Combipres
Generic Name
Brimonidine Tartrate 0.2% + Timolol Maleate 0.5% Eye Drop
Manufacturer
Acme Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| combipres 02 05 eye drop | ৳ 140.00 | N/A |
Description
Overview of the medicine
Combipres-02-05 Eye Drop is a combination medication containing Brimonidine Tartrate and Timolol Maleate, used to reduce elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. It works by reducing the production of aqueous humor and increasing its outflow.
Uses & Indications
Dosage
Adults
One drop in the affected eye(s) twice daily, approximately 12 hours apart.
Elderly
No dosage adjustment required.
Renal_impairment
Use with caution. Dosage adjustment may be necessary in patients with severe renal impairment due to potential for increased systemic exposure.
How to Take
For ophthalmic use only. Tilt head back, pull down the lower eyelid, and instill one drop into the conjunctival sac. Close eye gently for a few minutes. Avoid touching the dropper tip to any surface. If using other ophthalmic medications, wait at least 5 minutes between applications.
Mechanism of Action
Brimonidine is an alpha-2 adrenergic agonist that reduces aqueous humor production and increases uveoscleral outflow. Timolol is a non-selective beta-adrenergic blocker that primarily reduces aqueous humor production.
Pharmacokinetics
Onset
Typically within 30 minutes, maximum IOP reduction within 2 hours.
Excretion
Brimonidine and its metabolites are excreted primarily via urine. Timolol and its metabolites are excreted primarily via urine.
Half life
Brimonidine: approximately 2-3 hours; Timolol: approximately 4 hours (systemic).
Absorption
Brimonidine is absorbed systemically after topical ocular administration, with peak plasma concentrations occurring within 1-4 hours. Timolol is also absorbed systemically, with peak plasma concentrations occurring within 1-2 hours.
Metabolism
Brimonidine is primarily metabolized in the liver. Timolol is extensively metabolized in the liver by CYP2D6.
Side Effects
Contraindications
- Bronchial asthma, history of bronchial asthma, or severe chronic obstructive pulmonary disease.
- Sinus bradycardia, second or third-degree atrioventricular block, overt cardiac failure, cardiogenic shock.
- Hypersensitivity to Brimonidine Tartrate, Timolol Maleate, or any component of the formulation.
- Neonates and infants (due to potential for systemic absorption and CNS depression with brimonidine).
Drug Interactions
MAO inhibitors
Extreme caution advised; may cause increased systemic absorption and potentiate the actions of brimonidine, leading to hypotension.
Systemic beta-blockers
Additive effects may occur, potentially leading to systemic beta-blockade (e.g., decreased heart rate, blood pressure).
Catecholamine-depleting drugs (e.g., Reserpine, Guanethidine)
Additive hypotensive and/or bradycardic effects.
Oral calcium channel blockers, antiarrhythmics, digitalis glycosides
Potential for additive effects leading to hypotension, bradycardia, or AV block.
Storage
Store at room temperature (15-25°C), away from light and moisture. Do not freeze.
Overdose
Systemic overdose may lead to bradycardia, hypotension, bronchospasm, and CNS depression. Treatment is symptomatic and supportive, including maintaining airway, monitoring vital signs, and intravenous fluids if necessary. Atropine may be used for bradycardia.
Pregnancy & Lactation
Use in pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether brimonidine is excreted in human milk, but timolol is. A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Side Effects
Contraindications
- Bronchial asthma, history of bronchial asthma, or severe chronic obstructive pulmonary disease.
- Sinus bradycardia, second or third-degree atrioventricular block, overt cardiac failure, cardiogenic shock.
- Hypersensitivity to Brimonidine Tartrate, Timolol Maleate, or any component of the formulation.
- Neonates and infants (due to potential for systemic absorption and CNS depression with brimonidine).
Drug Interactions
MAO inhibitors
Extreme caution advised; may cause increased systemic absorption and potentiate the actions of brimonidine, leading to hypotension.
Systemic beta-blockers
Additive effects may occur, potentially leading to systemic beta-blockade (e.g., decreased heart rate, blood pressure).
Catecholamine-depleting drugs (e.g., Reserpine, Guanethidine)
Additive hypotensive and/or bradycardic effects.
Oral calcium channel blockers, antiarrhythmics, digitalis glycosides
Potential for additive effects leading to hypotension, bradycardia, or AV block.
Storage
Store at room temperature (15-25°C), away from light and moisture. Do not freeze.
Overdose
Systemic overdose may lead to bradycardia, hypotension, bronchospasm, and CNS depression. Treatment is symptomatic and supportive, including maintaining airway, monitoring vital signs, and intravenous fluids if necessary. Atropine may be used for bradycardia.
Pregnancy & Lactation
Use in pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether brimonidine is excreted in human milk, but timolol is. A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24-36 months unopened. After opening, discard within 28 days.
Availability
Pharmacies
Approval Status
Approved
Patent Status
Generic available
Clinical Trials
Extensive clinical trials have demonstrated the efficacy and safety of Brimonidine/Timolol combination in reducing intraocular pressure in patients with glaucoma or ocular hypertension, showing superior or comparable IOP reduction to monotherapy with either component.
Lab Monitoring
- Regular intraocular pressure (IOP) measurements.
- Monitoring for systemic adverse effects, especially heart rate and blood pressure, in susceptible patients.
Doctor Notes
- Advise patients to maintain good hand hygiene before administration.
- Educate patients on proper instillation technique to minimize systemic absorption and contamination.
- Regularly assess for ocular side effects and monitor IOP.
- Be aware of potential systemic beta-blocker effects, especially in patients with pre-existing cardiovascular or respiratory conditions.
Patient Guidelines
- Use exactly as prescribed by your doctor.
- Do not touch the dropper tip to your eye or any other surface.
- Remove contact lenses before use and wait at least 15 minutes before reinserting.
- Inform your doctor about all other medications you are using, especially other eye drops, oral beta-blockers, or heart medications.
- Report any new or worsening eye symptoms or systemic side effects immediately.
Missed Dose Advice
If a dose is missed, administer it as soon as possible. If it is almost time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one.
Driving Precautions
May cause temporary blurred vision or dizziness, especially after instillation. Avoid driving or operating machinery until vision is clear and you know how the medication affects you.
Lifestyle Advice
- Maintain regular follow-up appointments with your ophthalmologist.
- Avoid activities that increase eye pressure if advised by your doctor.
- Wear protective eyewear during activities that pose a risk to your eyes.
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