Simbrinza (brinzolamide/brimonidine tartrate)

What is Simbrinza?

Simbrinza is a brand-name prescription medication. It’s FDA-approved to treat increased eye pressure in people who have either of the following conditions:

• ocular hypertension (high blood pressure in the eye)
• open-angle glaucoma, which is the most common type of glaucoma (an eye disease that’s most often caused by increased pressure inside the eye)

Simbrinza can be used in adults and in children 2 years and older.

Drug details

Simbrinza contains two active drugs:

• brinzolamide, which belongs to a group of drugs called carbonic anhydrase inhibitors
• brimonidine tartrate, whichbelongs to a group of drugs called alpha-2 adrenergic receptor agonists

Simbrinza lowers the pressure inside your eye by reducing the amount of fluid your eye naturally produces.

This medication comes as a liquid solution in a dropper bottle. Simbrinza bottles have a tip that you’ll use to place drops of the drug into your eye. You’ll likely use Simbrinza three times a day.

Simbrinza is available in one strength: 1% brinzolamide/0.2% brimonidine tartrate.

Effectiveness

For information on the effectiveness of Simbrinza, see the “Simbrinza uses” section below.

Simbrinza generic

Simbrinza contains two active drugs: brinzolamide and brimonidine tartrate.

Simbrinza is available only as a brand-name medication. It’s not currently available in generic form. (A generic drug is an exact copy of the active drug in a brand-name medication.)

Simbrinza side effects

Simbrinza can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while using Simbrinza. These lists don’t include all possible side effects.

For more information on the possible side effects of Simbrinza, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Simbrinza, you can do so through MedWatch.

Mild side effects

Mild side effects of Simbrinza can include:*

• eye side effects, such as:
  • blurry vision
  • eye allergy
  • eye irritation
• dry mouth
• changes in how things taste

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Simbrinza. For more information on these side effects, see “Side effect details” below. To learn about other mild side effects, talk with your doctor or pharmacist, or view Simbrinza’s prescribing information.

Serious side effects

Serious side effects from Simbrinza aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

• Decreased blood pressure. Symptoms can include:
  • dizziness
  • fainting
  • nausea
  • blurry vision
• Allergic reaction.*

* For more information about this side effect, see “Side effect details” below.

Side effects in children

Simbrinza is approved for use in children ages 2 years and older. There haven’t been clinical studies on children using Simbrinza. However, Simbrinza’s active drugs (brinzolamide and brimonidine tartrate) have been studied individually in clinical trials involving children. Brinzolamide has been studied in children ages 4 weeks to 5 years, while brimonidine tartrate has been studied in children ages 2 to 7 years.

Side effects seen in children using brimonidine tartrate include:

• drowsiness
• decreased alertness

No side effects were seen in children using brinzolamide during these trials. But this doesn’t mean side effects can’t occur in children taking this drug. Keep in mind that side effects of a drug may not be seen until the drug has been available and on the market for many years.

If you have questions about side effects that may occur in a child using Simbrinza, talk with your doctor or pharmacist.

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail about certain side effects this drug may cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after using Simbrinza. It’s not known how many people in clinical trials had an allergic reaction to the drug.

Symptoms of a mild allergic reaction can include:

• skin rash
• itchiness, which may affect your skin or eyes
• flushing (warmth and redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your tongue, mouth, or throat
• trouble breathing

If you’re using Simbrinza and you have a sulfa allergy, you may have an increased risk of a severe rash or a life threatening reaction. This is because one of Simbrinza’s active drugs, brinzolamide, is a sulfonamide (a “sulfa drug”). Even though Simbrinza is used topically on your eye, the drug can still cause these reactions in some people.

If you’re allergic to sulfa drugs, tell your doctor before using Simbrinza. They may recommend a medication other than Simbrinza to treat your condition.

Call your doctor right away if you have an allergic reaction to Simbrinza. But call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Eye side effects

You may develop eye side effects while you’re using Simbrinza.

In clinical trials, eye side effects occurred in about 3% to 5% of people using Simbrinza. These side effects included blurry vision, eye irritation, or eye allergy. Symptoms of eye irritation or eye allergy can include redness or itchiness in your eye.

In these trials, Simbrinza wasn’t compared with a placebo (a treatment with no active drug). So it’s not known how many people using a placebo might also have had eye side effects.

If you have eye side effects while you’re using Simbrinza, your doctor may recommend ways to decrease your side effects. Or your doctor may recommend a medication other than Simbrinza.

Note: It’s possible that certain eye-related symptoms could occur with an allergic reaction to Simbrinza. For more information about this, see the “Allergic reaction” section above.)

