What is Combigan® (Timolol Maleate 5mg + Brimonidine Tartrate 2mg)?
Combigan® (Brimonidine Tartrate/ Timolol Ophthalmic solution) 0.2%/0.5% is indicated for the reduction of elevated intraocular pressure in patients with glaucoma or ocular hypertension who are insufficiently responsive to topical Beta-Blockers.
Combigan® (brimonidine tartrate/timolol maleate ophthalmic solution) 0.2%/0.5% is approved for reducing elevated intraocular pressure (IOP) in patients with glaucoma who require additional or adjunctive IOP-lowering therapy. Combigan® lowers IOP slightly less than taking both brimonidine tartrate three times a day and timolol maleate two times a day.
Ocular hypertension is a condition where the pressure inside the eye is higher than normal eye pressure due to fluid build-up. Combigan Ophthalmic Solution increases the flow of fluid from inside the eye into the bloodstream thereby lowering the increased eye pressure. This prevents further damage or complications such as a change in vision or even loss of vision. You should only use Combigan Ophthalmic Solution in the affected eye and take it regularly as prescribed by your doctor.
Combigan ophtalmic solution lowers intraocular pressure. It contains a combination of two medicines, brimonidine and timolol. Both molecules act on the eyeballs, promoting fluid drainage and decreasing the tension inside the eyes.
The indication of Combigan eyedrops is to treat glaucoma and eye conditions associated with high pressure. High intraocular pressure is the first risk factor for vision loss in glaucoma patients. Lowering the pressure inside the eyeballs is associated with better prognostics and a slower course of the disease.
Combigan is a topical treatment, but it can bypass the eyes barriers and seep into the blood, causing systemic side effects. Combigan is contraindicated in the following conditions:
- Hypersensitivity to the excipients or any of the active ingredients (timolol and brimonidine)
- Reactive airway disease: bronchial asthma, obstructive airway disease, and dyspnea caused by pulmonary illness. Combigan contains timolol and brimonidine. Timolol is a beta-blocker that exacerbates bronchial muscle contraction and glands secretion. Combigan eye drops can worsen airways narrowing and dyspnea.
- Overt Heart failure and bradycardia: beta-blockers impede heart rate and muscle contraction, an effect that can result in deadly consequences in patients with an already compromised heart function.
- Infants and neonates: aged two years or younger.
The correct application of Combigan prevents systemic side effects. After applying the eye drops to the lower eyelids, press the inner angle of your eyes with your thumb to prevent the medication from seeping into the tissues.
The indications for Combigan ophtalmic solution
The Combigan solution is a combination of an alpha-adrenergic receptor agonist and a beta‐adrenergic receptor inhibitor. The main effect they have on the eyeballs is lowering of aqueous humor production with the resultant decrease in fluids volume inside the eye.
The main indication of Combigan is the reduction of pathological high intraocular pressure.
Open-angle glaucoma: Glaucoma is the first cause of worldwide visual acuity impairment, and it is the second leading cause of blindness after cataracts.
Glaucoma, by definition, is a disease that causes progressive damage to the optic nerve. High pressure inside the eyeballs is a crucial mechanism in the development of glaucoma, and it is the most important prognostic factor.
Studies have shown that a slight increase in intraocular pressure is associated with accelerated optic nerve damage. Whereas a reduction of IOP with each 1mmhg is associated with a 10% reduction in the risk of vision loss.
Patients who require a combination of two agents are usually the ones in whom a monotherapy did not reach an adequate reduction in intraocular pressure.
A study that included 31 open-angle glaucoma patients revealed that the application of Combigan twice daily resulted in a 28% fall of intraocular pressure. Additionally, a four weeks treatment with Combigan three times a day achieved a further 10% fall of eyeballs pressure. An increase in Combigan dosage reached higher efficiency while keeping the same safety profile.
Ocular hypertension: Ocular hypertension occurs when there is increased pressure inside the eyeballs with no damage to the optic nerve. Combigan lowers the production of aqueous humor via its sympathetic effect on ciliary cells. With reduced aqueous humor secretion occurs an equilibrium between fluid production and drainage inside the eye.
What is glaucoma?
Glaucoma is a disease that damages the eye’s optic nerve, which can be caused by extra fluid that increases pressure in the eye. Open-angle glaucoma is the most common form of glaucoma. It develops gradually and often goes unnoticed at first. Regular eye exams are important to find early signs of damage to the optic nerve.
While there is no cure for glaucoma, studies show that lowering high eye pressure can help reduce the risk of glaucoma-related vision loss. That’s why treatment of high eye pressure is very important. Remember, high eye pressure can slowly, but permanently, damage your optic nerve before you notice any change in vision.
Your doctor can recommend an eye drop to help you manage your glaucoma or high eye pressure. One option is Combigan®. Twice-daily Combigan® is a treatment proven to lower eye pressure for glaucoma patients who require additional medication. Combigan® is approved to lower pressure in the eyes of people with primary open-angle glaucoma or ocular hypertension (both conditions involve high pressure in the eye) who require additional or adjunctive IOP-lowering therapy.
Remember to use Combigan® twice a day, every day
- The recommended dose of Combigan® is 1 drop in the affected eye(s) twice a day, about 12 hours apart.
- Combigan® may be used alone or with other eye drops to lower eye pressure for your glaucoma requiring additional IOP-lowering therapy.
- If you use more than 1 type of topical eye drop, they should be applied at least 5 minutes apart.
How to use Combigan® (Timolol Maleate 5mg + Brimonidine Tartrate 2mg)?
- Apply Combigan® eye drops exactly as your eye doctor prescribed. The recommended dose is 1 drop of Combigan® in the affected eye(s) twice a day, 12 hours apart. If you use more than 1 type of eye drop, just be sure to apply them at least 5 minutes apart.
- If you have open-angle glaucoma or ocular hypertension, it is important to continue your Combigan® therapy. Don’t skip or stop treatment (unless you have spoken to your doctor). Remembering to use your eye drops is easier if you make it part of your daily routine.
- If you wear contact lenses, remove them first, then wait 15 minutes after using Combigan® before you put them back into your eyes.
Side effects of Combigan®
In a year-long study, the most common adverse reactions occurring in approximately 5% to 15% of patients (n=385) included:
- Allergic inflammation of the eye
- Abnormally large lymph follicles in the mucous membrane lining the inner surface of the eyelid and the exposed surface of the eyeball (also called the conjunctiva)
- Eye redness
- Severe itching of the eyes
- Burning and stinging of the eyes
Combigan® eye drops can be absorbed by your body. Contact your eye care professional right away if you experience any of the following potentially serious side effects:
- Shortness of breath
- Visual changes
- Irregular heartbeat and/or slowing of your heart rate
Combigan® ophthalmic solution may cause fatigue and/or drowsiness. If you drive or perform hazardous work, such as operating machinery, make sure you feel appropriately alert. Ocular hypersensitivity reactions have been reported, with some reported to be associated with an increase in intraocular pressure. These risks are not the only risks associated with Combigan®. If you experience these or other side effects, you should immediately contact your eye doctor.