Combigan eye drops (brimonidine, timolol)

• Open angle glaucoma.
• Raised pressure in the eye (ocular hypertension).

• These eye drops must not be taken by mouth.
• When using these eye drops you should take care to not touch the dropper tip to any surface, or to your eye, in order to avoid contaminating the eye drops.
• Combigan eye drops contain the preservative benzalkonium chloride, which can be absorbed by soft contact lenses and cause eye irritation. If you wear soft contact lenses, you should remove them before putting in these eye drops. You should wait at least 15 minutes after using the drops before putting your contact lenses back in.
• These eye drops may cause blurred or abnormal vision, which could affect your ability to drive or operate machinary, especially at night or in reduced lighting. You should also take into account that this medicine can sometimes drowsiness or fatigue, which may also affect your ability to drive or operate machinary.
• You should store the bottle of Combigan eye drops in its outer carton, in order to protect from light.
• Combigan eye drops are sterile until opened. The bottles contain a preservative that helps keep the eye drops sterile once they are in use. However, any medicine remaining in the bottle after it has been open for four weeks or more is likely to be contaminated with germs and should no longer be used. Dispose of carefully, preferably by returning to your pharmacy. You may find it helpful to write the date of first opening on the packet.
• While using these eye drops you should have regular eye examinations.
• Beta-blockers such as timolol can be absorbed into the bloodstream after being applied into the eye. They may mask the symptoms of low blood sugar (hypoglycaemia) such as increased heart rate, tremor and nausea. For this reason, people with diabetes should carefully monitor their blood sugar while using these eye drops.
• Beta-blockers such as timolol can increase sensitivity to substances which cause allergy and the seriousness of severe allergic reactions (anaphylaxis). People who experience an anaphylactic reaction while using this medicine may need larger than normal doses of adrenaline to treat the reaction. Seek further medical advice from your doctor if you have a history of allergies.

• Severe or unstable and uncontrolled disease involving the heart and blood vessels (cardiovascular disease).
• History of severe heart disease.
• Heart failure.
• Decreased blood supply to the heart (coronary insufficiency), eg people with angina.
• A severe form of angina pectoris, not caused by exertion (Prinzmetal’s angina).
• Decreased blood supply to the brain (cerebral insufficiency), eg people who have had a stroke or mini-stroke (transient ischaemic attack).
• Low blood pressure (hypotension).
• People who experience drops in blood pressure when going from lying down to sitting or standing, that result in dizziness and light-headedness (postural hypotension).
• Severe disorders of blood circulation.
• Narrowing of the blood vessels in the hands, causing numb and painful fingers (Raynaud’s disease).
• Progressive disease involving narrowing of the blood vessels in the legs (thromboangiitis obliterans).
• Increase in the acidity of the blood (metabolic acidosis).
• Untreated tumour of the adrenal gland (phaeochromocytoma).
• Decreased kidney function.
• Decreased liver function.
• Diabetes.
• People who suffer from drops in blood sugar (hypoglycaemia).
• Overactive thyroid gland (hyperthyroidism).
• Depression.
• History of allergies.
• Psoriasis.
• Abnormal muscle weakness (myaesthenia gravis).

• Asthma or history of asthma.
• Severe chronic obstructive pulmonary disease (COPD).
• Slow heart rate caused by the pacemaker of the heart (sinus bradycardia).
• Serious defect in the heart’s electrical message pathways resulting in decreased function of the heart (2nd or 3rd degree heart block).
• Uncontrolled heart failure.
• Failure of the heart to maintain adequate circulation of blood (cardiogenic shock).
• People taking monoamine oxidase inhibitor (MAOI) or tricyclic antidepressants or mianserin.
• Breastfeeding.
• Babies and infants under two years of age.
• This medicine is also not recommended for children or adolescents aged 2 to 17 years of age, because its safety and effectiveness have not been established in this age group. There is a high risk of sleepiness if used in children who are aged two to seven years or weigh less than 20kg.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

• The safety of this medicine during pregnancy has not been established. It should not be during pregnancy unless considered essential by your doctor, as it may be absorbed into the bloodstream and could be harmful to the unborn baby. Seek medical advice from your doctor.
• It is not known if brimonidine passes into breast milk, however, timolol does pass into breast milk after application to the eye. These eye drops should not be used by breastfeeding mothers. Seek medical advice from your doctor.

• Red eye due to increased blood supply (hyperaemia).
• Burning sensation in the eye.

• Eye stinging, itching, irritation, dryness, pain or discharge.
• Inflammation of the membrane that lines the inside of the eyelids and outside of the eyeball, causing redness and discharge (conjunctivitis).
• Inflammation of the eyelids (blepharitis).
• Corneal erosion.
• Sensation of something being in the eye.
• Eyelid swelling, redness or itching.
• Sleepiness.
• Feeling weak or fatigued.
• Headache.
• Dry mouth.
• Increased blood pressure.
• Depression.

• Dislike of light (photophobia).
• Dizzines or fainting.
• Awareness of your heart beat (palpitations).
• Nasal inflammation or dryness.
• Abnormal taste.
• Heart failure.

The side effects listed above may not include all of the side effects reported by the medicine’s manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

• monoamine oxidase inhibitor (MAOIs), eg the antidepressants phenelzine, tranylcypromine or isocarboxacid (these eye drops should not be started until 14 days after stopping treatment with an MAOI)
• tricyclic antidepressants, eg amitriptyline, imipramine
• related antidepressants, eg mianserin.

In people with diabetes, timolol can prolong the lowering of blood sugar (hypoglycaemia) caused by insulin or other antidiabetic medicines. People with diabetes should monitor their blood sugar while using these eye drops, as timolol can also mask the signs of hypoglycaemia.

• beta-blockers, eg atenolol
• calcium channel blockers, eg nifedipine, verapamil, diltiazem
• digoxin
• medicines for abnormal heart rhythms (antiarrhythmics), eg amiodarone
• medicines for high blood pressure.

If the medicine clonidine is suddenly stopped it can cause an increase in blood pressure. This increase in blood pressure may be worse in people taking beta-blockers, including eye drops such as this one.
Beta-blockers oppose the action of medicines for asthma that open the airways, which is why these eye drops should not be used by people with asthma or other breathing difficulties.