use Caution/Monitor.

            • chlorzoxazone

              brimonidine and chlorzoxazone both increase sedation. 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.

            • clemastine

              brimonidine and clemastine both increase sedation. Use Caution/Monitor.

            • 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.

            • clorazepate

              brimonidine and clorazepate both increase sedation. Use Caution/Monitor.

            • clozapine

              brimonidine and clozapine both increase sedation. Use Caution/Monitor.

            • cyclobenzaprine

              brimonidine and cyclobenzaprine both increase sedation. 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.

            • desflurane

              brimonidine and desflurane both increase sedation. Use Caution/Monitor.

            • desipramine

              brimonidine and desipramine both increase sedation. Use Caution/Monitor.

            • 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.

            • difenoxin hcl

              brimonidine and difenoxin hcl both increase sedation. Use Caution/Monitor.

            • 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.

            • dimenhydrinate

              brimonidine and dimenhydrinate both increase sedation. Use Caution/Monitor.

            • diphenhydramine

              brimonidine and diphenhydramine both increase sedation. Use Caution/Monitor.

            • diphenoxylate hcl

              brimonidine and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

            • doxepin

              brimonidine and doxepin both increase sedation. Use Caution/Monitor.

            • doxylamine

              brimonidine and doxylamine both increase sedation. Use Caution/Monitor.

            • droperidol

              brimonidine and droperidol both increase sedation. Use Caution/Monitor.

            • efavirenz

              brimonidine and efavirenz both increase sedation. Use Caution/Monitor.

            • entacapone

              brimonidine and entacapone both increase sedation. 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.

            • estazolam

              brimonidine and estazolam both increase sedation. Use Caution/Monitor.

            • eszopiclone

              brimonidine and eszopiclone both increase sedation. Use Caution/Monitor.

            • ethanol

              brimonidine and ethanol both increase sedation. Use Caution/Monitor.

            • ethosuximide

              brimonidine and ethosuximide both increase sedation. Use Caution/Monitor.

            • ethotoin

              brimonidine and ethotoin both increase sedation. Use Caution/Monitor.

            • felbamate

              brimonidine and felbamate both increase sedation. Use Caution/Monitor.

            • fenfluramine

              brimonidine and fenfluramine both increase sedation. Use Caution/Monitor.

            • fexofenadine

              brimonidine and fexofenadine both increase sedation. Use Caution/Monitor.

            • 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.

            • gabapentin

              brimonidine and gabapentin both increase sedation. Use Caution/Monitor.

            • ganaxolone

              brimonidine and ganaxolone both increase sedation. Use Caution/Monitor.

            • guanfacine

              brimonidine and guanfacine both increase sedation. Use Caution/Monitor.

            • haloperidol

              brimonidine and haloperidol both increase sedation. Use Caution/Monitor.

            • hydroxyzine

              brimonidine and hydroxyzine both increase sedation. Use Caution/Monitor.

            • iloperidone

              brimonidine and iloperidone both increase sedation. Use Caution/Monitor.

            • imipramine

              brimonidine and imipramine both increase sedation. Use Caution/Monitor.

            • irbesartan

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

            • isoflurane

              brimonidine and isoflurane both increase sedation. Use Caution/Monitor.

            • ketamine

              brimonidine and ketamine both increase sedation. Use Caution/Monitor.

            • ketotifen, drug-eluting contact lens

              brimonidine and ketotifen, drug-eluting contact lens both increase sedation. 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.

            • lemborexant

              brimonidine and lemborexant both increase sedation. Use Caution/Monitor.

            • levetiracetam

              brimonidine and levetiracetam both increase sedation. Use Caution/Monitor.

            • levocetirizine

              brimonidine and levocetirizine both increase sedation. Use Caution/Monitor.

            • levorphanol

              brimonidine and levorphanol both increase sedation. Use Caution/Monitor.

            • lisdexamfetamine

              brinzolamide will increase the level or effect of lisdexamfetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • loratadine

              brimonidine and loratadine both increase sedation. Use Caution/Monitor.

            • lorazepam

              brimonidine and lorazepam both increase sedation. Use Caution/Monitor.

            • losartan

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

            • loxapine

              brimonidine and loxapine both increase sedation. Use Caution/Monitor.

            • 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.

            • meclizine

              brimonidine and meclizine both increase sedation. Use Caution/Monitor.

            • meperidine

              brimonidine and meperidine both increase sedation. Use Caution/Monitor.

            • meprobamate

              brimonidine and meprobamate both increase sedation. Use Caution/Monitor.

            • 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.

            • 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.

            • midazolam

              brimonidine and midazolam both increase sedation. Use Caution/Monitor.

            • mirtazapine

              brimonidine and mirtazapine both increase sedation. Use Caution/Monitor.

            • molindone

              brimonidine and molindone both increase sedation. Use Caution/Monitor.

            • nalbuphine

              brimonidine and nalbuphine both increase sedation. Use Caution/Monitor.

            • nitroglycerin rectal

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

            • nitrous oxide

              brimonidine and nitrous oxide both increase sedation. 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

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

            • 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.

            • oxazepam

              brimonidine and oxazepam both increase sedation. Use Caution/Monitor.

            • paliperidone

              brimonidine and paliperidone both increase sedation. Use Caution/Monitor.

