This is a combination medication that contains brinzolamide and timolol. Brinzolamide belongs to the group of medications called carbonic anhydrase inhibitors. Timolol belongs to the group of medications called beta-blockers. This combination medication is available in eye-drop form and is used to reduce the pressure inside the eye for people with open-angle glaucoma or intraocular hypertension (increased pressure in the eye).

Fluid is constantly being formed in, and drained out of, the eye. When this fluid does not drain out of the eye properly or too much fluid is produced, pressure inside the eye increases. Brinzolamide and timolol work by reducing the amount of fluid produced by the eye.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are using this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.

The usual dose of this medication is 1 drop in the affected eye(s) 2 times a day, morning and night.

Before using this medication, shake the bottle well.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

To use the eye drops:

1. Wash your hands before using the eye drops.
2. Remove the cap and place it in a clean location. To avoid possible contamination, keep the tip of the container away from contact with any surface.
3. Tilt the head back and look towards the ceiling.
4. With your index finger, gently pull the lower eyelid down and away from the eye to form a pouch.
5. Apply one drop into the pouch by gently pressing on the base of the bottle (do not squeeze the bottle). Do not allow the tip of the container to touch the eye or areas around the eye.
6. Gently apply pressure to the inner corner of the eye (at the bridge of the nose) for about 2 minutes. This prevents the medication from dripping down through the tear duct and entering the bloodstream, which could cause you to experience some side effects.
7. Repeat with the other eye, if prescribed by your physician.
8. Wash your hands again to remove any medication.

Do not allow the dropper tip of the bottle to touch the eye or any other surface. This can contaminate the tip with common bacteria known to cause eye infections. Serious damage to the eye may result if you use eye drop solutions that have become contaminated.

Brinzolamide - timolol eye drops should be used at least 5 minutes before or after other eye drops that are being used.

It is important that this medication be used exactly as prescribed by your doctor. If you miss a dose, use it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not use a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication between 2°C and 30°C and keep it out of the reach of children. Discard the bottle 60 days after opening.

Each mL of ophthalmic suspension contains 10 mg of brinzolamide, 5 mg of timolol as timolol maleate, and the preservative benzalkonium chloride 0.01%. Nonmedicinal ingredients: carbomer 974P, edetate disodium, mannitol, purified water, sodium chloride, sodium hydroxide and/or hydrochloric acid (to adjust pH), and tyloxapol.

Do not use brinzolamide - timolol if you:

• are allergic to brinzolamide, timolol, or any ingredients of the medication
• are allergic to other beta-blockers (e.g., metoprolol, atenolol)
• are allergic to sulfonamides (e.g., sulfamethoxazole)
• have an extremely slow heart rate, second- or third-degree heart block, heart failure, or shock due to heart-related causes
• have asthma or severe chronic obstructive pulmonary disease (e.g., chronic bronchitis, emphysema)
• have hyper-reactive airways
• have severe allergic rhinitis
• have severely reduced kidney function
• have too much acidity in the blood (called hyperchloremic acidosis)

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is used in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people using this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• abdominal discomfort
• blurred vision
• changes to the eyelid
• eye discomfort, dryness, or redness
• feeling of something in the eye
• increased tear production
• runny nose
• sensitivity to light
• taste changes
• trouble sleeping

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• coughing, shortness of breath, troubled breathing, tightness in the chest, or wheezing
• decreased blood pressure
• dizziness
• eye pain
• hallucinations (seeing, hearing, or feeling things that aren't there)
• increased frequency of infections, colds, or flu-like symptoms
• itching or swelling of the eye
• lightheadedness or fainting
• ringing in the ears
• skin rash, redness, or itching
• fast, slow, or abnormal heartbeat
• symptoms of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
• throat irritation or pain
• unusual tiredness or weakness

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort
• symptoms of a severe allergic reaction such as hives, difficulty breathing, or swelling of the face or throat

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Allergies: Brinzolamide belongs to the family of medications known as sulfonamides or "sulfas." The same type of allergic reaction can occur with this medication as with other sulfonamides. Contact your doctor if you experience a skin rash while using this medication. Stop using this medication and get medical attention if you experience hives; shortness of breath; peeling or blistering skin; or swelling of the mouth, lips, tongue, or throat.

Blurred vision: This medication can cause temporary blurred vision. Do not drive or operate machinery until your vision returns to normal.

