Precautions and Warnings With Brimonidine/Timolol
If you have diabetes, hyperthyroidism, or any allergies, tell your healthcare provider before starting treatment with brimonidine/timolol. Other warnings and precautions for the eye drop include being aware that it may worsen certain medical conditions, such as myasthenia gravis and asthma. People who have heart failure, COPD, or an allergy to any of the drug's ingredients should not use it.
What Should I Tell My Healthcare Provider?Prior to using brimonidine/timolol (Combigan®), tell your healthcare provider if you have:
- Chronic obstructive pulmonary disease (COPD)
- Myasthenia gravis
- Heart failure
- Had a recent heart attack
- A slow heart rate (bradycardia)
- Heart block
- An upcoming surgery
- Raynaud's disease
- Had a stroke
- Low blood pressure (hypotension)
- Heart disease
- Thromboangiitis obliterans (a rare disease that blocks certain blood vessels in the hands and feet)
- Any allergies, including to food, dyes, or preservatives.
Also, let your healthcare provider know if you are:
- Pregnant or thinking of becoming pregnant
Make sure to tell your healthcare provider about any other medications you are taking, including prescription and nonprescription medicines, vitamins, and herbal supplements.
Specific Brimonidine/Timolol Warnings and PrecautionsWarnings and precautions to be aware of prior to using these eye drops include the following:
- Heart disease
- Raynaud's disease
- A history of a stroke
- Low blood pressure
- Thromboangiitis obliterans.
There is a small chance that this medication could worsen such conditions. However, many people with these conditions can safely use it with no problems whatsoever.
- Brimonidine/timolol may worsen allergic reactions and may make epinephrine (one of the standard treatments for life-threatening allergic reactions) less effective. If you have a history of severe allergic reactions, brimonidine/timolol (or any other beta blocker) may not be the best choice for you.
- Like all beta blockers, brimonidine/timolol can worsen heart failure in some situations. If you have heart failure, your healthcare provider may need to monitor you very closely while you use this product. Let your healthcare provider know immediately if your heart failure symptoms seem to worsen.
- Beta blockers can worsen breathing problems like asthma or COPD. In many cases, brimonidine/timolol is not recommended for people with such lung problems.
- This medicine may worsen myasthenia gravis symptoms or may even cause it. Let your healthcare provider know if you develop symptoms of this problem, such as muscle weakness, double vision, or a droopy eyelid.
- If you will be having surgery, make sure your surgeon and anesthesiologist know you use brimonidine/timolol, as it may affect the choice of medications used during the surgery.
- Beta blockers can mask some of the symptoms of low blood sugar (hypoglycemia), particularly the "racing heart" feeling. This can cause serious problems for people with diabetes, who need to be able to sense that they have low blood sugar in order to correct it before it becomes life-threatening. Some beta blockers may also worsen low blood sugar, although it is not known if this is a problem with brimonidine/timolol.
- Beta blockers can mask some of the symptoms of an overactive thyroid (hyperthyroidism).
- Brimonidine/timolol can potentially interact with a number of other medications (see Drug Interactions With Brimonidine/Timolol).
- If you wear soft contact lenses, be sure to remove them before each brimonidine/timolol dosage and wait at least 15 minutes before reinserting them. This medication contains a preservative (benzalkonium chloride) that can bind to soft contact lenses.
- If you will be having eye surgery or develop any other eye problems or conditions (such as an infection), ask your healthcare provider if you should continue to use this medication.
- If you use other eye drops, be sure to separate your dose of brimonidine/timolol from that of the other drops by at least 10 minutes.
- Brimonidine/timolol is considered a pregnancy Category C medication. This means that it may not be safe for use during pregnancy, although the full risks are not currently known (see Combigan and Pregnancy).
- At least one of the active ingredients in brimonidine/timolol passes through breast milk in humans. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to using the drug (see Combigan and Breastfeeding).