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Brinzolamide and brimonidine: Pediatric drug information

Brinzolamide and brimonidine: Pediatric drug information
2025© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Brinzolamide and brimonidine: Drug information" and "Brinzolamide and brimonidine: Patient drug information"

For abbreviations, symbols, and age group definitions show table
Brand Names: US
  • Simbrinza
Brand Names: Canada
  • Simbrinza
Therapeutic Category
  • Alpha2 Agonist, Ophthalmic;
  • Carbonic Anhydrase Inhibitor (Ophthalmic);
  • Ophthalmic Agent, Antiglaucoma
Dosing: Pediatric
Intraocular pressure reduction

Intraocular pressure (IOP) reduction: Children ≥2 years and Adolescents: Ophthalmic: Instill 1 drop in affected eye(s) 3 times daily.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Mild to moderate renal impairment (CrCl ≥30 ml/minute): There are no dosage adjustment provided in the manufacturer's labeling; brinzolamide and metabolite are excreted predominately by the kidney; use with caution.

Severe renal impairment (CrCl <30 mL/minute): Use is not recommended (has not been studied); brinzolamide and metabolite are excreted predominately by the kidney.

Dosing: Liver Impairment: Pediatric

There are no dosage adjustments provided in manufacturer's labeling (has not been studied); use with caution.

Dosing: Adult

(For additional information see "Brinzolamide and brimonidine: Drug information")

Intraocular pressure reduction

Intraocular pressure reduction (alternative): Ophthalmic: Instill 1 drop in affected eye(s) 3 times daily.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

CrCl ≥30 mL/minute: There are no dosage adjustments provided in the manufacturer’s labeling.

CrCl <30 mL/minute: Use is not recommended (has not been studied; brinzolamide and metabolite are excreted predominately by the kidney).

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied); use with caution.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Percentages as reported with combination product. Also see individual agents.

1% to 10%:

Gastrointestinal: Dysgeusia (3% to 5%), xerostomia (3% to 5%)

Hypersensitivity: Local ocular hypersensitivity reaction (3% to 5%)

Ophthalmic: Blurred vision (3% to 5%), eye irritation (3% to 5%)

Contraindications

Hypersensitivity to brinzolamide, brimonidine, or any component of the formulation; neonates, infants, and children <2 years of age.

Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to sulfonamides (see Warnings/Precautions for additional details); concurrent monoamine oxidase inhibitor therapy or antidepressant therapy that affects noradrenergic transmission (eg, tricyclic antidepressants, mianserin); severe renal impairment (CrCl <30 mL/minute); hyperchloremic acidosis.

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Although sulfonamide hypersensitivity may be considered, cross-reactivity between antibiotic sulfonamides, and nonantibiotic sulfonamides may not occur, or at the very least this potential is extremely low (Brackett 2004; Johnson 2005; Slatore 2004; Tornero 2004).

Warnings/Precautions

Concerns related to adverse events:

• Acid-base disturbances: Brinzolamide is absorbed systemically following topical administration; acid-base disturbances reported with oral carbonic anhydrase inhibitors may occur following topical application.

• Bacterial keratitis: Inadvertent contamination of multiple-dose ophthalmic solutions has caused bacterial keratitis.

• CNS effects: May cause CNS depression and/or blurred vision, which may impair physical or mental abilities; patients must be cautioned about performing tasks that require mental alertness, especially when used in children.

• Sulfonamide (“sulfa”) allergy: The FDA-approved and Health Canada-approved product labelings for many medications containing a sulfonamide chemical group includes a broad contraindication in patients with a prior allergic reaction to sulfonamides. There is a potential for cross-reactivity between members of a specific class (eg, two antibiotic sulfonamides). However, concerns for cross-reactivity have previously extended to all compounds containing the sulfonamide structure (SO2NH2). An expanded understanding of allergic mechanisms indicates cross-reactivity between antibiotic sulfonamides and nonantibiotic sulfonamides may not occur or at the very least this potential is extremely low (Brackett 2004; Johnson 2005; Slatore 2004; Tornero 2004). In particular, mechanisms of cross-reaction due to antibody production (anaphylaxis) are unlikely to occur with nonantibiotic sulfonamides. T-cell-mediated (type IV) reactions (eg, maculopapular rash) are less well understood and it is not possible to completely exclude this potential based on current insights. In cases where prior reactions were severe (Stevens-Johnson syndrome/toxic epidermal necrolysis), some clinicians choose to avoid exposure to these classes.

Disease-related concerns:

• Acute angle-closure (narrow-angle) glaucoma: Use has not been studied in patients with acute angle-closure glaucoma.

• Cardiovascular disease: Use with caution in patients with coronary insufficiency or severe or unstable cardiovascular disease.

• Cerebrovascular insufficiency: Use with caution in patients with cerebral insufficiency; may precipitate or aggravate symptoms.

