Carbonic anhydrase inhibitor + alpha-2 agonist (combination eye drops) Pregnancy: SPC §4.6: there are no or limited data from use in pregnant women; brinzolamide/brimonidine is not recommended during pregnancy or in women of childbearing potential not using contraception. Breast-feeding: it is unknown whether topical brinzolamide/brimonidine is excreted in human milk; orally administered brimonidine is excreted in breast milk — should not be used by women who are breast-feeding.

Brinzolamide with brimonidine

Brand names: Simbrinza

This fixed-combination eye drop pairs brinzolamide, a topical carbonic anhydrase inhibitor, with brimonidine, a selective alpha-2 adrenergic agonist, to lower intraocular pressure in open-angle glaucoma and ocular hypertension when a single agent is insufficient.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One drop in the affected eye(s)

Route: Topical ocular (brinzolamide/brimonidine tartrate 10 mg/ml + 2 mg/ml eye drops, suspension)

Frequency: Two times daily

SPC §4.2 'Use in adults, including the elderly': the recommended dose is one drop of the medicine in the affected eye(s) two times daily. If a dose is missed, treatment should be continued with the next dose as planned. Shake the bottle well before use; using nasolacrimal occlusion with the eyelids closed for 2 minutes reduces systemic absorption. May be used concomitantly with other topical ophthalmic medicinal products to lower IOP — administer at least 5 minutes apart. Must not be injected and must not be swallowed (§4.4). Paediatric: safety and efficacy in children and adolescents aged 2 to 17 years have not been established (no data available); contraindicated in neonates and infants aged less than 2 years. Hepatic impairment: not studied, caution recommended. The US (openFDA) record retrieved for this id was Azopt (brinzolamide alone) — a single component of this fixed combination, so it was not used.

Dose adjustments

Renal

SPC §4.2/§4.3: contraindicated in severe renal impairment. Not studied in patients with severe renal impairment (CrCl <30 ml/min) or in hyperchloraemic acidosis, as the brinzolamide component and its metabolite are excreted predominantly by the kidney. No numeric dose adjustment is stated for lesser degrees of impairment.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substances or to any of the excipients
Hypersensitivity to sulphonamides
Patients receiving monoamine oxidase (MAO) inhibitor therapy
Patients on antidepressants which affect noradrenergic transmission (e.g. tricyclic antidepressants and mianserin)
Patients with severe renal impairment
Patients with hyperchloraemic acidosis
Neonates and infants under the age of 2 years

Side effects

Ocular hyperaemia and ocular allergic-type reactions (most common; approximately 6–7% of patients)
Dysgeusia — bitter or unusual taste in the mouth following instillation (approximately 3% of patients)
Somnolence, dizziness (common)
Eye allergy, keratitis, eye pain, ocular discomfort, blurred vision, abnormal vision, conjunctival blanching (common)
Hypotension (uncommon); bradycardia, tachycardia, arrhythmia, palpitations (uncommon)
Serious sulphonamide-type reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis (§4.4 — discontinue if they occur)

Interactions

Monoamine oxidase (MAO) inhibitors — contraindicated (SPC §4.3, cross-referring to §4.5)
Antidepressants affecting noradrenergic transmission, e.g. tricyclic antidepressants and mianserin — contraindicated (SPC §4.3, cross-referring to §4.5)
Antihypertensives and/or cardiac glycosides — caution advised, as small decreases in blood pressure were observed in some patients (SPC §4.4)
Other topical ophthalmic medicinal products — administer at least 5 minutes apart (SPC §4.2)

Clinical monograph

How it works

Brinzolamide inhibits carbonic anhydrase in the ciliary body to reduce aqueous humour formation, while brimonidine both decreases aqueous production and increases uveoscleral outflow, giving additive pressure reduction without a beta-blocker.

Prescribing in practice

Brimonidine crosses the blood-brain barrier and is contraindicated in neonates and infants because of the risk of apnoea and CNS depression; brinzolamide is a sulfonamide, so avoid in those with sulfonamide hypersensitivity.
Brinzolamide commonly causes transient blurred vision and a bitter or unusual taste, and brimonidine can cause drowsiness, dry mouth and allergic conjunctivitis.
Use with caution in significant renal or hepatic impairment and with other systemic carbonic anhydrase inhibitors or CNS depressants.

Monitoring

Monitor intraocular pressure for response and review for sulfonamide-type reactions, ocular allergy and systemic effects such as taste disturbance or drowsiness.

Counselling the patient

Instil twice daily; shake the bottle and press on the inner corner of the eye after each drop.
Temporary blurring, a bitter taste, tiredness or a dry mouth may occur.
Report a red, itchy eye or any rash, and let your clinician know if you are allergic to sulfa medicines.

Evidence & guidelines

This beta-blocker-free fixed combination is supported as an alternative dual therapy in glaucoma where beta-blockade is contraindicated or poorly tolerated.

Reference: NICE NG81; RCOphth; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways