Combigan (brimonidine/timolol)

What are Combigan eye drops?

Combigan eye drops are a brand-name prescription medication. They’re FDA-approved to treat increased eye pressure from either of the following in certain situations:*

• open-angle glaucoma (a type of eye condition in which pressure builds in the eye and can damage the optic nerve†)
• ocular hypertension (high pressure in the eye)

Combigan is approved for use in adults as well as children 2 years and older.

* For details on the uses of Combigan, see the “Combigan uses” section below.
† The optic nerve helps your eyes and brain communicate with each other.

Drug ingredients and other details

Two active drugs make up Combigan: brimonidine and timolol.

Brimonidine belongs to a group of drugs called alpha-2 adrenergic receptor agonists. Timolol belongs to a group of drugs called beta-adrenergic receptor blockers (beta-blockers). Both brimonidine and timolol work in different ways to decrease the amount of pressure in your eye.

Combigan is a liquid solution that comes in eye-drop form. It’s available in one strength: 0.2% brimonidine tartrate/0.5% timolol maleate.

Effectiveness

For information on the effectiveness of Combigan, see the “Combigan uses” section below.

Combigan generic

Combigan is available only as a brand-name medication. It’s not currently available in generic form.

A generic drug is an exact copy of the active drug in a brand-name medication. Generics usually cost less than brand-name drugs.

Combigan side effects

Combigan can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Combigan. These lists don’t include all possible side effects.

For more information on the possible side effects of Combigan, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Combigan, you can do so through MedWatch.

Mild side effects

Mild side effects of Combigan can include:*

• eye itching, burning, or stinging†
• eyelid swelling or irritation†
• blood vessels in your eye that are redder and larger than usual†
• fatigue (lack of energy)†
• unusual taste in your mouth

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Combigan. To learn about other mild side effects, talk with your doctor or pharmacist, or visit Combigan’s prescribing information.
† For more information on these side effects, see “Side effect details” below. The eye side effects are grouped together in a section called “Eye side effects.”

Serious side effects

Serious side effects from Combigan aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

• Muscle weakness. Symptoms can include:
  • eyelid drooping
  • blurry vision
• Depression. Symptoms can include:
  • feeling sad or lonely
  • not wanting to do activities you used to enjoy
• Allergic reaction.*
• Breathing problems, such as trouble breathing.*
• Heart side effects, such as low blood pressure and heart failure.*

* For more information on these side effects, see “Side effect details” below.

Side effects in children

Combigan side effects that occurred in children were similar to those that occurred in adults. Combigan is approved for use in children ages 2 years and older.

The most common Combigan side effects that occurred in children during clinical trials were feeling sleepy and decreased alertness.

Side effect details

You may wonder how often certain side effects occur with this drug or whether certain side effects pertain to it. Here’s some detail on certain side effects this drug may or may not cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Combigan. In clinical trials, allergic reactions did occur in some people using Combigan. However, it’s not known how many people may have experienced an allergic reaction from the medication.

Symptoms of a mild allergic reaction can include:

• skin rash
• itchiness
• flushing (warmth, swelling, or redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your tongue, mouth, or throat
• trouble breathing

Call your doctor right away if you have a severe allergic reaction to Combigan. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Fatigue

Combigan may cause fatigue (a lack of energy) and sleepiness. It’s not known how many people using Combigan in clinical trials may have experienced fatigue while they were taking the medication. However, 1% to 5% of people who took the drug reported sleepiness in the trials.

When you first start taking Combigan, you shouldn’t drive or take part in hazardous activities until you know how the drug will affect you. (Hazardous activities can include operating machinery.) If Combigan makes you very tired, you may not be able to drive or perform other tasks after a dose. To learn more, see the “Common questions about Combigan” section below.

If you have fatigue or sleepiness that’s bothersome while taking Combigan, talk with your doctor. They can suggest ways to help ease this side effect.

Eye side effects

Eye side effects may occur with Combigan use, including:

• eye itching, burning, or stinging
• blood vessels in your eye that are redder and larger than usual

These side effects occurred in 5% to 15% of people who used Combigan in clinical trials. Although Combigan was compared with timolol and brimonidine, it’s not known how often eye side effects occurred with timolol and brimonidine. Those are the two active drugs in Combigan.