• Corneal endothelium: Use with caution in patients with low endothelial cell counts; may be at increased risk of corneal edema.

• Hepatic impairment: Use with caution in patients with hepatic impairment; has not been evaluated in this population.

• Orthostatic hypotension: Use with caution in patients with orthostatic hypotension; may precipitate or aggravate symptoms.

• Renal impairment: Use is not recommended in patients with severe renal impairment; use has not been evaluated in this population. Use caution in mild or moderate renal impairment due to possible risk of acid/base disturbances.

• Thromboangiitis obliterans: Use with caution in patients with thromboangiitis obliterans; may precipitate or aggravate symptoms.

• Vascular insufficiency: Use with caution in patients with vascular insufficiency, including Raynaud disease; may precipitate or aggravate symptoms.

Dosage form specific issues:

• Ophthalmic solution: May contain benzalkonium chloride which may be absorbed by contact lenses; remove lens prior to administration and wait 15 minutes before reinserting. Allow at least 5 minutes between applications with other eye drops. To avoid contamination, do not touch tip of container to any surface. Benzalkonium chloride may also cause punctate keratopathy or toxic ulcerative keratopathy. If use is frequent or prolonged, monitor closely.

Warnings: Additional Pediatric Considerations

May cause CNS depression, particularly in young children; contraindicated for use in infants or children <2 years. Brimonidine has been reported to cause somnolence (50% to 83%) and decreased alertness in children 2 to 6 years of age with pediatric glaucoma.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Suspension, Ophthalmic:

Simbrinza: Brinzolamide 1% and brimonidine tartrate 0.2% (8 mL) [contains benzalkonium chloride, propylene glycol]

Generic Equivalent Available: US

No

Pricing: US

Suspension (Simbrinza Ophthalmic)

1-0.2% (per mL): $31.68

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Suspension, Ophthalmic:

Simbrinza: Brinzolamide 1% and brimonidine tartrate 0.2% (10 mL) [contains benzalkonium chloride, propylene glycol]

Administration: Pediatric

Ophthalmic: Shake bottle well prior to administration. If using additional topical ophthalmic preparations, separate administration by at least 5 minutes. Remove contact lenses prior to administration and wait 15 minutes after administration before reinserting. Apply gentle pressure to lacrimal sac immediately following instillation (1 minute) or instruct patient to gently close eyelid after administration to decrease systemic absorption of ophthalmic drops (Ref). Instruct patients to avoid allowing the tip of the dispensing container to contact the eye or surrounding structures. Ocular solutions can become contaminated by common bacteria known to cause ocular infections. Serious damage to the eye and subsequent loss of vision may occur from using contaminated solutions. If solution changes color or becomes cloudy, do not use. Vision may be temporarily blurred and drowsiness may occur; following administration, use caution when operating machinery, driving a motor vehicle, or performing other tasks that require concentration.

Administration: Adult

For ophthalmic use only. Shake bottle well prior to administration. If using additional topical ophthalmic preparations, separate administration by at least 5 minutes. Remove contact lenses prior to administration and wait 15 minutes after administration before reinserting. Instruct patients to avoid allowing the tip of the dispensing container to contact the eye or surrounding structures. Ocular solutions can become contaminated by common bacteria known to cause ocular infections. Serious damage to the eye and subsequent loss of vision may occur from using contaminated solutions.

To minimize systemic absorption, have patient block the drainage of the eyedrop from the conjunctival sac by pressing their inner ocular corner with the forefinger and then closing the eyelid (Ref).

Storage/Stability

Store at 2°C to 25°C (36°F to 77°F).

Use

Reduction of elevated intraocular pressure (IOP) in patients with ocular hypertension or open-angle glaucoma (FDA approved in ages ≥2 years and adults)

Metabolism/Transport Effects

Refer to individual components.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program

Acrivastine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Alcohol (Ethyl): CNS Depressants may increase CNS depressant effects of Alcohol (Ethyl). Risk C: Monitor

Alizapride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Amantadine: Carbonic Anhydrase Inhibitors may increase serum concentration of Amantadine. Risk C: Monitor

Amisulpride (Oral): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Articaine: May increase CNS depressant effects of CNS Depressants. Management: Consider reducing the dose of articaine if possible when used in patients who are also receiving CNS depressants. Monitor for excessive CNS depressant effects with any combined use. Risk D: Consider Therapy Modification

Azelastine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Benperidol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Beta-Blockers: May increase rebound hypertensive effects of Alpha2-Agonists. This effect can occur when the Alpha2-Agonist is abruptly withdrawn. Alpha2-Agonists may increase AV-blocking effects of Beta-Blockers. Sinus node dysfunction may also be enhanced. Management: Closely monitor heart rate during treatment with a beta blocker and clonidine. Withdraw beta blockers several days before clonidine withdrawal when possible, and monitor blood pressure closely. Recommendations for other alpha2-agonists are unavailable. Risk D: Consider Therapy Modification

