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Combigan (brimonidine tartrate and timolol maleate) 

Indications  

Combigan is indicated for: 

• Glaucoma 
• Ocular hypertension 

Dosage and Administration  

• Use Combigan exactly as prescribed by your healthcare provider. 
• Apply one drop in the affected eye(s) twice daily, approximately 12 hours apart. 
• Wash your hands thoroughly before using the eye drops. 
• Tilt your head back, pull down the lower eyelid to create a small pocket, and apply one drop into the pocket. 
• Close your eyes for 1-2 minutes after application to allow the medication to be absorbed. 
• Do not double the dose to make up for a missed one. If you miss a dose, apply it as soon as you remember, or skip it if it’s almost time for your next dose. 
• Do not use other eye medications unless your healthcare provider advises you to. 
• Do not use Combigan if it has expired or if the solution has changed color. 

Mechanism of Action 

Combigan combines two medicines: Brimonidine tartrate and Timolol maleate. Brimonidine tartrate helps reduce the fluid in the eye and increases fluid drainage. Timolol maleate also helps reduce the fluid in the eye. Together, they lower the pressure inside the eye. 

Contraindications  

Combigan is contraindicated in patients with: 

• Bronchial asthma or a history of bronchial asthma 
• Severe chronic obstructive pulmonary disease (COPD) 
• Sinus bradycardia 
• Atrioventricular block 
• Overt cardiac failure 
• Cardiogenic shock 
• Neonates and infants under the age of 2 years 
• Hypersensitivity to any component of the product 

Side Effects  

Common Side Effects: 

• Eye redness 
• Burning or stinging in the eye 
• Dry mouth 
• Drowsiness 
• Headache 
• Blurred vision 

Serious Side Effects: 

• Severe allergic reactions (e.g., hives, difficulty breathing) 
• Severe respiratory reactions (e.g., bronchospasm) 
• Severe cardiac reactions (e.g., bradycardia, heart failure) 
• Hypotension 

Precautions 

• Systemic Absorption: Combigan contains Timolol maleate, which can be absorbed systemically even when applied topically, potentially causing severe respiratory and cardiac reactions.
• Respiratory Risks: If you have asthma or severe COPD, use Combigan cautiously, as it can cause bronchospasm and even death.
• Cardiac Risks: Combigan can impair your heart rate response and increase the risk of hypotension. Monitor yourself for symptoms of heart failure.
• Use with Caution: Use Combigan with caution if you have a history of severe cardiovascular disease.

Storage Instructions 

• Store Combigan at a temperature between 15°C to 25°C (59°F to 77°F). 
• Protect from light. 
• Keep the bottle tightly closed when not in use. 

References 

https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/021398s007lbl.pdf