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      Drugs & Diseases

      brinzolamide/brimonidine (Rx)

      Brand and Other Names:Simbrinza
      • Print

      Dosing & Uses

      AdultPediatric

      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

      Next:

      Interactions

      Interaction Checker

      and brinzolamide/brimonidine

      No Results

         activity indicator 
        No Interactions Found
        Interactions Found

        Contraindicated

          Serious - Use Alternative

            Significant - Monitor Closely

              Minor

                All Interactions Sort By:
                 activity indicator 

                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.

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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

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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

                  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

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                  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.

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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

                  Adding plans allows you to compare formulary status to other drugs in the same class.

                  To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

                  Create Your List of Plans

                  Adding plans allows you to:

                  • View the formulary and any restrictions for each plan.
                  • Manage and view all your plans together – even plans in different states.
                  • Compare formulary status to other drugs in the same class.
                  • Access your plan list on any device – mobile or desktop.

                  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.

                  View explanations for tiers and restrictions
                  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.
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