Other eye side effects, such as eye dryness, pain, eyelid swelling, and irritation occurred in 1% to 5% of people who used Combigan. Although Combigan was compared with timolol and brimonidine, it’s not known how often eye side effects occurred with timolol and brimonidine.

If you have eye side effects that don’t go away or are bothersome to you while taking Combigan, talk with your doctor. They may be able to recommend ways to help you feel more comfortable.

Breathing problems

Although rare, it’s possible to develop breathing problems during Combigan treatment. It’s not known how many people in clinical trials may have developed this side effect while using the medication.

One of the active drugs in Combigan, called timolol, may affect your airways. Even though the drug works to treat your eye or eyes, a small amount of timolol maleate may be absorbed into your blood through your eye. Once the drug is in your blood, it may reach your lungs and make it hard to breathe.

Slowed breathing and bronchospasm (tightening of your muscles in your airways) may occur after you use Combigan.*

Symptoms of bronchospasm can include:

• tightness and pain in your back and chest
• coughing
• trouble breathing

If you have any trouble breathing while you’re using Combigan, tell your doctor right away. They may recommend that you stop treatment and switch to a different medication.

* Because of the risk for bronchospasm, you shouldn’t take Combigan if you have certain breathing conditions such as asthma or chronic obstructive pulmonary disorder (COPD). To learn more, see the “Combigan precautions” section below.

Heart side effects

Heart side effects may occur with Combigan use. One of the active drugs in Combigan called timolol can lead to heart side effects such as low blood pressure, heart failure,* and increased blood pressure.

It’s not known how many people using Combigan may have had low blood pressure or heart failure in clinical trials.

However, 1% to 5% of people taking the medication had an increase in blood pressure in the trials. Although Combigan was compared with timolol and brimonidine, it’s not known how often eye side effects occurred with timolol and brimonidine. Those are the two active drugs in Combigan.

Even though Combigan works to treat your eye or eyes, it can be absorbed into your blood through your eye. Once the drug is in your blood, it may reach your heart and lead to heart failure. Combigan may also circulate in your blood throughout the rest of your body and lower or raise your blood pressure.

* You shouldn’t use Combigan if you already have heart failure. This is because the drug can cause your heart failure to become even worse. To learn more, see the “Combigan precautions” section below.

Symptoms of heart side effects

Low blood pressure often doesn’t have any symptoms, but it can cause symptoms such as blurry vision, thirst, and dizziness.

Heart failure symptoms can include sudden weight gain, extreme fatigue, and an irregular pulse.

An increase in blood pressure often doesn’t have any symptoms. You may not know your blood pressure is higher than usual unless you check it at home or your doctor measures it.

If you’re taking Combigan and notice any changes in your blood pressure or the symptoms mentioned above, talk with your doctor. They may recommend switching you to a different medication to treat your increased eye pressure.

Kidney problems (not a side effect)

Kidney problems weren’t a side effect reported in clinical trials of people taking Combigan. Although the drug is removed from your body through your kidneys, you shouldn’t experience kidney problems during your Combigan treatment.

Combigan cost

As with all medications, the cost of Combigan can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Before approving coverage for Combigan, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure if you’ll need to get prior authorization for Combigan, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Combigan, or if you need help understanding your insurance coverage, help is available.

Allergan, the manufacturer of Combigan, offers a savings card. For more information and to find out if you’re eligible for support, call 833‑Dial‑AYS (833‑342‑5297) or visit the program website.

Generic version

Combigan is not available in a generic form. A generic drug is an exact copy of the active drug in a brand-name medication. Generics tend to cost less than brand-name drugs.

Alternatives to Combigan

Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Combigan, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Alternatives for increased eye pressure from open-angle glaucoma or ocular hypertension

Examples of other drugs that may be used to treat increased eye pressure from open-angle glaucoma or ocular hypertension include:

• latanoprost (Xalatan)
• bimatoprost (Lumigan)
• travoprost (Travatan-Z)
• betaxolol (Betoptic)
• carteolol
• timolol maleate (Timoptic)
• dorzolamide/timolol (Cosopt)
• brimonidine (Alphagan-P)
• brinzolamide (Azopt)
• dorzolamide (Trusopt)
• brinzolamide/brimonidine (Simbrinza)

Combigan dosage

The Combigan dosage your doctor prescribes will depend on several factors. However, usually the dose of Combigan is the same. In some cases, your doctor may change your dose of Combigan if you’re experiencing side effects or if you have other medical conditions.

Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Combigan is a liquid solution that comes in eye-drop form. It contains two active drug ingredients: brimonidine and timolol. Combigan is available in one strength: 0.2% brimonidine tartrate and 0.5% timolol maleate.

Combigan comes in the following bottle sizes:

• 5 mL of Combigan in a 10 mL bottle
• 10 mL of Combigan in a 10 mL bottle
• 15 mL of Combigan in a 15 mL bottle

Dosage for increased eye pressure from open-angle glaucoma or ocular hypertension

Combigan is used to treat increased eye pressure from either open-angle glaucoma or ocular hypertension. The typical dosage for this use is one drop into the affected eye or eyes, twice per day. Ideally, you should space out your doses of Combigan by 12 hours.

Pediatric dosage

Combigan is approved for use in children ages 2 years and older. The Combigan dosage for this age group is the same as the dosage for adults. For details, see “Dosage for increased eye pressure from glaucoma or ocular hypertension” right above.

Dosage questions

Below are answers to some questions you may have about taking Combigan.

What if I miss a dose?

If you miss your dose of Combigan, talk with your doctor or pharmacist about when you should take your next dose. If you missed your dose by a few hours, they may recommend that you take your dose as soon as you remember. But if it’s almost time for your next dose, you may be advised to skip your missed dose and take your next dose when it’s due.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm on your phone or downloading a reminder app. A kitchen timer can work, too.

Will I need to use this drug long term?

Combigan is meant to be used as a long-term treatment. If you and your doctor determine that Combigan is safe and effective for you, you’ll likely take it long term.

How Combigan works

Combigan is approved to treat increased eye pressure due to either:

• open-angle glaucoma (a type of eye condition in which pressure builds in the eye and can damage the optic nerve*), or
• ocular hypertension (high pressure in the eye)

For information on how glaucoma and ocular hypertension occur in the body, see the “Combigan uses” section below.

* The optic nerve helps your eyes and brain communicate with each other.

What Combigan does

There are two drugs that make up Combigan: brimonidine and timolol. Both of these drugs work in different ways to decrease the amount of pressure in your eye.

Brimonidine is a type of drug known as an alpha-2 adrenergic agonist. Brimonidine works by reducing the level of fluid in the eye called aqueous humor. Brimonidine also causes the eye to increase drainage of the fluid, which can help decrease the pressure in the eye.

Timolol is a type of drug known as a beta-blocker. It’s thought that timolol reduces the level of aqueous humor in the front part of your eye. As a result, the pressure in your eye decreases.

How long does it take to work?

Combigan will begin to work to decrease eye pressure after you use the medication for the first time.

How long does Combigan stay in your system?

Combigan stays in your system for about 7 hours. However, each person’s body is different. The drug may break down more slowly or quickly in different people. This means that Combigan may stay in your system for a longer or shorter time than 7 hours.

Combigan uses

The Food and Drug Administration (FDA) approves prescription drugs such as Combigan to treat certain conditions.

Combigan for increased eye pressure from open-angle glaucoma or ocular hypertension

Combigan is FDA-approved to treat increased eye pressure due to either:

• open-angle glaucoma (a type of eye condition in which pressure builds in the eye and can damage the optic nerve), or
• ocular hypertension (high pressure in the eye)

Combigan is approved for use in adults as well as children ages 2 years and older. The drug should be used only if:

• other drugs haven’t been able to lower your eye pressure enough, or
• you need a second drug to help lower your eye pressure

Increased eye pressure explained

The eye contains fluid. When this fluid builds up, eye pressure increases. As the pressure in the eye rises, so does the risk for vision loss and eye damage. In severe cases, the results can be permanent.

