brimonidine / timolol
Combigan is a combination eye drop containing brimonidine (an alpha agonist) and timolol (a beta blocker). It's used to lower high pressure inside the eye in adults with conditions like glaucoma or ocular hypertension. Typically, you apply one drop to the affected eye(s) twice daily, about 12 hours apart. Common side effects include eye redness, itching, or dryness. Combigan (brimonidine / timolol) is available as both a brand-name and generic medication.
What is Combigan (brimonidine / timolol)?
What is Combigan (brimonidine / timolol) used for?
Treatment of high pressure in the eye in people ages 2 years and older with:
How Combigan (brimonidine / timolol) works
Combigan is a combination eye drop containing two medications that work differently to lower eye pressure.
Brimonidine is an alpha agonist. It works to lessen how much fluid is made in the eye and also to help more fluid flow out of the eye.
Timolol is a non-selective beta blocker. It works to lower the amount of fluid that's made in the eye.
Drug Facts
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What are the side effects of Combigan (brimonidine / timolol)?
Common Side Effects
- Eye redness
- Eye itching
- Eye burning or stinging
Other Side Effects
- Dry eye or eye irritation
- Eye pain
- Eyelid swelling, redness, or itching
- Crusting or discharge from the eye
- Feeling like there's something in your eye
- Headache
- Dry mouth
- Changes in vision
Serious Side Effects
- Allergic reaction: skin rash (hives), itching, eye redness, swollen eyes, shortness of breath
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Heart failure—shortness of breath, swelling of the ankles, feet, or hands, sudden weight gain, unusual weakness or fatigue
- Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
- New or worsening eye pain, redness, irritation, or discharge
- Slow heartbeat—dizziness, feeling faint or lightheaded, confusion, trouble breathing, unusual weakness or fatigue
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Change in taste
- Dry eyes
- Dry mouth
- Eye irritation or itching
- Headache
- Increased tears after use
Pros and cons of Combigan (brimonidine / timolol)
Pros
Convenient to have a single eye drop that combines two different medications
Can be stored at room temperature
Possible option for children older than 2 years old
Cons
Used twice a day
Can cause tiredness or drowsiness in some people
Not for people with asthma, severe chronic obstructive pulmonary disease (COPD), or certain heart-related problems
Pharmacist tips for Combigan (brimonidine / timolol)
Mark your appointments on your calendar to visit your optometrist or ophthalmologist. You'll need regular eye exams so that your eye specialist can check how well Combigan (brimonidine / timolol) is working for you and whether there are any side effects related to the eyes.
Remove any soft contact lenses from your eye(s) before placing the Combigan (brimonidine / timolol) eye drops. The eye drops contain a preservative that can damage your contacts. You can put your contacts back in 15 minutes after you use the eye drops.
You might need to use many different eye drop medications to help lower your eye pressure. Wait at least 5 minutes between each eye medication medication to give your eye(s) time to absorb each one.
Combigan (brimonidine / timolol) can cause your vision to become blurry temporarily after you put the medication into your eye. Don't drive until your vision clears up.
Make sure to keep the bottle capped and closed tightly when you're not using it. This will help keep it clean and free of germs. Also, don't touch the dropper tip with your hands or let it touch your eye or any other surface. Otherwise, germs can get into medication. You could be at risk for an eye infection if you use contaminated eye drops.
Tell your care team about all of the medications you're taking or planning to take, including medications that you take by mouth. Combigan (brimonidine / timolol) can interact with other medications so it's important for your care team to check that all of your medications are safe to take together.
Store Combigan (brimonidine / timolol) only at room temperature and keep it away from light.
Wash your hands well with soap and water before you use the eye drops.
Tilt your head back so you're looking at the ceiling. Use your index (pointer) finger to pull your lower eyelid down to form a pocket.
Gently squeeze 1 drop of medication into the pocket. Then, close your eye and lightly press on the inside corner of your eye for at least a minute. You can wipe away any extra liquid around the eye with a clean tissue.
Frequently asked questions about Combigan (brimonidine / timolol)
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What are the risks and warnings for Combigan (brimonidine / timolol)?
Combigan (brimonidine / timolol) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Only use in the eye
Only put Combigan (brimonidine / timolol) eye drops on the surface of the eye. Avoid touching the tip of the eye drop bottle to lower the risk of contamination. Don't swallow the medication or use the suspension as an injection.
Allergic reaction of the eye
Some people have reported allergic reactions to brimonidine-containing eye drops, sometimes months after starting the medication. Symptoms include eye itchiness, watery eyes, and eyelid swelling. Let your healthcare team know if you notice symptoms of allergic reactions after starting Combigan (brimonidine / timolol).
