TM Owner Alcon
Simbrinza 1% + 0.2% Eye Drop
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Indications & Clinical Uses
- Simbrinza (brinzolamide 1% / brimonidine tartrate 0.2%) is a fixed-combination eye drop pairing a carbonic anhydrase inhibitor with an alpha-2 adrenergic agonist, approved in the United States and Europe to reduce elevated intraocular pressure in adults with open-angle glaucoma or ocular hypertension.
- It is used when a single pressure-lowering eye drop does not control intraocular pressure adequately, and is instilled as one drop in the affected eye(s) three times daily.
- Simbrinza is self-administered at home after training from an eye-care professional.
- It is contraindicated in neonates and infants under 2 years of age, and safety and effectiveness in children aged 2 to under 18 have not been established.
- If other topical ophthalmic medicines are used at the same time, doses should be spaced at least 5 minutes apart so each drop is properly absorbed.
- Alcon markets the same fixed combination without a change of brand name across major markets.
Side Effects
- The most commonly reported Simbrinza side effects, in about 3% to 5% of patients, are blurred vision, eye irritation, an altered or bitter taste in the mouth (dysgeusia), dry mouth and eye allergy; about 11% of patients stopped treatment because of an adverse reaction.
- Other reported effects include eye redness, itching, watering, a foreign-body sensation, drowsiness and headache.
- This product carries no boxed warning.
- Because brinzolamide is a sulfonamide, rare but serious sulfa-type reactions, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, blood disorders and severe skin reactions, are possible even though the drug is applied to the eye.
- Seek urgent medical attention for eye pain, sudden vision changes, facial or throat swelling, difficulty breathing, or a spreading skin rash, and tell your eye-care professional promptly about any common side effect that does not settle.
Precautions & Warnings
- Simbrinza is contraindicated in neonates and infants under 2 years of age, and in patients with hypersensitivity to any component.
- Use with caution if you have a low corneal endothelial cell count, since carbonic anhydrase inhibitors can affect corneal fluid balance; caution is also advised in severe hepatic impairment and in severe renal impairment (creatinine clearance below 30 mL/min), which has not been studied.
- Brimonidine, an alpha-2 agonist, can cause drowsiness, low blood pressure and fainting, particularly with cardiovascular disease, so take care when driving or operating machinery until you know how the drops affect you.
- Remove contact lenses before instilling the drops and wait 15 minutes before reinserting them.
- There is no adequate human data on use in pregnancy or breastfeeding, so Simbrinza should be used only if clearly needed and discussed first with your healthcare provider.
Avoid Interactions
- Tell your eye-care professional about all medicines you use, especially oral carbonic anhydrase inhibitors such as acetazolamide, which should not be combined with Simbrinza because of additive systemic effects.
- Brimonidine can interact with monoamine oxidase inhibitors (MAOIs) and tricyclic or tetracyclic antidepressants, which may affect blood pressure control, and with other central-nervous-system depressants, including alcohol, sedatives and opioids, which can add to drowsiness.
- Caution is advised with other antihypertensive drugs and cardiac glycosides, since brimonidine can further lower blood pressure and heart rate.
- If you use other topical eye medicines, apply them at least 5 minutes apart from Simbrinza.
- Report any new prescription, over-the-counter or herbal product to your prescriber before starting, since additive sedative or cardiovascular effects are the main concern with this combination.
References
Frequently Asked Questions
Simbrinza (brinzolamide/brimonidine) is an eye drop that lowers high eye pressure in adults with open-angle glaucoma or ocular hypertension. It combines two pressure-lowering medicines in one bottle and is used when a single eye drop does not control pressure well enough on its own.
You instill one drop of Simbrinza into the affected eye or eyes three times a day. If you use other eye drops too, wait at least 5 minutes between Simbrinza and the other medicine so each drop is properly absorbed and not washed out.
The most common Simbrinza side effects are blurred vision, eye irritation, a bitter taste in the mouth, dry mouth and eye allergy, each affecting around 3% to 5% of users. About 1 in 9 people stop treatment because of a side effect; report eye pain or sudden vision changes promptly.
Avoid combining Simbrinza with oral carbonic anhydrase inhibitors like acetazolamide, since effects can add up. Because brimonidine can cause drowsiness and lower blood pressure, be cautious with alcohol, sedatives, MAOI antidepressants and other blood-pressure medicines until you know how the drops affect you.
Remove contact lenses before using Simbrinza, since the preservative can be absorbed by soft lenses, and wait at least 15 minutes before putting them back in. Simbrinza needs no special refrigeration; store it at 2°C to 25°C and use it until the printed expiry date once opened.
No. Simbrinza is contraindicated in neonates and infants under 2 years old, and its safety and effectiveness have not been established in children aged 2 to under 18. It is approved only for adults with open-angle glaucoma or ocular hypertension.
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