Dry mouth

You may experience dry mouth while you’re using Simbrinza.

In clinical trials, dry mouth occurred in about 3% to 5% of people using the drug. In these trials, Simbrinza wasn’t compared with a placebo (treatment with no active drug). So it’s not known how many people using a placebo might also have had a dry mouth.

If you have a dry mouth while you’re using Simbrinza, your doctor may be able to recommend ways to decrease this side effect.

Changes in how things taste

Some people using Simbrinza noticed a change in their sense of taste while using the drug.

In clinical trials, about 3% to 5% of people using Simbrinza noticed change in how things tasted. In these trials, Simbrinza wasn’t compared with a placebo (treatment with no active drug). So it’s not known how many people might have had this side effect while using a placebo.

If you notice a change in how things taste while you’re using Simbrinza, your doctor may recommend ways to decrease this side effect. Or your doctor may have you use a medication other than Simbrinza to treat your condition.

Hair loss (not a side effect)

Hair loss isn’t a known side effect of Simbrinza. It wasn’t reported in clinical trials of the drug.

However, in trials of brinzolamide eye drops, hair loss was reported in less than 1% of people studied. (Brinzolamide is one of the active drugs in Simbrinza.) In these trials, brinzolamide wasn’t compared with a placebo (a treatment with no active drug). So it’s not known how many people using a placebo might also have had hair loss.

If you have hair loss that’s sudden or bothersome to you, talk with your doctor. They may recommend a different medication to treat your condition.

Simbrinza dosage

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Simbrinza comes as a liquid solution inside a dropper bottle. Simbrinza bottles have a tip that you’ll use to place drops of the drug into your eye.

Simbrinza is available in one strength: 1% brinzolamide/0.2% brimonidine tartrate.

Dosage for increased eye pressure

Simbrinza is approved for treating increased eye pressure due to ocular hypertension (high blood pressure in the eye) or open-angle glaucoma. The recommended dosage is one drop into the affected eye (or eyes), three times a day.

When using Simbrinza, be careful to avoid touching the tip of the Simbrinza bottle to your eye. Doing so can increase the risk of serious infections in your eye.

Note: If you use other eye drops, talk with your doctor about whether you can continue to use the drops along with Simbrinza. If your doctor approves, make sure to wait at least 5 minutes between using each of the eye drops.

Pediatric dosage

Simbrinza shouldn’t be used in children younger than 2 years old. However, for children ages 2 years and older, the recommended dosage of Simbrinza is the same as it is for adults. See the “Dosage for increased eye pressure” section above for details.

What if I miss a dose?

If you miss a dose of Simbrinza, call your doctor or pharmacist. Depending on how long ago you missed the dose, they may recommend that you either:

• take the missed dose right away, or
• skip the missed dose and take your next dose as scheduled

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm on your phone or downloading a reminder app. A kitchen timer can work, too.

Will I need to use this drug long term?

Simbrinza is meant to be used as a long-term treatment. If you and your doctor determine that Simbrinza is safe and effective for you, you’ll likely take it long term.

If you have questions about how long you’ll need to use Simbrinza, talk with your doctor.

Simbrinza cost

As with all medications, the cost of Simbrinza can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Before approving coverage for Simbrinza, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure if you’ll need to get prior authorization for Simbrinza, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Simbrinza, or if you need help understanding your insurance coverage, help is available.

Novartis, the manufacturer of Simbrinza, offers a program called Patient Assistance NOW. For more information and to find out if you’re eligible for support, call 800-245-5356 or visit the program website.

Generic version

Simbrinza isn’t available in generic form. (A generic drug is an exact copy of the active drug in a brand-name medication.)

Simbrinza uses

The Food and Drug Administration (FDA) approves prescription drugs such as Simbrinza to treat certain conditions. Simbrinza may also be used off-label for other conditions. Off-label drug use is when an FDA-approved drug is used for a purpose other than what it’s approved for.

Simbrinza for increased eye pressure due to glaucoma or ocular hypertension

Simbrinza is approved to treat increased eye pressure in people who have either of the following conditions:

• ocular hypertension (high blood pressure in the eye)
• open-angle glaucoma, which is the most common type of glaucoma

When you have open-angle glaucoma, the pressure in your eye is too high due to problems with drainage of eye fluid. With this form of glaucoma, the angle of your eye that allows for the proper drainage of fluid is correct. But the drains themselves are clogged. Because of this clogging, the pressure in your eye builds up.

Over time, increased eye pressure can lead to permanent vision problems and even vision loss.

Simbrinza lowers the pressure inside your eye by reducing the amount of fluid your eye naturally produces.

