Uses

This combination medication is used to treat high pressure inside the eye due to glaucoma (open-angle type) or other eye diseases (such as ocular hypertension). Lowering high pressure inside the eye helps to prevent blindness. This product contains brimonidine and timolol. These medications are used together when 1 drug is not controlling the pressure inside the eye. Brimonidine works by allowing better fluid drainage from within the eye and also by decreasing the amount of fluid formed in the eye. It belongs to a class of drugs known as alpha agonists. Timolol is thought to work by decreasing the amount of fluid formed in the eye. Timolol belongs to a class of drugs known as beta blockers.

This medication is not recommended for use in children less than 2 years old due to an increased risk of serious side effects. Ask the doctor or pharmacist for more details.

How To Use

Read the Patient Information Leaflet if available from your pharmacist before you start using this product and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

To apply eye drops, wash your hands first. To avoid contamination, do not touch the dropper tip or let it touch your eye or any other surface.

Use this medication in the affected eye(s) as directed by your doctor, usually 2 times daily (12 hours apart).

The preservative in this product may be absorbed by contact lenses. If you wear contact lenses, remove them before using the eye drops. Wait at least 15 minutes after using this medication before putting in your contact lenses.

Tilt your head back, look up, and pull down the lower eyelid to make a pouch. Hold the dropper directly over your eye and place 1 drop in the pouch. Look down and gently close your eyes for 1 to 2 minutes. Place one finger at the corner of your eye (near the nose) and apply gentle pressure. This will prevent the medication from draining away from the eye. Try not to blink and do not rub your eye. Repeat these steps for your other eye if so directed.

Do not rinse the dropper. Replace the dropper cap after each use.

If you are using another kind of eye medication (such as drops or ointments), wait at least 10 minutes before applying other medications. Use eye drops before eye ointments to allow the eye drops to enter the eye.

Wait several minutes for your vision to clear before driving or operating machinery.

Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same times each day. Keep using this medication even if you feel well. Most people with glaucoma or high pressure in the eyes do not feel sick.

Side Effects

Temporary blurred vision, temporary burning/stinging/itching/redness of the eye, watery eyes, dry eyes, dry mouth, feeling as if something is in the eye, headache, dizziness, or drowsiness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including:

• vision changes
• eye sensitivity to light
• eye pain/swelling/discharge
• slow/irregular heartbeat
• muscle weakness
• unusual tiredness
• mental/mood changes
• coldness/numbness/pain in the hands or feet
• swelling ankles/feet
• sudden unexplained weight gain
• shortness of breath

Get medical help right away if you have any very serious side effects, including:

• dizziness that doesn't stop
• trouble breathing
• chest pain
• weakness on one side of the body
• trouble speaking
• confusion
• fainting

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including:

• rash
• itching/swelling (especially of the face/tongue/throat)
• severe dizziness
• trouble breathing

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before using this product, tell your doctor or pharmacist if you are allergic to brimonidine or timolol; or to apraclonidine; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of:

• lung disease (such as current or past asthma, severe chronic obstructive pulmonary disease-COPD)
• certain types of irregular heartbeats (sinus bradycardia, second- or third-degree AV block)
• heart disease (severe heart failure, cardiogenic shock)
• kidney disease
• liver disease
• blood vessel disease (such as thromboangiitis obliterans, Raynaud's phenomenon)
• blood circulation disorders (cerebral/coronary insufficiency)
• dizziness after standing (orthostatic hypotension)
• diabetes
• depression
• overactive thyroid (hyperthyroidism)
• muscle weakness disorders (such as myasthenia gravis)
• severe allergies

If you develop an eye infection or injury, or have eye surgery, check with your doctor about whether you should continue to use your current bottle of this medication. You may be advised to start using a new bottle.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

This product may prevent the fast/pounding heartbeat you would usually feel when your blood sugar level falls too low (hypoglycemia). The risk is higher if you have diabetes, or are vomiting, fasting, or not eating regularly. Other symptoms of low blood sugar level, such as dizziness and sweating, are not affected by this drug.

If you have diabetes, this product may make it harder to control your blood sugar levels. Check your blood sugar levels regularly as directed by your doctor. Tell your doctor right away if you have symptoms of high blood sugar such as increased thirst/urination. Your doctor may need to adjust your diabetes medication, exercise program, or diet.

This drug may make you dizzy or drowsy or temporarily blur your vision. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

This medication passes into breast milk, but is unlikely to harm a nursing infant. Consult your doctor before breast-feeding.

Drug Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug include:

• beta blockers taken by mouth (such as propranolol)
• certain antidepressants (SSRIs such as fluoxetine, tricyclics such as amitriptyline)
• digoxin
• epinephrine
• high blood pressure medications (such as clonidine, methyldopa)
• quinidine

Tell your doctor or pharmacist if you are using other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).

Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

Overdose

This medicine may be harmful if swallowed. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Alberta residents can call PADIS (Poison and Drug Information Service) 24 hours a day at 1-800-332-1414. Canada residents can call a provincial poison control center. Symptoms of overdose may include: trouble breathing, slow heartbeat.

Notes

Do not share this medication with others.

Lab and/or medical tests (such as eye exams, measuring intraocular pressure) should be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.

Missed Dose

If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

If you have questions about missing a dose or you don't have more medication, contact your healthcare provider or pharmacist.

Storage

Store at room temperature away from light. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.