In glaucoma, your optic nerve may become damaged. (The optic nerve helps your eyes and brain communicate with each other.) The damage is due to a problem with the drainage in your eye. Your body may have trouble getting rid of the excess eye fluid. When there’s too much fluid, the pressure of your eye rises. The increased pressure may harm your optic nerve and in severe cases, it may slowly cause blindness.

There are several types of glaucoma, but the main ones are open-angle glaucoma and closed-angle glaucoma. Open-angle glaucoma is the most common. Early on, glaucoma doesn’t usually have symptoms. But open-angle glaucoma can lead to the gradual loss of peripheral vision. With closed-angle glaucoma, pain and vision loss occur suddenly.

Ocular hypertension occurs when the front part of the eye can’t properly drain fluid. This causes increased pressure in the eye. With ocular hypertension, the optic nerve isn’t damaged. If you have ocular hypertension, you’re at an increased risk for developing glaucoma.

Effectiveness for increased eye pressure from open-angle glaucoma or ocular hypertension

Clinical trials looked at people with glaucoma or ocular hypertension. They used either:

• Combigan two times daily
• brimonidine 0.2% three times daily
• timolol 0.5% two times daily

Brimonidine 0.2% and timolol 0.5% are the active drugs in Combigan.

After the first 7 hours, people using Combigan had a decrease in their eye pressure that was:

• 1 mmHg to 3 mmHg greater than people using brimonidine alone
• 1 mmHg to 2 mmHg greater than people using timolol alone

This means that the Combigan group had a larger decrease in eye pressure than the brimonidine or timolol group. Eye pressure is described using a unit of measurement called millimeters of mercury (mmHg).

In another trial, people took either:

• Combigan two times daily
• brimonidine 0.2% two times daily and timolol 0.5% three times daily

Eye pressure was 1 mmHg to 2 mmHg higher in people using Combigan than in people using brimonidine with timolol. However, Combigan caused less severe sleepiness than brimonidine with timolol.

Combigan and children

Combigan is approved for use in children ages 2 years and older.

Clinical trials looked at children ages 2 through 16 years who had increased eye pressure. They were given Combigan or brimonidine 0.2% plus a beta-blocker eye drop. Researchers found that Combigan was safe and effective to treat increased eye pressure in this age group.

Combigan expiration, storage, and disposal

When you get Combigan from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk with your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication. Usually the pharmacy will label your medication with an expiration date. There may also be an expiration date on your bottle of Combigan. You should always go by the expiration date that’s the soonest. And be sure to discard your Combigan eye drops when they’re expired.

You should store Combigan at room temperature (59°F to 77°F/15°C to 30°C ) in a tightly sealed container away from light. Combigan eye drops do not need to be refrigerated.

After opening your Combigan bottle, you should use it within 28 days because it can start to grow bacteria after this time. (Bacteria can cause eye infections, which may be serious.)

Avoid storing this medication in areas where it could get damp or wet, such as bathrooms.

Disposal

After 28 days have passed since you opened Combigan, you should dispose of the bottle and open a new one. And if you no longer need to take Combigan and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

This article provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.

Combigan vs. Lumigan

You may wonder how Combigan compares with other medications that are prescribed for similar uses. Here we look at how Combigan and Lumigan are alike and different.

Ingredients

Combigan is made up of two drug ingredients: brimonidine tartrate and timolol maleate. Lumigan is made up of one drug ingredient, called bimatoprost.

Combigan and Lumigan belong to different drug classes. A drug class is a group of medications that work in a similar way. Combigan belongs to the beta-blocker drug class. Lumigan belongs to the alpha-2 adrenergic agonist drug class.

Uses

The Food and Drug Administration (FDA) has approved Combigan and Lumigan to treat increased eye pressure from open-angle glaucoma or ocular hypertension (high pressure in the eye).

However, Combigan should be used only if:

• other drugs haven’t been able to lower your eye pressure enough, or
• you need a second drug to help lower your eye pressure

Combigan and Lumigan are also used for different age groups. Combigan is approved for use in adults as well as children ages 2 years and older. Lumigan is approved for use in adults as well as children ages 16 years and older.

For details on Combigan’s uses, see the “Combigan uses” section below. For more information on Lumigan’s uses, talk with your doctor or pharmacist.