Effectiveness for increased eye pressure due to glaucoma or ocular hypertension

In clinical trials, Simbrinza was effective in reducing increased eye pressure in people with either ocular hypertension or open-angle glaucoma.

In one clinical trial, people used either Simbrinza or one of its two active drugs: brinzolamide and brimonidine tartrate.

After 3 months, eye pressure was decreased between 1 mmHg and 3 mmHg* more in people who used Simbrinza than in people who used either active drug alone.

* Eye pressure is often reported as mmHg (millimeters of mercury). Normal eye pressure in adults and children 12 years and older is about 12 mmHg to 22 mmHg.

Simbrinza and children

Simbrinza is approved for use in children 2 years and older. Although Simbrinza hasn’t been studied in children, each of its active drugs have been studied in children. (Simbrinza’s two active drugs are brinzolamide and brimonidine tartrate.)

In separate clinical trials, compared with their eye pressure before treatment, the children’s eye pressure was decreased by:

• 4.1 mmHg* to 5 mmHg (in a 2008 trial of children who used brinzolamide)
• about 1.8 mmHg (in a 2006 trial of children who used brimonidine tartrate)

* Eye pressure is often reported in mmHg (millimeters of mercury). Normal eye pressure in adults and children ages 12 years and older is about 12 mmHg to 22 mmHg. In younger children, eye pressure may vary, but it’s usually lower than eye pressure in adults. This is true until age 12, when eye pressure becomes about the same as that of adults. If you have questions about the correct eye pressure for your child, talk with your child’s doctor.

Alternatives to Simbrinza

Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Simbrinza, talk with your doctor. They can tell you about other medications that may work well for you.

Alternatives for treating increased eye pressure

Some other drugs that might be used to treat increased eye pressure due to ocular hypertension (high blood pressure in the eye) or open-angle glaucoma include:

• latanoprost (Xalatan)
• bimatoprost (Lumigan)
• brimonidine (Alphagan-P)
• brinzolamide (Azopt)
• dorzolamide (Trusopt)
• dorzolamide/timolol (Cosopt)
• brimonidine/timolol (Combigan)
• timolol (Timoptic, Timoptic in Ocudose, Timoptic-XE)
• travoprost (Travatan-Z)
• betaxolol (Betoptic)
• carteolol

Simbrinza vs. Combigan

You may wonder how Simbrinza compares with other medications that are prescribed for similar uses. Here we look at how Simbrinza and Combigan are alike and different.

Ingredients

Simbrinza contains two active drugs:

• brinzolamide, which belongs to a group of drugs called carbonic anhydrase inhibitors
• brimonidine tartrate, which belongs to a group of drugs called alpha-2 adrenergic receptor agonists

Combigan also contains brimonidine tartrate. But the other active drug contained in Combigan is timolol maleate. And it belongs to a group of drugs called beta-blockers.

Uses

Simbrinza and Combigan are both approved for use in adults and children ages 2 years and older. Both of these drugs are approved to treat increased eye pressure in people who have either of the following conditions:

• ocular hypertension (high blood pressure in the eye)
• open-angle glaucoma, which is the most common type of glaucoma

Combigan is approved for use in people who’ve already tried other treatments for their increased eye pressure. Simbrinza, on the other hand, can be used by people who have or haven’t tried other treatments.

If your doctor recommends Combigan or Simbrinza, they may prescribe them to be used alone or in addition to your existing treatment plan.

Drug forms and administration

Both Simbrinza and Combigan come as a liquid solution in a dropper bottle. The bottles have a tip that you’ll use to place drops of the drug into your eye.

Usually, Simbrinza is used three times a day, while Combigan is used twice a day.

Side effects and risks

Simbrinza and Combigan both contain the active drug brimonidine tartrate. However, each medication also contains a second, different active drug.

Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with each drug, or with both Simbrinza and Combigan (when taken individually).

• Can occur with Simbrinza:
  • changes in how things taste
• Can occur with Combigan:
  • conjunctival hyperemia (redness and enlargement of the blood vessels in your eye)
  • allergic conjunctivitis
• Can occur with both Simbrinza and Combigan:
  • eye side effects, such as blurry vision, eye irritation, or eye allergy
  • dry mouth

Serious side effects

These lists contain examples of serious side effects that can occur with Simbrinza, with Combigan, or with both drugs (when taken individually).

• Can occur with Simbrinza:
  • decreased blood pressure
• Can occur with Combigan:
  • heart failure
• Can occur with both Simbrinza and Combigan:
  • allergic reaction

Effectiveness

The only condition both Simbrinza and Combigan are used to treat is increased pressure in the eye in people with open-angle glaucoma or ocular hypertension.

