Simbrinza
Simbrinza is a combination eye drop containing two medications: brinzolamide (a carbonic anhydrase inhibitor) and brimonidine (an alpha-2 agonist). It's used to treat glaucoma and high pressure in the eye. The dosage for the eye drops is placed 1 drop placed directly into the eye(s) three times per day to lower the pressure in the eye. Simbrinza is not yet available as a lower-cost generic. Side effects include eye irritation, blurry vision, and changes in taste.
What is Simbrinza (brinzolamide / brimonidine)?
What is Simbrinza (brinzolamide / brimonidine) used for?
Treatment of high pressure in the eye in people ages 2 years and older with:
How Simbrinza (brinzolamide / brimonidine) works
Simbrinza is a combination eye drop containing two medications that work differently to lower eye pressure.
Brinzolamide is a carbonic anhydrase inhibitor. It lessens the amount of fluid that's made in the eye.
Brimonidine is an alpha-2 agonist. It works to lessen how much fluid is made in the eye and also to help more fluid flow out of the eye.
Drug Facts
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What are the side effects of Simbrinza (brinzolamide / brimonidine)?
Common Side Effects
- Blurry vision
- Eye irritation
- Changes in taste (e.g., bad taste in mouth)
- Dry mouth
- Eye allergy
Other Side Effects
- Burning or stinging sensation in the eye
- Eye redness
- Headache
- Tiredness or sleepiness
Serious Side Effects
- Allergic reaction: skin rash (hives), itching, eye redness, swollen eyes, shortness of breath
Source:Â DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Rare
Burning, dry, or itching eyes
discharge or excessive tearing
hives or welts
redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid
skin rash
Incidence not known
Chest pain or discomfort
constricted, pinpoint, or small pupils (black part of the eye)
fast, pounding, or irregular heartbeat or pulse
hoarseness
irritation
joint pain, stiffness, or swelling
lightheadedness, dizziness, or fainting
redness of the skin
shortness of breath
slow or irregular heartbeat
swelling of the eyelids, face, lips, hands, or feet
tearing
throbbing pain
tightness in the chest
troubled breathing or swallowing
unusual tiredness
Get emergency help immediately if any of the following symptoms of overdose occur:
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Burning and stinging sensation
change in color vision
change in taste
difficulty seeing at night
drowsiness
feeling of having something in the eye
headache
increase in blood flow to the whites of the eyes
increased sensitivity of the eyes to sunlight
lack or loss of strength
loss of taste
paleness of the eye or inner lining of the eyelid
redness and tiny bumps on the lining of the eyelid
Rare
Acid or sour stomach
belching
body aches or pain
congestion
crusting in the corner of the eye
double vision
dryness or soreness of the throat
excessive muscle tone
hair loss or thinning of the hair
hoarseness
indigestion
muscle stiffness
muscle tension or tightness
stomach discomfort, upset, or pain
tender, swollen glands in the neck
tightness in the chest
voice changes
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Simbrinza (brinzolamide / brimonidine)
Pros
Works well to lower eye pressure
Conveniently combines two medications into one eye drop
Can use in children as young as 2 years old
Cons
Must use three times a day
Might not be safe if you're allergic to sulfa medications
Not available as a lower-cost generic
Pharmacist tips for Simbrinza (brinzolamide / brimonidine)
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 Simbrinza (brinzolamide / brimonidine) is working for you and whether there are any side effects related to the eyes.
Take out any soft contact lenses from your eye(s) before each time you use the Simbrinza (brinzolamide / brimonidine) 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.
Simbrinza (brinzolamide / brimonidine) can cause your vision to become blurry temporarily after you put the medication into your eye. It's possible for the medication to make some people feel tired too. Don't drive until your vision clears up and you feel alert.
Keep the bottle of Simbrinza (brinzolamide / brimonidine), including the tip of the bottle, clean and free of germs. Make sure to keep the bottle capped and closed tightly when you're not using it. And 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. Simbrinza (brinzolamide / brimonidine) can interact with many medications so it's important for your care team to check that all of your medications are safe to take together.
Each bottle of Simbrinza (brinzolamide / brimonidine) contains 8 mL of medication. Each bottle should last about 50 days when the eye drops are taken as prescribed (1 drop three times per day).
You can keep Simbrinza (brinzolamide / brimonidine) either in the refrigerator or at room temperature at 36 to 77 degrees Fahrenheit. Don't place the eye drops in the freezer.
Wash your hands well with soap and water before you use the eye drops. Shake the bottle before you place the drop into your eye to mix the medication well.
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.
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.
Frequently asked questions about Simbrinza (brinzolamide / brimonidine)
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What are the risks and warnings for Simbrinza (brinzolamide / brimonidine)?
Simbrinza (brinzolamide / brimonidine) 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 Simbrinza (brinzolamide / brimonidine) eye drops on the surface of the eye. Don't swallow the medication or use the suspension as an injection.