Blonanserin: CNS Depressants may increase CNS depressant effects of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Risk D: Consider Therapy Modification

Brexanolone: CNS Depressants may increase CNS depressant effects of Brexanolone. Risk C: Monitor

Brimonidine (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Bromopride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Bromperidol: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Buclizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Buprenorphine: CNS Depressants may increase CNS depressant effects of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Risk D: Consider Therapy Modification

BusPIRone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Cannabinoid-Containing Products: CNS Depressants may increase CNS depressant effects of Cannabinoid-Containing Products. Risk C: Monitor

Carbonic Anhydrase Inhibitors: May increase adverse/toxic effects of Carbonic Anhydrase Inhibitors. The development of acid-base disorders with concurrent use of ophthalmic and oral carbonic anhydrase inhibitors has been reported. Management: Avoid concurrent use of different carbonic anhydrase inhibitors if possible. Monitor patients closely for the occurrence of kidney stones and with regards to severity of metabolic acidosis. Risk X: Avoid

Cetirizine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk D: Consider Therapy Modification

Chloral Hydrate/Chloral Betaine: CNS Depressants may increase CNS depressant effects of Chloral Hydrate/Chloral Betaine. Management: Consider alternatives to the use of chloral hydrate or chloral betaine and additional CNS depressants. If combined, consider a dose reduction of either agent and monitor closely for enhanced CNS depressive effects. Risk D: Consider Therapy Modification

Chlormethiazole: May increase CNS depressant effects of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Risk D: Consider Therapy Modification

Chlorphenesin Carbamate: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

CNS Depressants: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

Dantrolene: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Daridorexant: May increase CNS depressant effects of CNS Depressants. Management: Dose reduction of daridorexant and/or any other CNS depressant may be necessary. Use of daridorexant with alcohol is not recommended, and the use of daridorexant with any other drug to treat insomnia is not recommended. Risk D: Consider Therapy Modification

DexmedeTOMIDine: CNS Depressants may increase CNS depressant effects of DexmedeTOMIDine. Management: Monitor for increased CNS depression during coadministration of dexmedetomidine and CNS depressants, and consider dose reductions of either agent to avoid excessive CNS depression. Risk D: Consider Therapy Modification

Difelikefalin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Difenoxin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Digoxin: Brimonidine (Ophthalmic) may increase bradycardic effects of Digoxin. Risk C: Monitor

Dihydralazine: CNS Depressants may increase hypotensive effects of Dihydralazine. Risk C: Monitor

Dimethindene (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Dothiepin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Doxylamine: CNS Depressants may increase CNS depressant effects of Doxylamine. Risk C: Monitor

DroPERidol: May increase CNS depressant effects of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Risk D: Consider Therapy Modification

Emedastine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk C: Monitor

Entacapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Esketamine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Flunarizine: CNS Depressants may increase CNS depressant effects of Flunarizine. Risk X: Avoid

Flunitrazepam: CNS Depressants may increase CNS depressant effects of Flunitrazepam. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression (eg, sedation, respiratory depression). Use non-CNS depressant alternatives when available. Risk D: Consider Therapy Modification

HydrOXYzine: May increase CNS depressant effects of CNS Depressants. Management: Consider a decrease in the CNS depressant dose, as appropriate, when used together with hydroxyzine. Increase monitoring of signs/symptoms of CNS depression in any patient receiving hydroxyzine together with another CNS depressant. Risk D: Consider Therapy Modification

Ixabepilone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Kava Kava: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Ketotifen (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Kratom: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Lemborexant: May increase CNS depressant effects of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Risk D: Consider Therapy Modification

Levocetirizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lisuride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lofepramine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lofexidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Loxapine: CNS Depressants may increase CNS depressant effects of Loxapine. Management: Consider reducing the dose of CNS depressants administered concomitantly with loxapine due to an increased risk of respiratory depression, sedation, hypotension, and syncope. Risk D: Consider Therapy Modification

Magnesium Sulfate: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Melitracen [INT]: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Mequitazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Metergoline: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Methotrimeprazine: CNS Depressants may increase CNS depressant effects of Methotrimeprazine. Methotrimeprazine may increase CNS depressant effects of CNS Depressants. Management: Reduce the usual dose of CNS depressants by 50% if starting methotrimeprazine until the dose of methotrimeprazine is stable. Monitor patient closely for evidence of CNS depression. Risk D: Consider Therapy Modification

Methoxyflurane: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Metoclopramide: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

MetyroSINE: CNS Depressants may increase sedative effects of MetyroSINE. Risk C: Monitor