The use of Simbrinza and Combigan in treating increased eye pressure has been directly compared in a clinical trial. In the trial, people used either Simbrinza three times daily or Combigan twice daily.

In this trial, intraocular eye pressure (IOP) was measured at certain times of the day. (IOP is the pressure inside your eye.) This is because throughout the day, your eye pressure may vary due to your eye producing and draining fluid. Because of this, eye pressure in clinical trials is sometimes measured based on the time of day.

After 90 days of treatment, the following results were seen:

* Eye pressure is often reported as mmHg (millimeters of mercury). Normal eye pressure in adults and children 12 years and older is about 12 mmHg to 22 mmHg.

Costs

Simbrinza and Combigan generally cost about the same. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Simbrinza and Combigan are both brand-name drugs. There are currently no generic forms of either drug.

Simbrinza vs. Lumigan

Like Combigan (discussed above), the drug Lumigan has uses similar to those of Simbrinza. Here’s a comparison of how Simbrinza and Lumigan are alike and different.

Ingredients

Simbrinza contains two active drugs:

• brinzolamide, which belongs to a group of drugs called carbonic anhydrase inhibitors
• brimonidine tartrate, which belongs to a group of drugs called alpha-2 adrenergic receptor agonists

Lumigan contains the active drug bimatoprost. It belongs to a group of drugs called prostaglandins.

Although both Simbrinza and Lumigan work to decrease your eye pressure, they work in different ways in your eye.

Uses

Simbrinza and Lumigan are both approved to treat increased eye pressure in people who have either of the following conditions:

• ocular hypertension (high blood pressure in the eye)
• open-angle glaucoma, which is the most common type of glaucoma

Simbrinza is approved for use in adults and children ages 2 years and older. However, Lumigan is only approved for use in adults and children ages 16 years and older.

Drug forms and administration

Both Simbrinza and Lumigan come as a liquid solution in a dropper bottle. Each bottle has a tip that you’ll use to place drops of the drug into your eye.

Simbrinza is typically used three times a day. Lumigan is usually only used once a day, in the evening.

Side effects and risks

Simbrinza and Lumigan both contain medications used to treat increased eye pressure. Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with each drug, or with both Simbrinza and Lumigan (when taken individually).

• Can occur with Simbrinza:
  • dry mouth
  • changes in how things taste
• Can occur with Lumigan:
  • conjunctival hyperemia (redness and enlargement of the blood vessels in your eye)
• Can occur with both Simbrinza and Lumigan:
  • eye side effects, such as blurry vision, eye irritation, or eye allergy

Serious side effects

These lists contain examples of serious side effects that can occur with Simbrinza, with Lumigan, or with both drugs (when taken individually).

• Can occur with Simbrinza:
  • decreased blood pressure
• Can occur with Lumigan:
  • changes in the color of your iris (the colored portion of your eye), such as the iris becoming more brown
  • changes in eyelashes, such as thickening
  • swelling of the eye
  • macular edema (fluid buildup in part of your eye)
  • eye infections, which can become serious
• Can occur with both Simbrinza and Lumigan:
  • allergic reaction

Effectiveness

The only condition both Simbrinza and Lumigan are used to treat is increased pressure in the eye in people with open-angle glaucoma or ocular hypertension. These drugs haven’t been directly compared in clinical studies, but studies have found both Simbrinza and Lumigan to be effective for treating increased eye pressure.

Costs

Simbrinza generally costs less than Lumigan. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Simbrinza and Lumigan are both brand-name drugs. There are currently no generic forms of Simbrinza. However, Lumigan is available as the generic drug bimatoprost.

A generic drug is an exact copy of the active drug in a brand-name medication. Generics tend to cost less than brand-name drugs.

Common questions about Simbrinza

Here are answers to some frequently asked questions about Simbrinza.

Is Simbrinza a beta-blocker?

No, Simbrinza isn’t a beta-blocker. Beta-blockers are a group of drugs that are often used for heart conditions. But certain beta-blockers, such as timolol (Timoptic), may also be used to treat increased eye pressure.

Simbrinza contains two active drugs that aren’t beta-blockers. Specifically, it contains:

• Brinzolamide. This drug belongs to a group of drugs called carbonic anhydrase inhibitors. It works to decrease eye pressure by reducing the amount of fluid that’s found inside your eye.
• Brimonidine tartrate. This drug belongs to a group of drugs called alpha-2 adrenergic receptor agonists. It reduces the amount of fluid that your eye produces. It also increases the amount of fluid that drains from your eye.

Will Simbrinza lower my blood pressure?

Possibly. Simbrinza is approved to reduce increased pressure in the eye. But the drug may also lower your blood pressure.