Drug forms and administration

Combigan and Lumigan are both liquid solutions that come in eye-drop form.

Combigan is typically used twice daily, while Lumigan is typically used once daily.

Side effects and risks

Combigan and Lumigan both contain drugs that reduce eye pressure. Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with each drug, or with both Combigan and Lumigan (when taken individually).

• Can occur with Combigan:
  • fatigue (lack of energy)
  • unusual taste in your mouth
• Can occur with Lumigan:
  • no unique mild side effects
• Can occur with both Combigan and Lumigan:
  • blood vessels in your eye that are redder and larger than usual
  • eye itching, burning, or stinging
  • eyelid swelling or irritation

Serious side effects

These lists contain examples of serious side effects that can occur with Combigan, with Lumigan, or with both drugs (when taken individually).

• Can occur with Combigan:
  • muscle weakness
  • heart side effects, such as low blood pressure and heart failure
  • breathing problems, such as trouble breathing
  • depression
• Can occur with Lumigan:
  • changes in the color of your eye, eyelid, or eyelashes
  • increased length, thickness, or number of eyelashes
• Can occur with both Combigan and Lumigan:
  • allergic reaction

Effectiveness

The only condition both Combigan and Lumigan are used to treat is increased eye pressure from open-angle glaucoma or ocular hypertension.

These drugs haven’t been directly compared in clinical studies, but studies have found both Combigan and Lumigan to be effective for treating increased eye pressure.

Researchers have looked at how well Combigan and Lumigan work together when compared to the use of Lumigan alone. After 12 weeks of use, eye pressure was:

• 15.4 mmHg* in people taking both Lumigan and Combigan
• 19.2 mmHg* in people taking Lumigan alone

Lumigan and Combigan were more effective at lowering eye pressure than Lumigan alone.

* Eye pressure is described using a unit of measurement called millimeters of mercury (mmHg).

Costs

The costs of Combigan and Lumigan may vary depending on your treatment plan. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Combigan and Lumigan are both brand-name drugs. There’s currently no generic form of Combigan. However, there’s a generic form of Lumigan called bimatoprost.

Brand-name medications usually cost more than generics.

Common questions about Combigan

Here are answers to some frequently asked questions about Combigan.

Can Combigan lower blood pressure?

It’s possible that Combigan can lower your blood pressure.

Combigan comes in eye-drop form and works to treat your eye or eyes. But a small amount of it can be absorbed into your blood through your eye. Once the drug is in your blood, Combigan can circulate throughout the rest of your body and reduce your blood pressure.

It’s not known how much Combigan may decrease your blood pressure.

If you have more questions about Combigan lowering your blood pressure, talk with your doctor.

Will Combigan cure my condition?

No, Combigan won’t cure your glaucoma or ocular hypertension (high pressure in the eye). At this time, there’s no cure for these two conditions.

However, Combigan should work to decrease your eye pressure. When your eye pressure is lower, you have less of a risk for developing long-term side effects from your condition, such as vision loss.

Can I wear contacts during my Combigan treatment?

You can wear contact lenses during your Combigan treatment, but you should remove them before you use the drug.

Combigan contains a preservative called benzalkonium chloride. This preservative helps prevent bacteria from growing in the bottle for about 28 days after you open it.* (Bacteria can cause eye infections, which may be serious.) However, contact lenses can absorb the preservative.

After each Combigan dose, wait at least 15 minutes before putting in your contacts. This should help prevent your contacts from absorbing the preservative.

If you have other questions about Combigan and contacts, talk with your doctor.

* After 28 days have passed since you opened Combigan, you should dispose of the bottle and open a new one.

Is it OK to drive after using Combigan?

It depends on how your eyes react to Combigan. In some people, Combigan may cause blurred vision, especially right after you put in the eye drops. If you experience this side effect, you shouldn’t drive until your vision returns to normal. Combigan may also cause fatigue (a lack of energy) or sleepiness, which can make driving dangerous.

It’s helpful to avoid driving after you use Combigan for the first time. This is because you don’t know what side effects you may experience from the drug. Once you’re comfortable with how your body reacts to Combigan, you may be able to drive.

