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Simbrinza

brinzolamide / brimonidine
Used for Eye Pressure, Glaucoma

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.

Reviewed by:Last reviewed on September 10, 2024
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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

Common BrandsSimbrinza
Drug ClassCarbonic anhydrase inhibitor / Alpha agonist
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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Side effects of Simbrinza (brinzolamide / brimonidine)

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Reported in up to 5% of people:

  • Blurry vision
  • Eye irritation
  • Changes in taste (e.g., bad taste in mouth)
  • Dry mouth
  • Eye allergy

Less Common Side Effects

  • Burning or stinging sensation in the eye
  • Eye redness
  • Headache
  • Tiredness or sleepiness

Simbrinza (brinzolamide / brimonidine) serious side effects

Contact your healthcare provider immediately if you experience any of the following.

  • Allergic reaction: skin rash (hives), itching, eye redness, swollen eyes, shortness of breath

Source: DailyMed

The following Simbrinza (brinzolamide / brimonidine) 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:

More common

Blurred vision

discoloration of the white part of the eye

eye irritation or redness

Less common

Decreased vision

eye pain

eyes sensitive to light

red, sore eyes

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

fever

hoarseness

irritation

itching

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:

Symptoms of overdose

Confusion

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

muscle cramps or pain

numbness, tingling, pain, or weakness in the hands or feet

seizures

sweating

trembling

weakness and heaviness of the legs

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

cough

crusting in the corner of the eye

diarrhea

double vision

dryness or soreness of the throat

excessive muscle tone

hair loss or thinning of the hair

heartburn

hoarseness

indigestion

muscle stiffness

muscle tension or tightness

nausea

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.

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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
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Pharmacist tips for Simbrinza (brinzolamide / brimonidine)

pharmacist
  • 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.

How to use Simbrinza (brinzolamide / brimonidine):

  • 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.
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Common questions about Simbrinza (brinzolamide / brimonidine)

It's possible for Simbrinza (brinzolamide / brimonidine) to cause headaches as a side effect. People have reported headaches while they used brimonidine, one of the ingredients in Simbrinza. Consider making some lifestyle changes to help manage headaches, such as drinking plenty of water during the day and breathing exercises to minimize stress. Speak with your prescriber if you get headaches after you use Simbrinza (brinzolamide / brimonidine) and they're too bothersome for you to handle.

No, Simbrinza (brinzolamide / brimonidine) doesn't contain a beta blocker. Simbrinza contains two active ingredients, brinzolamide (a carbonic anhydrase inhibitor) and brimonidine (an alpha-2 agonist). These three types of eye drops work differently to lower eye pressure. Depending on how severe your eye condition is, it's possible that your eye specialist might prescribe multiple eye drop medications for you to use. For example, they might prescribe a beta blocker eye drop medication, such as timolol (Timoptic) or betaxolol (Betoptic S), to take with Simbrinza (brinzolamide / brimonidine).

You can put Simbrinza (brinzolamide / brimonidine) in the refrigerator or in a safe place at room temperature. The recommended temperature range for storage is 36 to 77 degrees Fahrenheit.

No, Simbrinza isn't available as a lower-cost generic. But the two active ingredients in Simbrinza, brinzolamide and brimonidine, each come as separate eye drop medications that are both available as lower-cost generics. If you end up switching to using brinzolamide and brimonidine as separate eye drop medications, just make sure that you place the drop of each medications into eye about 5 minutes apart. This helps each medication get fully absorbed into your eye.

Some examples of reasonable alternatives to Simbrinza (brinzolamide / brimonidine) that you can consider include Combigan (brimonidine / timolol) and Cosopt (dorzolamide / timolol). In general, glaucoma eye drops differ by how they work in the eye, how many times a day they're used, and whether they're available as lower-cost generics. Additionally, glaucoma eye drops can come as single-ingredient medications or as a combination of two medications. Speak with your eye specialist to learn more about what other treatment options are appropriate and available for you.

Simbrinza and Cosopt are combination eye drop medications for glaucoma and high eye pressure. But they contain different active ingredients and have different instructions. Simbrinza contains brinzolamide and brimonidine. You have to shake the Simbrinza bottle well before using, and you use the eye drops three times per day. On the other hand, Cosopt contains dorzolamide and timolol. You don't need to shake the Cosopt bottle, and you use the eye drops twice per day. Studies showed that the active ingredients in each eye drop medication work well and are first-choice treatment options. Talk to your eye specialist to learn more about comparing between Simbrinza and Cosopt.

Simbrinza and Combigan are both combination eye drop medications containing two active ingredients that work differently to help lower eye pressure. Simbrinza contains brimonidine and brinzolamide, whereas Combigan contains brimonidine and timolol. You'll need to shake the Simbrinza bottle before each time you use the eye drops, and it's used three times per day. But Combigan doesn't require any shaking before use and the eye drop is used twice per day. Both brand names are good choices for treating high eye pressure. Ask your eye specialist about comparing between Simbrinza and Combigan.

No, Simbrinza (brinzolamide / brimonidine) isn't discontinued. It's still available for use. Ask your local pharmacy whether they have it in stock. They can order it for you if they don't have the medication available at the moment.

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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.

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Simbrinza (brinzolamide / brimonidine) dosage

The average cost for 1 eye dropper of 8ml of 1%/0.2% of Simbrinza (brinzolamide / brimonidine) is $215.73 with a free GoodRx coupon. This is 14.39% off the average retail price of $252.00.
eye dropperEye dropper
DosageQuantityPrice as low asPrice per unit
8ml of 1%/0.2%1 eye dropper$215.73$215.73

Typical dosage 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.

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Interactions between Simbrinza (brinzolamide / brimonidine) and other drugs

Simbrinza (brinzolamide / brimonidine) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Simbrinza (brinzolamide / brimonidine). Please note that only the generic name of each medication is listed below.

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

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.

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Simbrinza (brinzolamide / brimonidine) contraindications

Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Simbrinza (brinzolamide / brimonidine) will not be safe for you to take.

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What are alternatives to Simbrinza (brinzolamide / brimonidine)?

There are a number of medications that your doctor can prescribe in place of Simbrinza (brinzolamide / brimonidine). Compare a few possible alternatives below.
Simbrinza (brinzolamide / brimonidine)
Used for:

Treatment of high pressure in the eye in people ages 2 years and older with:

$215.73Lowest GoodRx priceView prices
Used for:
$15.31Lowest GoodRx priceView prices
Used for:

Treatment of high pressure in the eye in people ages 2 years and older with:

$28.19Lowest GoodRx priceView prices
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References

Best studies we found

Alcon 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.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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