In clinical trials, people using brimonidine tartrate had their blood pressure measured 2 hours after their dose. (Brimonidine tartrate is one of the active drugs in Simbrinza.) On average, people’s blood pressure was decreased by less than 5% just 2 hours after their dose.

This decrease in blood pressure may be small. But it could affect people with heart disease more than people without heart disease. For more about this, see the “Simbrinza precautions” section below.

This decrease in blood pressure may also be a problem for people taking other medications that decrease blood pressure. This includes drugs such as lisinopril (Prinivil). If you’re taking multiple drugs that affect your blood pressure, your doctor may monitor you more often than usual during treatment. This allows your doctor to ensure that your blood pressure doesn’t get too low.

For more information about drugs that may interact with Simbrinza, see the “Simbrinza interactions” section below.

Will Simbrinza cure my condition?

No, Simbrinza won’t cure your condition. Currently, there isn’t a cure for either of the conditions that Simbrinza’s approved to treat: ocular hypertension (high blood pressure in the eye) and glaucoma.

However, in clinical trials Simbrinza was effective in reducing increased eye pressure in people with those conditions. And having decreased eye pressure can help prevent damage to your eye that may be permanent.

If you have questions about what you can expect from Simbrinza treatment, talk with your doctor.

Can I use Simbrinza while wearing contacts?

Yes, you can wear contact lenses during Simbrinza treatment. But you’ll need to remove your contact lenses before putting Simbrinza drops into your eyes. This is because some of the ingredients in Simbrinza can be absorbed into contact lenses.

After using Simbrinza drops, you’ll need to leave your contacts out for at least 15 minutes. Then you can put your contacts back in.

If you have questions about using contact lenses during Simbrinza treatment, talk with your doctor.

Can I use Simbrinza with other eye drops or eye ointments?

Yes, if your doctor recommends it, you can use Simbrinza along with other eye drops or ointments. But be sure to wait at least 5 minutes between placing doses of each eye product into your eye. Spacing out your doses helps make sure that your body can properly absorb each medication.

If you have questions about using other products with Simbrinza, talk with your doctor or pharmacist.

Can I drive or work after using Simbrinza?

Maybe. But you shouldn’t drive a vehicle or use heavy machinery until you know how Simbrinza affects your body.

After you use Simbrinza eye drops, you may have blurry vision. Usually, this side effect is temporary and should go away on its own. However, during the time that you’re experiencing blurry vision, don’t drive or operate machinery.

In addition, Simbrinza may cause you to feel tired or drowsy. And this may increase your risk of having an accident while doing things like driving or using machinery. Because of this risk, you shouldn’t do these activities until you know how Simbrinza affects you. If the drug makes you too drowsy to drive or work, talk with your doctor about other medications to treat your eye condition.

If Simbrinza causes blurry vision, or makes you feel tired or drowsy, talk with your doctor. They may recommend a medication other than Simbrinza to treat your condition.

Simbrinza expiration, storage, and disposal

When you get Simbrinza from the pharmacy, the pharmacist will add an expiration date to the label that’s on the bottle or the box the bottle comes in. This date is typically 1 year from the date the medication is dispensed.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that’s past its expiration date, talk with your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

Simbrinza eye drops should be stored at a temperature of 36°F to 77°F (2°C to 25°C). This can be done at room temperature or in a refrigerator.

Avoid storing Simbrinza in areas where it could get damp or wet, such as bathrooms.

Disposal

If you no longer need to use Simbrinza and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

This article provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.

Simbrinza and alcohol

It’s not known exactly how alcohol may interact with Simbrinza. And there are no known interactions between Simbrinza and alcohol.

However, using alcohol and Simbrinza together may be dangerous. This is because both drugs may cause you to have slowed breathing and a slowed heart rate.

Talk with your doctor about how much alcohol is safe for you to drink during your Simbrinza treatment.

Simbrinza interactions

Simbrinza can interact with several other medications. It’s not known to interact with supplements or foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Simbrinza and other medications

Below are some of the medications that can interact with Simbrinza. This section doesn’t contain all drugs that may interact with Simbrinza.

Before using Simbrinza, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Simbrinza and oral carbonic anhydrase inhibitors

One of the active drugs in Simbrinza, called brinzolamide, belongs to the group of drugs called carbonic anhydrase inhibitors. You shouldn’t take Simbrinza along with any carbonic anhydrase inhibitors that are taken orally (by mouth).

When used as an eye drop, carbonic anhydrase inhibitors work to lower pressure inside your eye. But when taken orally, these drugs may be used to treat glaucoma or other conditions, such as seizures.