To learn more, talk with your doctor about side effects that you may experience after using Combigan. They can also advise you on whether it’s safe for you to drive after using the drug.

If I’m using other eye medications, when should I take Combigan?

If you’re using more than one eye medication, you should separate them from Combigan doses by at least 5 minutes. This helps prevent one eye medication from washing out the other.

If you use Combigan and another eye medication within 5 minutes of each other, your body won’t have enough time to absorb Combigan.

For more information on when to take Combigan and other eye medications, talk with your doctor.

Combigan interactions

Combigan can interact with several other medications. It can also interact with certain supplements as well as certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Combigan and other medications

Below are examples of medications that can interact with Combigan. This section doesn’t contain all drugs that may interact with Combigan.

Before taking Combigan, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Combigan and beta-blockers

Combigan may decrease your blood pressure. If you’re also taking a beta-blocker, your blood pressure may become too low. This can be dangerous and cause blurry vision, dizziness, or fainting.

Because Combigan contains a beta-blocker (timolol), you shouldn’t use any other beta-blockers while taking Combigan. This is because both drugs work in the same way and may cause an increased risk of low blood pressure.

Examples of other eye drops that contain beta-blockers include:

• timolol (Timoptic, Betimol, Istalol)
• betaxolol (Betoptic, Betoptic S)
• carteolol

It’s not recommended that you use two eye drops that are both beta-blockers. If you’re already using another beta-blocker eye drop, your doctor may have you stop taking it. Or they may recommend an eye drop other than Combigan.

Oral beta-blockers

In addition to beta-blocker eye drops, beta-blockers come in oral form that’s taken by mouth. Oral beta-blockers may be used to treat heart failure, hypertension (high blood pressure), and migraine.

Examples of oral beta-blockers include:

• atenolol (Tenormin)
• nebivolol (Bystolic)
• propranolol (Inderal)
• metoprolol (Lopressor, Toprol XL)

If you take an oral beta-blocker during your Combigan treatment, your doctor may monitor your blood pressure more often than usual.

Before Combigan treatment

Before you start taking Combigan, talk with your doctor about any medications that you use. They can tell you if any of them are beta-blockers.

Combigan and calcium channel blockers

You may not be able to use Combigan if you’re also taking a calcium channel blocker. Taking the two drugs together may cause heart problems, such as heart failure, a decrease in blood pressure, and heart block. (Heart block is a kind of abnormal electrical activity in your heart.) Both Combigan and calcium channel blockers can affect your blood pressure and your heart.

Examples of calcium channel blockers include:

• amlodipine (Norvasc)
• diltiazem (Cardizem, Cartia XT)
• nifedipine (Procardia)
• verapamil (Calan, Verelan)

Before you start using Combigan, talk with your doctor about any other medications you take. If you’re taking a calcium channel blocker, they may monitor you more closely for symptoms of heart conditions or low blood pressure. If you have a decrease in the function in your heart, your doctor may recommend that you use a medication other than Combigan.

Combigan and drugs that slow your central nervous system

Combigan may decrease your blood pressure and breathing rate. (Your central nervous system [CNS] controls these functions.) Using Combigan with drugs that can slow your CNS may lower your blood pressure and breathing rate further. This can be dangerous.

Examples of drugs that can slow your CNS include:

• diazepam (Valium)
• clonazepam (Klonopin)
• alprazolam (Xanax)
• oxycodone (Roxicodone)
• phenobarbital

Alcohol may also slow your CNS when taken along with Combigan. (For more information, see the “Combigan and alcohol” section below.)

It’s not known exactly what may occur if you use Combigan along with alcohol or a drug that slows your CNS. However, it may cause decreased blood pressure and slowed breathing, which can be dangerous.

If you’re taking a medication that may slow your CNS, talk with your doctor before using Combigan. They may recommend a different medication to treat your increased eye pressure.

Combigan with digoxin and calcium channel blockers

If you use Combigan along with digoxin (Lanoxin) and a calcium channel blocker, you may be at an increased risk for developing a certain heart problem. The problem is called prolonged atrioventricular conduction time (PACT), and it causes your heartbeat to be longer than it should be. PACT may lead to serious symptoms, including fainting, chest pain, and trouble breathing.

