Simbrinza (brinzolamide/brimonidine) dosing, indications, interactions, adverse effects, and more , , , Simbrinza (brinzolamide/brimonidine) dosing, indications, interactions, adverse effects, and more, , , , , , , , , , , , , , , , , Edition:EnglishFrançaisDeutsch, Search, , No Results, News & Perspective, Drugs & Diseases, CME & Education, Log In, Register, , , , , https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cDovL3JlZmVyZW5jZS5tZWRzY2FwZS5jb20vZHJ1Zy9zaW1icmluemEtYnJpbnpvbGFtaWRlLWJyaW1vbmlkaW5lLTk5OTg0MQ==, , , processing.... , , , , , brinzolamide/brimonidine (Rx)Brand and Other Names:Simbrinza, Classes: Antiglaucoma, Combos, , Dosing & Uses, Interactions, Adverse Effects, Warnings, Pregnancy, Pharmacology, Images, Patient Handout, Formulary, Dosing & Uses, AdultPediatric, Dosage Forms & Strengths, , brinzolamide/brimonidine, , ophthalmic suspension, , 1%/0.2%, , , more... Glaucoma, , Indicated for reduction of elevated intraocular pressure in patients with primary open-angle glaucoma, , Instill 1 gtt in affected eye(s) TID, , Ocular Hypertension, , Indicated for reduction of elevated intraocular pressure in patients with ocular hypertension, , Instill 1 gtt in affected eye(s) TID, , Administration, , Shake well before use, , If more than 1 ophthalmic drop is administered, the drugs should be administered at least 5 minutes apart, , Dosage Forms & Strengths, , brinzolamide/brimonidine, , ophthalmic suspension, , 1%/0.2%, , , more... Glaucoma, , Indicated for reduction of elevated intraocular pressure in patients with primary open-angle glaucoma, , <2 years: Safety and efficacy not established, , ≥2 years: Instill 1 gtt in affected eye(s) TID, , Ocular Hypertension, , Indicated for reduction of elevated intraocular pressure in patients with ocular hypertension, , <2 years: Safety and efficacy not established, , ≥2 years: Instill 1 gtt in affected eye(s) TID, , Administration, , Shake well before use, , If more than 1 ophthalmic drop is administered, the drugs should be administered at least 5 minutes apart, , Interactions, Interaction Checker, brinzolamide/brimonidine and , No Results, No Interactions Found, Interactions Found, Contraindicated, Serious - Use Alternative, Significant - Monitor Closely, Minor, Sort by : , , Adverse Effects, , >10% (brimonidine), , Somnolence in children (50-83%), , Xerostomia (10-30%), , Ocular hyperemia (10-30%), , Burning and stinging (10-30%), , Headache (10-30%), , Blurring (10-30%), , Foreign body sensation (10-30%), , Fatigue/drowsiness (10-30%), , Conjunctival follicles (10-30%), , Ocular allergic reactions (10-30%), , Ocular pruritus (10-30%), , , 1-10% (brinzolamide), , Blurred vision (5-10%), , Dysgeusia (5-10%), , Blepharitis (1-5%), , Dermatitis (1-5%), , Dry eye (1-5%), , Foreign body sensation (1-5%), , Headache (1-5%), , Hyperemia (1-5%), , Ocular discharge (1-5%), , Ocular discomfort (1-5%), , Ocular keratitis (1-5%), , Ocular pain (1-5%), , Ocular pruritus (1-5%), , Rhinitis (1-5%), , , 1-10% (brimonidine), , Corneal staining/erosion (3-9%), , Photophobia (3-9%), , Eyelid erythema (3-9%), , Ocular ache/pain (3-9%), , Ocular dryness (3-9%), , Tearing (3-9%), , Upper respiratory symptoms (3-9%), , Eyelid edema (3-9%), , Conjunctival edema (3-9%), , Dizziness (3-9%), , Blepharitis (3-9%), , Ocular (3-9%), , Irritation (3-9%), , Gastrointestinal symptoms (3-9%), , Asthenia (3-9%), , Conjunctival blanching (3-9%), , Abnormal vision (3-9%)Muscular pain (3-9%), , Lid crusting (<3%), , Conjunctival hemorrhage (<3%), , Abnormal taste (<3%), , Insomnia (<3%), , Conjunctival discharge (<3%), , Depression (<3%), , Hypertension (<3%), , Anxiety (<3%), , Palpitations/arrhythmias (<3%), , Nasal dryness (<3%), , Syncope (<3%), , , <1% (brinzolamide), , Allergic reactions, , Alopecia, , Chest pain, , Conjunctivitis, , Diarrhea, , Diplopia, , Dizziness, , Dry mouth, , Dyspnea, , Dyspepsia, , Eye fatigue, , Hypertonia, , Keratoconjunctivitis, , Keratopathy, , Kidney pain, , Lid margin crusting or sticky sensation, , Nausea, , Pharyngitis, , Tearing, , Urticaria, , , Warnings, , Contraindications, , Hypersensitivity, , Neonates and infants (younger than 2 yr), , , Cautions, , Contains brinzolamide, a sulfonamide; caution with history of sulfonamide allergy, , Carbonic anhydrase activity observed