            • pentazocine

              brimonidine and pentazocine both increase sedation. Use Caution/Monitor.

            • pentobarbital

              brimonidine and pentobarbital both increase sedation. Use Caution/Monitor.

            • perampanel

              brimonidine and perampanel both increase sedation. 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.

            • pimozide

              brimonidine and pimozide both increase sedation. Use Caution/Monitor.

            • pomalidomide

              brimonidine and pomalidomide both increase sedation. Use Caution/Monitor.

            • pregabalin

              brimonidine and pregabalin both increase sedation. Use Caution/Monitor.

            • primidone

              brimonidine and primidone both increase sedation. Use Caution/Monitor.

            • prochlorperazine

              brimonidine and prochlorperazine both increase sedation. Use Caution/Monitor.

            • promethazine

              brimonidine and promethazine both increase sedation. Use Caution/Monitor.

            • propofol

              brimonidine and propofol both increase sedation. 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.

            • ramelteon

              brimonidine and ramelteon both increase sedation. 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.

            • 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.

            • scopolamine

              brimonidine and scopolamine both increase sedation. Use Caution/Monitor.

            • sevoflurane

              brimonidine and sevoflurane both increase sedation. Use Caution/Monitor.

            • sodium oxybate

              brimonidine and sodium oxybate both increase sedation. Use Caution/Monitor.

            • 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.

            • sufentanil

              brimonidine and sufentanil both increase sedation. Use Caution/Monitor.

            • sufentanil SL

              brimonidine and sufentanil SL both increase sedation. Use Caution/Monitor.

            • 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.

            • suvorexant

              brimonidine and suvorexant both increase sedation. Use Caution/Monitor.

            • tapentadol

              brimonidine and tapentadol both increase sedation. Use Caution/Monitor.

            • tasimelteon

              brimonidine and tasimelteon both increase sedation. Use Caution/Monitor.

            • telmisartan

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

            • temazepam

              brimonidine and temazepam both increase sedation. Use Caution/Monitor.

            • tetrabenazine

              brimonidine and tetrabenazine both increase sedation. Use Caution/Monitor.

            • thioridazine

              brimonidine and thioridazine both increase sedation. Use Caution/Monitor.

            • thiothixene

              brimonidine and thiothixene both increase sedation. Use Caution/Monitor.

            • tiagabine

              brimonidine and tiagabine both increase sedation. Use Caution/Monitor.

            • tizanidine

              brimonidine and tizanidine both increase sedation. Use Caution/Monitor.

            • tolcapone

              brimonidine and tolcapone both increase sedation. Use Caution/Monitor.

            • topiramate

              brimonidine and topiramate both increase sedation. Use Caution/Monitor.

              topiramate, brinzolamide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of kidney stone formation.

            • tramadol

              brimonidine and tramadol both increase sedation. 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.

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            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

            Postmarketing Reports

            Serious skin and subcutaneous tissue reactions, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)

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            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; exercise caution

            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

            Hypersensitivity reactions

            • Formulation contains brinzolamide, a sulfonamide; although administered topically absorbed systemically
            • The same types of adverse reactions attributable to sulfonamides may occur with topical administration
            • Fatalities have occurred due to severe reactions to sulfonamides including Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, agranulocytosis, aplastic anemia, and other blood dyscrasias
            • Sensitization may recur when sulfonamide is re-administered irrespective of route of administration; if signs of serious reactions or hypersensitivity occur, discontinue use immediately
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            Pregnancy & Lactation

            Pregnancy

            There are no adequate and well-controlled studies in pregnant women; therapy should be administered during pregnancy only if potential benefit justifies the potential risk to the fetus

            Animal data

            • Developmental toxicity studies with brinzolamide in rabbits at oral doses of 1, 3, and 6 mg/kg/day (20, 60, and 120 times recommended human ophthalmic dose) produced maternal toxicity at 6 mg/kg/day and significant increase in the number of fetal variations, such as accessory skull bones, which was only slightly higher than historic value at 1 and 6 mg/kg
            • In rats, statistically, decreased body weights of fetuses from dams receiving oral doses of 18 mg/kg/day (180 times the recommended human ophthalmic dose) during gestation were proportional to reduced maternal weight gain, with no statistically significant effects on organ or tissue development. Increases in unossified sternebrae reduced ossification of the skull, and unossified hyoid that occurred at 6 and 18 mg/kg were not statistically significant
            • No treatment-related malformations were seen; following oral administration of 14C-brinzolamide 14Cbrinzolamide to pregnant rats, radioactivity was found to cross the placenta and was present in fetal tissues and blood

            Lactation

            There is no information regarding presence of dapagliflozin in human milk, effects on breastfed infants, or effects on milk production; dapagliflozin is present in milk of lactating rats

            Due to species-specific differences in lactation physiology, the clinical relevance of these data are not clear; since human kidney maturation occurs in utero and during first 2 years of life when lactational exposure may occur, there may be risk to developing human kidney

            Because of potential for serious adverse reactions in breastfed infants, advise women that use of this medication is not recommended while breastfeeding

            Pregnancy Categories

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

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

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

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

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

            NA: Information not available.

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            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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            Images

            No images available for this drug.
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            Patient Handout

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

            FormularyPatient Discounts

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            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.