For examples of calcium channel blockers, see “Combigan and calcium channel blockers” above.

If you take digoxin and a calcium channel blocker, talk with your doctor before starting Combigan treatment. They may monitor you more often than usual or recommend a medication other than Combigan.

Combigan and CYP2D6 inhibitors

Combigan may be broken down in your liver by a protein called CYP2D6. Drugs known as CYP2D6 inhibitors may prevent CYP2D6 from working properly. If you take Combigan and a CYP2D6 inhibitor, the level of Combigan in your body may build up. This may raise your risk for side effects from Combigan, such as decreased heart rate and depression.

Examples of CYP2D6 inhibitors include:

• quinidine
• paroxetine (Paxil)
• fluoxetine (Prozac)

Before you start using Combigan, talk with your doctor about any other medications that you take. They can determine if any of the drugs are CYP2D6 inhibitors and adjust your treatment plan if needed.

Combigan with clonidine and tricyclic antidepressants

Clonidine is a drug that helps reduce blood pressure. If you use clonidine and a tricyclic antidepressant (TCA), the TCA may make clonidine less effective. And if you take Combigan with clonidine and a TCA, Combigan may not work as well to decrease your eye pressure.

Examples of TCAs include:

• amitriptyline
• imipramine (Tofranil)
• nortriptyline (Pamelor)

Before you use Combigan, talk with your doctor about any medications that you take. They can determine if any of the drugs are TCAs and adjust your treatment plan if you’re also using clonidine. This may mean monitoring you more often than usual or changing your medications.

Combigan and MAOIs

One of the ingredients in Combigan is brimonidine. A group of drugs called monoamine oxidase inhibitors (MAOIs) may decrease the breakdown of brimonidine in your body. This may cause the level of brimonidine to rise. If the level of this drug gets too high, it may increase your risk for side effects such as low blood pressure, which can be serious.

Examples of MAOIs include:

• tranylcypromine (Parnate)
• phenelzine (Nardil)
• selegiline (Emsam)

Before starting Combigan treatment, talk with your doctor about any medications that you take. If you’re using an MAOI, they may monitor you more often.

Combigan and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Combigan. However, you should still check with your doctor or pharmacist before using any of these products while taking Combigan.

Combigan and foods

There aren’t any foods that have been specifically reported to interact with Combigan. If you have any questions about eating certain foods with Combigan, talk with your doctor.

Combigan and alcohol

Both Combigan and alcohol may decrease your blood pressure and rate of breathing, cause blurry vision, and increase sleepiness. Therefore, using Combigan and drinking alcohol may further raise your risk for these side effects. (For more about Combigan side effects, see the “Combigan side effects” section above.)

Before you start Combigan treatment, ask your doctor if it’s safe for you to drink alcohol and what amount they recommend.

How to use Combigan

You should take Combigan according to your doctor’s or healthcare professional’s instructions.

Combigan is a liquid solution that comes in eye-drop form.

It’s important that you don’t touch your eye with the tip of the Combigan bottle. If you do, bacteria may form on the tip and enter your eye when you take your next dose. This can cause serious eye infections to occur.

When to use

Combigan should be used two times daily, with the doses spaced about 12 hours apart.

If you use other eye medications, be sure to use them at least 5 minutes apart from Combigan. This helps make sure that your body absorbs both drugs. It also helps prevent one medication from washing out the other.

In addition, you should use each Combigan bottle for only 28 days after opening it. If you use it for a longer time, the risk of bacteria forming in it increases.

If you have any questions about how to use Combigan, talk with your doctor or pharmacist.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm on your phone or downloading a reminder app. A kitchen timer can work, too.

Combigan and pregnancy

It’s not known if Combigan is safe to use while pregnant. There haven’t been any clinical trials of the drug during pregnancy.

In animal studies, brimonidine (one of the ingredients in Combigan) was present in the blood of the fetus. This means that the when pregnant animals were given the drug, it passed into the developing offspring. No side effects were noticed in the developing animal fetuses. However, animal studies don’t always predict what will happen in people.

It’s recommended that you use Combigan during pregnancy only if the benefits outweigh the risks. If you’re pregnant or planning to become pregnant, talk with your doctor. They can review the pros and cons of Combigan with you.