Using Simbrinza with an oral carbonic anhydrase inhibitor may increase your risk of side effects of both drugs. (For more information about the side effects of Simbrinza, see the “Simbrinza side effects” section above.)

Examples of carbonic anhydrase inhibitors that are taken by mouth include:

• acetazolamide, which is used for mountain sickness, glaucoma, and some other conditions
• methazolamide, which is used for certain eye conditions, such as glaucoma
• dichlorphenamide (Keveyis), which is used for a type of paralysis

Before you start using Simbrinza drops, tell your doctor about all of the medications you take. If you take an oral carbonic anhydrase inhibitor, your doctor may recommend a medication other than Simbrinza to treat your condition.

Simbrinza and salicylates

Taking a salicylate medication along with Simbrinza may cause changes in your blood, such as abnormal electrolyte levels. Taking these drugs together may also affect the acid level in your blood.

Salicylate is a substance that’s found in some medications, such as:

• aspirin
• bismuth subsalicylate (Pepto Bismol)
• magnesium salicylate (Doan’s)

In studies, changes in electrolyte or acid levels didn’t occur in people using eye drops containing brinzolamide alone. (Brinzolamide is one of the active drugs in Simbrinza.) But this side effect is possible in people using carbonic anhydrase inhibitors, which is the group of drugs that brinzolamide belongs to.

In rare cases, people taking an oral carbonic anhydrase inhibitor with a salicylate drug did have changes in their electrolyte or acid levels. But this interaction only occurred in people taking a high dose of the salicylate medication.

If you’re taking a salicylate drug, talk with your doctor before you start using Simbrinza. If you use these drugs together, your doctor may monitor you more closely than usual during treatment. This allows them to ensure you aren’t having side effects from the drugs.

Simbrinza and central nervous system depressants

It’s not known exactly how central nervous system depressants may interact with Simbrinza. But using these drugs together may be dangerous. (Central nervous system depressants work to slow down your body’s neurological functions.) This is because both drugs cause you to have a slower breathing rate and heart rate.

Examples of central nervous system depressants include:

• opiates such as oxycodone (Roxicodone), which is used to reduce pain
• barbiturates such as phenobarbital, which is used to treat seizures
• sedative drugs such as alprazolam (Xanax), which is used to treat panic disorders and anxiety

Before you start using Simbrinza eye drops, tell your doctor about all of the medications you take. If you use Simbrinza and a central nervous system depressant together, your doctor may monitor you more closely than usual during treatment. This allows them to ensure you aren’t having side effects from the drugs.

Simbrinza and blood pressure drugs

One of Simbrinza’s active drugs, called brimonidine tartrate, may lower your blood pressure. Using Simbrinza while you’re also taking another drug that lowers your blood pressure may cause your blood pressure to become too low. And this can cause side effects such as dizziness or blurry vision.

Examples of drugs that lower blood pressure include:

• losartan (Cozaar)
• amlodipine (Norvasc)
• metoprolol (Toprol XL, Lopressor)

If you’re taking a drug that lowers your blood pressure while you’re using Simbrinza, your doctor may monitor you more often than usual. This allows them to ensure you aren’t having side effects such as dizziness or blurry vision.

Simbrinza and digoxin

Using Simbrinza and digoxin at the same time may increase your risk of low heart rate or low blood pressure. Digoxin (Lanoxin) is used to treat certain heart conditions.

If you’re taking digoxin, talk with your doctor before you start using Simbrinza. They may monitor your heart function more often than usual during treatment.

Simbrinza and certain antidepressants

Taking tricyclic antidepressants (TCAs) along with Simbrinza may cause Simbrinza to not work as well as it should. (TCAs are a certain group of drugs used to treat depression.)

This interaction hasn’t been proven. However, TCAs may decrease Simbrinza’s ability to reduce eye pressure. And this means the medication may not work as well to treat your eye condition.

Examples of TCAs include:

• amitriptyline
• doxepin (Silenor)
• nortriptyline (Pamelor)
• imipramine

If you take a TCA, talk with your doctor before starting Simbrinza. They may monitor you more often than usual to make sure Simbrinza is working for you.

Simbrinza and monoamine oxidase inhibitors

Taking monoamine oxidase inhibitors (MAOIs) while you’re using Simbrinza may keep your body from breaking down Simbrinza like usual. (MAOIs are a group of drugs used to treat depression.)

And this interaction can increase your risk of side effects from the MAOI, from Simbrinza, or from both drugs. For more information about possible side effects of Simbrinza, see the “Simbrinza side effects” section above.