Contact lenses: The preservative used in the eye drops (benzalkonium chloride) may be absorbed by soft contact lenses. Contact lenses should be removed before using the eye drops and not reinserted for at least 15 minutes.

Drowsiness and reduced alertness: This medication may cause fatigue or drowsiness. Avoid driving, using machinery, or doing hazardous activities until you determine how the medication affects you.

Eye surgery, infections, trauma: If you have had eye surgery or trauma to the eye, or if you have symptoms of an eye infection (e.g., eye redness, itchiness, discharge, crusts on the eyelids, or the feeling of something in the eye), contact your doctor about further use of the eye drop.

General: As with other eye drops, this medication may be absorbed into the bloodstream. You may experience the same side effects reported with oral medications from the families known as beta-blockers (e.g., timolol, propranolol, metoprolol), carbonic anhydrase inhibitors (e.g., acetazolamide, methazolamide), or sulfonamides (e.g., sulfamethoxazole). These side effects may include, but are not limited to, shortness of breath, dizziness, lightheadedness, rash, or slow heartbeat. Refer to the section, "What side effects are possible with this medication?" for more information.

Heart problems: This medication can make certain types of heart disease worse. People with heart failure should have their condition under control before starting this medication. If you have heart failure, high blood pressure or angina (chest pains), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: If you have reduced liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Low blood sugar: If you are prone to low blood sugar or have diabetes, monitor your blood sugar closely while taking this medication, as it may mask the signs of low blood sugar.

Muscle weakness: Beta-blockers such as timolol have been reported to increase muscle weakness associated with certain conditions, such as myasthenia gravis. If you experience symptoms of muscle weakness, contact your doctor.

Surgery: Timolol can change the effects of medications used during surgery. If you have surgery planned, let your doctors know that you are using this medication.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while using this medication, contact your doctor immediately.

Breast-feeding: It is not known if brinzolamide passes into breast milk. Timolol does pass into breast milk. If you are breast-feeding and are using this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

There may be an interaction between brinzolamide - timolol and any of the following:

• acetylcholinesterase inhibitors (e.g., donepezil, galantamine, neostigmine, rivastigmine)
• alpha/beta agonists (e.g., epinephrine, norepinephrine)
• alpha-blockers (e.g., alfuzosin, doxazosin, tamsulosin)
• alpha-agonists (e.g., clonidine, methyldopa, guanfacine)
• amantadine
• antiarrhythmics (e.g., amiodarone, dronedarone, flecainide)
• first generation anti-psychotics (e.g., chlorpromazine, fluphenazine, haloperidol, trifluoperazine)
• "azole" antifungals (e.g., itraconazole, ketoconazole, voriconazole)
• barbiturates (e.g., butalbital, phenobarbital)
• other beta-adrenergic blockers (e.g., atenolol, metoprolol, propranolol)
• beta 2 agonists (e.g., salbutamol, formoterol, terbutaline, indacaterol, salmeterol, vilanterol, terbutaline)
• brimonidine
• bromocriptine
• bupropion
• calcium channel blockers (e.g., diltiazem, nifedipine, verapamil)
• cannabis
• other carbonic anhydrase inhibitors (e.g., acetazolamide, methazolamide, dorzolamide)
• diabetes medications (e.g., acarbose, canagliflozin, glyburide, insulin, lixisenatide, metformin, rosiglitazone, sitagliptin)
• digoxin
• dipyridamole
• disopyramide
• ergot alkaloids (e.g., dihydroergotamine, ergonovine, ergotamine, methylergonovine)
• fentanyl
• grass pollen extract
• ivabradine
• methadone
• non-steroidal anti-inflammatory medications (NSAIDs; e.g., diclofenac, ibuprofen, naproxen)
• other eye drops
• peginterferon Alfa-2b
• protein kinase inhibitors (e.g., alectinib, brigatinib, ceritinib)
• pseudoephedrine
• certain selective serotonin reuptake inhibitors (SSRIs; e.g., fluoxetine, paroxetine)
• somatostatin-like medications (e.g., lanreotide, octreotide, pasireotide)
• sphingosine 1-phosphate receptor (S1P) receptor inhibitors (e.g., fingolimod, ponesimod, siponimod)
• theophyllines (e.g., aminophylline, theophylline)
• tipranavir
• tizanidine
• tofacitinib
• topiramate
• white birch allergen extract

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.