Combigan and birth control

It’s not known if Combigan is safe to take during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Combigan.

For more information about taking Combigan during pregnancy, see the “Combigan and pregnancy” section above.

Combigan and breastfeeding

You shouldn’t use Combigan while breastfeeding.

One of the active ingredients in Combigan (timolol) is present in human breast milk when the breastfeeding mother takes a dose of Combigan. The other active ingredient in Combigan (brimonidine), may also be present in breast milk. Because of this, it’s recommended that breastfeeding women either stop using Combigan or stop breastfeeding while using Combigan.

If you have increased eye pressure and are breastfeeding or planning to breastfeed, talk with your doctor about your treatment options.

Combigan precautions

This drug comes with several precautions. Before taking Combigan, talk with your doctor about your health history. Combigan may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

Certain lung conditions

Combigan contains the drug timolol, which may cause bronchospasm. If you have a lung condition such as asthma or chronic obstructive pulmonary disease (COPD), using Combigan may worsen it. Before starting Combigan treatment, talk with your doctor. They may recommend a different medication for you.

Certain heart problems

If you have a heart condition, such as heart failure or low blood pressure, taking Combigan may make it worse. This is because Combigan may decrease your heart rate and blood pressure. If you have a heart condition, talk with your doctor before you start taking Combigan. They may recommend a different medication.

Conditions that cause weak muscles

Combigan may cause muscle weakness, which can lead to double vision, general weakness, and eyelid drooping. If you have a condition (such as myasthenia gravis) that causes weak muscles, Combigan may make it worse. Before starting Combigan treatment, talk with your doctor. They may recommend a different medication for you.

Conditions that lower blood pressure

If you have a condition (such as orthostatic hypotension) that affects your blood pressure, Combigan may worsen it. Before starting Combigan treatment, talk with your doctor. They may recommend a different medication to decrease your eye pressure.

Diabetes or risk of low blood sugar

If you have diabetes or are at risk for developing low blood sugar, talk with your doctor before using Combigan. The drug may cause symptoms of low blood sugar, such as heart palpitations and tremors, to not occur. As a result, you may not realize that your blood sugar is low. Untreated low blood sugar can be very serious. If you have diabetes or a history of low blood sugar, talk with your doctor. They may monitor your blood sugar more often than usual while you’re taking Combigan.

Thyroid conditions

Combigan use may cause symptoms of hyperthyroidism to not occur. (One such symptom is an increased heart rate.) If you have hyperthyroidism and take the drug, you may not know that your thyroid levels are high.

Also, if you have a history of thyroid problems, you shouldn’t suddenly stop using Combigan. If you do, a thyroid storm could occur. In some cases, a thyroid storm can be fatal. Therefore, if you have any thyroid conditions, it’s important to talk with your doctor before you start taking Combigan. They may recommend a different medication to treat your increased eye pressure.

Major surgery

If you’re planning to have major surgery, your doctor may have you stop using Combigan beforehand. Major surgery includes any surgery to an organ in your abdomen (belly), pelvic area, chest, or head. One of the ingredients in Combigan (timolol) is a beta-blocker. And beta-blockers may increase the risk of side effects of anesthesia during surgery.

If you’re taking Combigan and plan to have surgery, be sure to tell your doctor. They may recommend stopping your Combigan treatment before you have the procedure.

Allergic reaction

If you’ve had an allergic reaction to Combigan or any of its ingredients, you shouldn’t take Combigan. Ask your doctor what other medications are better options for you.

Pregnancy

It’s not known if Combigan is safe to use while you’re pregnant. For more information, see the “Combigan and pregnancy” section above.

Breastfeeding

You shouldn’t use Combigan while breastfeeding. For more information, see the “Combigan and breastfeeding” section above.

Note: For more information about the potential negative effects of Combigan, see the “Combigan side effects” section above.

Combigan overdose

Using more than the recommended dosage of Combigan can lead to serious side effects. Do not use more Combigan than your doctor recommends.

Overdose symptoms

Symptoms of an overdose can include:

• dizziness
• headache
• trouble breathing
• decreased heart rate
• heart attack

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away.