in both the cytoplasm and around the plasma membranes of the corneal endothelium, and therefore there is an increased potential for developing corneal edema in patients with low endothelial cell counts, , Brinzolamide and its metabolite are excreted predominantly by the kidney and is not recommended in patients with severe renal impairment, , Not studied in patients with acute angle-closure glaucoma, , Contains benzalkonium chloride (preservative); remove contact lenses during instillation to avoid absorption by soft lenses (may reinsert 15 minutes after instillation), , Brimonidine elicits <5% mean decrease in blood pressure 2 hr after instillation; caution with severe cardiovascular disease, , Not studied with severe hepatic impairment, , Brimonidine may potentiate syndromes associated with vascular insufficiency (eg, depression, cerebral or coronary insufficiency, Raynaud’s phenomenon, orthostatic hypotension, thromboangiitis obliterans), , Bacterial keratitis reported from inadvertent contamination of multiple-dose containers of topical ophthalmics, , , Pregnancy & Lactation, , Pregnancy Category: C, , Lactation: Unknown whether distributed in human breast milk; do not breast feed, , Pregnancy Categories, A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA:Information not available. more... Pharmacology, , Mechanism of Action, , Brinzolamide: Carbonic anhydrase inhibitor; inhibition of carbonic anhydrase in ciliary processes of the eye decreases aqueous humor secretion, presumably by slowing the formation of bicarbonate ions with subsequent reduction in sodium and fluid transport, , Brimonidine: Alpha2 adrenergic receptor agonist; decreases aqueous humor secretion and increases uveoscleral outflow, , , Absorption, , Peak plasma time: 1-4 hr (brimonidine), , Peak plasma concentration: <10 ng/mL (brinzolamide), , , Distribution, , Protein bound: ~60% (brinzolamide), , Due to its affinity for carbonic anhydrase (CA) II, brinzolamide distributes extensively into RBCs, , , Metabolism, , Metabolized by liver (brimonidine), , Metabolites: N-desethyl brinzolamide, , , Elimination, , Half-life: 111 days (brinzolamide); 3 hr (brimonidine), , Excretion: Predominantly in urine (brinzolamide); 87% urine (brimonidine), , , Images, , Patient Handout, Print w/ Office Info, Print w/out Office Info, , Formulary, FormularyPatient Discounts, To view formulary information first create a list of plans. Your list will be saved and can be edited at any time. Create Your List of Plans, Adding plans allows you to:, View the formulary and any restrictions for each plan. Manage and view all your plans together – even plans in different states. Compare formulary status to other drugs in the same class. Access your plan list on any device – mobile or desktop. The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. View explanations for tiers and restrictions, Tier, Description, 1, This drug is available at the lowest co-pay. Most commonly, these are generic drugs. 2, This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs. 3, This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs. 4, This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 5, This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 6, This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. NC, NOT COVERED, – Drugs that are not covered by the plan. Code, Definition, PA, Prior Authorization, Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription. , QL, Quantity Limits, Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered. , ST, Step Therapy, Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription. , OR, Other Restrictions, Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription. , Done, Add or Remove Plans, Plans for , Select State: , Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, , Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Non-Medicare PlansMedicare Plans, Select a box to add or remove a plan. close, Select a class to view formulary status for similar drugs, CLOSE, Additional Offers, CLOSE, Email to Patient, From:, To:, The recipient will receive more details and instructions to access this offer. By clicking send, you acknowledge that you have permission to email the recipient with this information. Send, CLOSE, Email Forms to Patient, From:,