Examples of MAOIs include:

• tranylcypromine (Parnate)
• selegiline (Emsam)
• phenelzine (Nardil)

If you’re taking an MAOI, talk with your doctor before you start using Simbrinza drops. During treatment, they may monitor you for side effects more often than usual.

Simbrinza and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Simbrinza. However, you should still check with your doctor or pharmacist before using any of these products while you’re using Simbrinza.

Simbrinza and foods

There aren’t any foods that have been specifically reported to interact with Simbrinza. If you have any questions about eating certain foods with Simbrinza, talk with your doctor.

Simbrinza use with other drugs

Simbrinza is approved to treat increased eye pressure in people who have either of the following conditions:

• ocular hypertension (high blood pressure in the eye)
• open-angle glaucoma (the most common type of glaucoma)

In some cases, Simbrinza may be used with other medications to reduce pressure in your eye. But generally, you’ll start with one medication. Then your doctor can add more medications if needed.

Examples of other eye drops that may be used with Simbrinza to treat increased eye pressure include:

• travoprost (Travatan Z)
• latanoprost (Xalatan)
• bimatoprost (Lumigan)

If you’re using Simbrinza with any other eye drops, wait at least 5 minutes between using each product. Don’t use the eye products at exactly the same time. Spacing out your doses helps make sure that your body can properly absorb each medication.

If you have questions about using other treatments with Simbrinza, talk with your doctor.

How to use Simbrinza

Be sure to use Simbrinza according to your doctor’s or healthcare provider’s instructions.

Simbrinza comes as a liquid solution in a dropper bottle. Simbrinza bottles have a tip that you’ll use to place the drops into your eye.

Shake the Simbrinza bottle well before you use the drops. If you wear contact lenses, remove them before you use Simbrinza.

When placing drops of Simbrinza, be careful to avoid touching the tip of the Simbrinza bottle to your eye, or to any other surfaces. Touching the bottle to any surfaces can increase your risk of eye infection. This is because germs from the surfaces can get onto the bottle, and then into your eye when you dispense the drops.

After you use Simbrinza eye drops, place the bottle’s cap back on right away. If you wear contact lenses, you can put your contacts back in 15 minutes after using Simbrinza.

When to take

Simbrinza should be used three times daily, about every 8 hours. It may be helpful to use Simbrinza drops at mealtimes to help you remember when to use it.

If you use other eye drops while you’re using Simbrinza, wait at least 5 minutes between using each eye product.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm on your phone or downloading a reminder app. A kitchen timer can work, too.

How Simbrinza works

Simbrinza is approved to treat increased eye pressure in people who have either of the following conditions:

• ocular hypertension (high blood pressure in the eye)
• open-angle glaucoma, the most common type of glaucoma

About eye pressure

Your eyes make a clear fluid called aqueous humor. This fluid drains from your eye through your pupil (the opening of your eye that appears black).

The pressure inside your eyes is determined by how much fluid your eye makes and how much of the fluid drains out. The pressure inside your eye is called intraocular pressure.

What Simbrinza does

Simbrinza works to lower pressure inside your eye by reducing the amount of fluid your eye makes. The active drugs in Simbrinza, which are listed below, do this in slightly different ways:

• Brinzolamide. This drug works to decrease eye pressure by reducing the amount of fluid that’s found inside your eye. It belongs to a group of medications called carbonic anhydrase inhibitors.
• Brimonidine tartrate. This drug decreases the amount of fluid that your eye makes. The drug also increases the amount of fluid that drains from your eye. Brimonidine tartrate belongs to a group of medications called alpha-2 adrenergic receptor agonists.

How long does it take to work?

Simbrinza begins working right after you use the eye drops for the first time. The drug is at its most effective in lowering your eye pressure about 2 hours after each dose. Even though you may not feel Simbrinza working to reduce your eye pressure, make sure to keep taking it according to your doctor’s instructions.

If you have questions about how Simbrinza works or what to expect with treatment, talk with your doctor.

Simbrinza and pregnancy

It’s not known if Simbrinza is safe to use during pregnancy. Because of this, it’s recommended that Simbrinza be used during pregnancy only if the benefit of using the drug outweighs the risks. This drug does cross the placenta, which means a developing fetus can be exposed to it.

The active drugs in Simbrinza have been studied in animals. But keep in mind that animal studies don’t always predict what will happen in humans.

• In some animal studies, pregnant females taking brinzolamide by mouth had offspring with changes in bone formation and low birth weights. (Brinzolamide is one of the active drugs in Simbrinza.) However, the doses given to the animals were between 20 and 120 times the recommended doses used by humans. And the animals were given brinzolamide by mouth. But Simbrinza is used as an eye drop in humans.
• In another animal study, there wasn’t any harm to fetuses exposed to brimonidine tartrate during pregnancy. (Brimonidine tartrate is the other active drug in Simbrinza.) In this study, blood levels of brimonidine in the animals were about 100 times higher than levels in humans should be.