Interaction with inhaled beta agonists for asthma or COPD
Risk factors: Asthma, COPD, or other breathing conditions
Though not common, the timolol in Combigan can get absorbed into your body and counteract the effects of inhaled beta agonists (e.g., albuterol (Ventolin), levalbuterol (Xopenex)). This can make them not work as well to treat sudden trouble breathing in people with asthma or chronic obstructive pulmonary disease (COPD). Tell your care team if you have asthma or COPD. They'll likely switch you to a different eye drop medication that doesn't contain a beta blocker like timolol.
Worsening heart problems
Risk factors: History of heart failure
Although rare, it's possible for timolol in Combigan to get absorbed into your body and affect the heart. Timolol can slow down heart rate and lower blood pressure, which might worsen certain heart conditions like heart failure. Make sure your care team knows about all of your medical conditions and medications you're taking before starting Combigan (brimonidine / timolol). Seek medical help if you experience shortness of breath, lower ability to exercise, tiredness, weakness, or swelling in your legs, ankles, or feet.
Worsening of other medical conditions
Risk factors: History of serious allergic reactions | Blood flow problems | Depression | Muscle weakness
There have been reports of Combigan (brimonidine / timolol) worsening other medical conditions, including those related to blood flow (vascular insufficiency) and muscle weakness (including eyelid drooping).
In addition, timolol in Combigan might make you more sensitive to allergens (or make your allergic reactions more severe) if you have a history of allergic reactions.
Let your healthcare team know about all of your medical conditions before starting Combigan (brimonidine / timolol).
Masked symptoms of low blood sugar in people with diabetes
Beta blockers, like timolol in Combigan, can hide certain symptoms of low blood sugar, such as fast heartbeat and shakiness. If you have diabetes, you might need to check your blood sugar more often while taking Combigan (brimonidine / timolol). Make sure you know how to recognize and treat low blood sugar. If you experience any symptoms of low blood sugar (e.g., dizziness, sweating, confusion), get medical help right away.
Masked symptoms of high thyroid hormone levels (hyperthyroidism)
Risk factors: Hyperthyroidism
Combigan (brimonidine / timolol) can hide certain symptoms of hyperthyroidism (overactive thyroid), like fast heart rate and tremors. Let your care team know if you have hyperthyroidism before starting Combigan (brimonidine / timolol).
Your prescriber might ask you to make appointments with your thyroid specialist while you're using Combigan (brimonidine / timolol) to monitor your thyroid health. Don't suddenly stop taking Combigan (brimonidine / timolol) without first talking to your eye specialist. Doing so can lead to a dangerous condition called "thyroid storm,” which include symptoms such as a high temperature, rapid heartbeat, and confusion.
Combigan (brimonidine / timolol) dosage forms
Typical dosing for Combigan (brimonidine / timolol)
Combigan contains 0.2% of brimonidine and 0.5% of timolol.
Age 2 years and older: The typical dose is 1 drop into the affected eye(s) twice a day (about 12 hours apart).
How much does Combigan (brimonidine / timolol) cost?
Combigan (brimonidine / timolol) contraindications
Symptomatic heart failure
Second or third degree heart block
Slow heartbeat
Heart not pumping enough blood
Age less than 2 years
Allergy to brimonidine or timolol
What are alternatives to Combigan (brimonidine / timolol)?
Treatment of high pressure in the eye in people ages 2 years and older with:
To lower eye pressure in people with open-angle glaucoma or high eye pressure
Combigan (brimonidine / timolol) images
References
Best studies we foundAllergan, Inc. (2024). Combigan- brimonidine tartrate, timolol maleate solution/ drops [package insert]. DailyMed.
American Academy of Allergy, Asthma & Immunology. (n.d.). Eye (ocular) allergy.
American Optometric Association. (n.d.). Ocular hypertension.
Boyd, K. (2024). What is ocular hypertension? American Academy of Ophthalmology.
Brooks, A. M., et al. (1992). Ocular beta-blockers in glaucoma management. Clinical Pharmacological Aspects. Drugs & Aging.
Glaucoma Research Foundation. (n.d.). Types of eye drops for glaucoma.
Mäenpää, J., et al. (2016). Cardiac safety of ophthalmic timolol. Expert Opinion on Drug Safety.
McGill, J. B. (2009). Reexamining misconceptions about β-blockers in patients with diabetes. Clinical Diabetes.
MedlinePlus. (2024). Venous insufficiency.
Moltolko, M. A. (2008). Comparison of allergy rates in glaucoma patients receiving brimonidine 0.2% monotherapy versus fixed-combination brimonidine 0.2%-timolol 0.5% therapy. Current Medical Research and Opinion.
National Eye Institute. (2024). How to put in eye drops.
Singh Hayreh, S., et al. (1999). Beta-blocker eyedrops and nocturnal arterial hypotension. American Journal of Ophthalmology.
Tanihara, H., et al. (2023). Crossover randomized study of pharmacologic effects of ripasudil-brimonidine fixed-dose combination versus ripasudil or brimonidine. Advances in Therapy.
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