Severe allergic reactions
Risk factors: Sulfa allergy
Although Simbrinza (brinzolamide / brimonidine) is mainly absorbed into the eye, it's possible for a little bit of the medication to get absorbed into your body through the eye. Tell your care team if you're allergic to sulfa medications like Bactrim (sulfamethoxazole / trimethoprim). Since Simbrinza contains brinzolamide and brinzolamide is a type of sulfa medication, you might also be allergic to Simbrinza and have a serious reaction when you use Simbrinza.
Seek medical help right away if you have any signs of an allergic reaction, such as trouble breathing, skin rash or redness, itching, or swelling. Contact your prescriber if you have any symptoms in or around your eyes, such as eye irritation, pain, or itching.
Risk for swelling of the cornea in certain people
Risk factors: Low number of cells on the cornea
Simbrinza contains brinzolamide, which can raise the risk of swelling of the cornea (or corneal edema) in certain people. The cornea is the outermost layer of the eye that protects the front of the eye. Talk to your eye specialist before you start Simbrinza (brinzolamide / brimonidine) if you've ever been told that your cornea is thin or or that you have a low number of cells on the cornea.
Risk for worsening of poor blood flow
Risk factors: Depression | Poor blood flow to the brain or heart | Raynaud's phenomenon | Low blood pressure upon standing (orthostatic hypotension) | Blood circulation problems | Serious heart problems
Simbrinza contains brimonidine. Based on how brimonidine works, there's a very small risk that the medication can worsen medical conditions related to poor blood flow. This might be a problem for people who already have poor blood flow to the brain, heart, hands, feet, or other important parts of the body. Let your prescriber know about your full medical history before you start Simbrinza (brinzolamide / brimonidine) so your care team can follow up with you about your health.
Risk for eye infection (from contamination)
Risk factors: Corneal disease | Injury or damage to the surface of the eye
Wash your hands before each time you use Simbrinza (brinzolamide / brimonidine). Also be careful not to let the tip of the eye drop bottle from touching your eye or any other surface. Don't touch the dropper tip with your hands. It's important to follow these steps to prevent contaminating the medication with germs. Otherwise, you could get eye infections, like bacterial keratitis (a bacterial infection of the cornea).
Take out soft contact lenses before using
Simbrinza (brinzolamide / brimonidine) has a preservative in it. This preservative, benzalkonium chloride, can get absorbed onto soft contact lenses and cause damage. Remove the soft contact lens from your eye before you place a drop of Simbrinza (brinzolamide / brimonidine) in the eye. Wait at least 15 minutes after you place the eye drop in before you put your contacts back in.
Simbrinza (brinzolamide / brimonidine) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 8ml of 1%/0.2% | 1 eye dropper | $190.78 | $190.78 |
Typical dosing for Simbrinza (brinzolamide / brimonidine)
Simbrinza contains 1% of brinzolamide and 0.2% of brimonidine.
The typical dose is 1 drop in the affected eye(s) 3 times daily.
Interactions between Simbrinza (brinzolamide / brimonidine) and other drugs
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Ceritinib
- Iobenguane I 131
- Memantine
How much does Simbrinza (brinzolamide / brimonidine) cost?
Simbrinza (brinzolamide / brimonidine) contraindications
Age younger than 2 years
Allergy to brinzolamide or brimonidine
What are alternatives to Simbrinza (brinzolamide / brimonidine)?
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
Simbrinza (brinzolamide / brimonidine) images
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References
Best studies we foundAlcon Laboratories, Inc. (2023). Simbrinza- brinzolamide/brimonidine tartrate suspension/ drops [package insert]. DailyMed.
American Academy of Ophthalmology. (2016). Cornea.
American Optometric Association. (n.d.). Ocular hypertension.
Boyd, K. (2024). What is ocular hypertension? American Academy of Ophthalmology.
Centers for Medicare and Medicaid Services. (2015). Pharmacy auditing and dispensing job aid: Billing other dosage forms.
Chaudhary, O. R. (2024). What is the treatment for corneal edema?
Gudgel, D. T. (2023). How to put in eye drops. American Academy of Ophthalmology.
Gupta, D., et al. (2016). Glaucoma. American Family Physician.
Li, T., et al. (2016). Comparative effectiveness of first-line medications for primary open-angle glaucoma: A systematic review and network meta-analysis. Ophthalmology.
Merchel Piovesan Pereira, B., et al. (2019). Benzalkonium chlorides: Uses, regulatory status, and microbial resistance. Applied and Environmental Microbiology.
National Eye Institute. (2021). How to put in eye drops.
Vaajanen, A., et al. (2017). A single drop in the eye - Effects on the whole body? The Open Ophthalmology Journal.
Wagner, I. V., et al. (2022). Updates on the diagnosis and management of glaucoma. Mayo Clinic Proceedings: Innovations, Quality & Outcomes.
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