If you have questions about using Simbrinza during pregnancy, talk with your doctor. They can discuss the risks and benefits of using this drug during pregnancy.

Simbrinza and birth control

It’s not known if Simbrinza is safe to use during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Simbrinza.

For more information about using Simbrinza during pregnancy, see the “Simbrinza and pregnancy” section above.

Simbrinza and breastfeeding

It’s not known if it’s safe to breastfeed while using Simbrinza. It’s possible that Simbrinza may pass into the milk of breastfeeding females who use the drug. And children who are breastfed may be exposed to the drug.

Because of this risk, you should either stop breastfeeding while using Simbrinza or stop using Simbrinza while breastfeeding. If you’re taking Simbrinza and are considering breastfeeding, talk with your doctor. They’ll help determine the best treatment options for you. And they can recommend safe and healthy ways to feed your child.

Simbrinza precautions

Before using Simbrinza, talk with your doctor about your health history. Simbrinza may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

• Low number of cells in your cornea. If you have a lowered amount of cells in your cornea, using Simbrinza can increase the risk of swelling in your cornea. (Your cornea is the clear covering over the front of your eye.) Your doctor may monitor your eyes more often while you’re using Simbrinza to ensure that your cornea doesn’t have swelling. Before starting Simbrinza, talk with your doctor about your risk of corneal swelling.
• Severe kidney disease. It’s not known how Simbrinza may affect people with kidney disease. However, brinzolamide (one of the active drugs in Simbrinza) is removed from your body by your kidneys. So, if you have severe kidney problems, it’s recommended that you don’t use Simbrinza. Instead, your doctor will recommend a medication other than Simbrinza to treat your condition.
• Sudden angle-closure glaucoma. It’s not known if Simbrinza is effective for treating angle-closure glaucoma that happens suddenly. There is a risk of permanent damage to your vision with angle-closure glaucoma. Because of this, only medications that have been proven effective should be used to treat it. Symptoms of sudden angle-closure glaucoma can include severe eye pain, vision that suddenly becomes blurry, seeing rainbow-colored rings, and feeling sick to your stomach, sometimes to the point of vomiting. If you think you’re having a sudden angle-closure attack, call your doctor or eye doctor right away and get medical attention.
• Heart disease, such as heart failure. If you have heart disease, such as heart failure, your doctor may recommend a medication other than Simbrinza for you. One of the active drugs in Simbrinza, called brimonidine tartrate, may lower your blood pressure. And lowered blood pressure can cause serious problems in people with a history of heart disease. Talk with your doctor if you have heart disease. They may recommend a medication other than Simbrinza to treat your condition.
• Liver disease, such as hepatitis. If you have a liver condition, such as hepatitis (inflammation in your liver), your doctor may monitor you more often than usual for side effects while you’re using Simbrinza. It’s not known if brimonidine tartrate, one of the drugs in Simbrinza, is safe for people with liver conditions. If you have any liver problems, talk with your doctor before starting Simbrinza.
• Vascular diseases, such as orthostatic hypotension. If you have a history of any vascular conditions (conditions that affect your blood vessels), using Simbrinza may worsen your condition. An example of a vascular disease is orthostatic hypotension. (With this condition, you have low blood pressure when you change body positions, such as when standing up.) Before using Simbrinza, tell your doctor about any history of vascular disease.
• Allergic reaction. If you’ve had an allergic reaction to Simbrinza or any of its ingredients, you shouldn’t use Simbrinza. In addition, you shouldn’t use Simbrinza if you have a sulfa allergy. If you aren’t sure about your medication allergies, talk with your doctor.
• Pregnancy. It isn’t known if Simbrinza is safe to use during pregnancy. For more information, see the “Simbrinza and pregnancy” section above.
• Breastfeeding. It isn’t known if Simbrinza is safe to use while breastfeeding. For more information, see the “Simbrinza and breastfeeding” section above.

Note: For more information about the potential negative effects of Simbrinza, see the “Simbrinza side effects” section above.

Simbrinza overdose

Do not use more Simbrinza than your doctor recommends. Using more than the recommended dosage of Simbrinza can lead to serious side effects.

Overdose symptoms

Symptoms of an overdose can include:

• electrolyte imbalances (having too much or too little of certain minerals in your body)
• changes in blood pH (how acidic your blood is)
• decreased blood pressure

What to do in case of overdose

If you think you’ve used too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away.