Minocycline (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Mirtazapine: May decrease antihypertensive effects of Alpha2-Agonists. Management: Consider avoiding concurrent use. If the combination cannot be avoided, monitor for decreased effects of alpha2-agonists if mirtazapine is initiated/dose increased, or increased effects if mirtazapine is discontinued/dose decreased. Risk D: Consider Therapy Modification

Monoamine Oxidase Inhibitors: May increase adverse/toxic effects of Brimonidine (Ophthalmic). Monoamine Oxidase Inhibitors may increase serum concentration of Brimonidine (Ophthalmic). Risk C: Monitor

Moxonidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Nabilone: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Nalfurafine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Noscapine: CNS Depressants may increase adverse/toxic effects of Noscapine. Risk X: Avoid

Olopatadine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Opicapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Opioid Agonists: CNS Depressants may increase CNS depressant effects of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification

Opipramol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Orphenadrine: CNS Depressants may increase CNS depressant effects of Orphenadrine. Risk X: Avoid

Oxomemazine: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Oxybate Salt Products: CNS Depressants may increase CNS depressant effects of Oxybate Salt Products. Management: Consider alternatives to this combination when possible. If combined, dose reduction or discontinuation of one or more CNS depressants (including the oxybate salt product) should be considered. Interrupt oxybate salt treatment during short-term opioid use Risk D: Consider Therapy Modification

OxyCODONE: CNS Depressants may increase CNS depressant effects of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification

Paliperidone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Paraldehyde: CNS Depressants may increase CNS depressant effects of Paraldehyde. Risk X: Avoid

Perampanel: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Periciazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Pipamperone: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

Piribedil: CNS Depressants may increase CNS depressant effects of Piribedil. Risk C: Monitor

Pizotifen: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Pramipexole: CNS Depressants may increase sedative effects of Pramipexole. Risk C: Monitor

Procarbazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Rilmenidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Ropeginterferon Alfa-2b: CNS Depressants may increase adverse/toxic effects of Ropeginterferon Alfa-2b. Specifically, the risk of neuropsychiatric adverse effects may be increased. Management: Avoid coadministration of ropeginterferon alfa-2b and other CNS depressants. If this combination cannot be avoided, monitor patients for neuropsychiatric adverse effects (eg, depression, suicidal ideation, aggression, mania). Risk D: Consider Therapy Modification

ROPINIRole: CNS Depressants may increase sedative effects of ROPINIRole. Risk C: Monitor

Rotigotine: CNS Depressants may increase sedative effects of Rotigotine. Risk C: Monitor

Serotonin/Norepinephrine Reuptake Inhibitor: May decrease therapeutic effects of Alpha2-Agonists. Risk C: Monitor

Suvorexant: CNS Depressants may increase CNS depressant effects of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Risk D: Consider Therapy Modification

Thalidomide: CNS Depressants may increase CNS depressant effects of Thalidomide. Risk X: Avoid

TiZANidine: Alpha2-Agonists may increase hypotensive effects of TiZANidine. Risk X: Avoid

Tricyclic Antidepressants: May decrease therapeutic effects of Alpha2-Agonists (Ophthalmic). Risk C: Monitor

Trimeprazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Valerian: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Zolpidem: CNS Depressants may increase CNS depressant effects of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider Therapy Modification

Zuranolone: May increase CNS depressant effects of CNS Depressants. Management: Consider alternatives to the use of zuranolone with other CNS depressants or alcohol. If combined, consider a zuranolone dose reduction and monitor patients closely for increased CNS depressant effects. Risk D: Consider Therapy Modification

Pregnancy Considerations

Animal reproduction studies have not been conducted with this combination product; refer to individual monographs.

Monitoring Parameters

Ophthalmic exams and intraocular pressure periodically.

Mechanism of Action

Brinzolamide inhibits carbonic anhydrase, leading to decreased aqueous humor secretion. This results in a reduction of intraocular pressure (IOP).

Brimonidine has selective agonism for alpha2-receptors and causes reduction of aqueous humor formation and increased uveoscleral outflow

Pharmacokinetics (Adult Data Unless Noted)

Absorption: Brinzolamide: Topical: Into systemic circulation; Brimonidine: Topical: Into systemic circulation. Systemic absorption variable and may be reduced by postadministration maneuvers to slow lacrimal drainage.

Distribution: Brinzolamide: Accumulates extensively in red blood cells, binding to carbonic anhydrase (brinzolamide and metabolite).

Protein binding: Brinzolamide: ~60%.

Metabolism:

Brimonidine: Extensively, hepatic.

Brinzolamide: To N-desethyl brinzolamide.

Half-life elimination:

Brimonidine: 2 to 3 hours.

Brinzolamide: 111 days.

Time to peak, serum concentration: Brimonidine: Within 1 to 4 hours.

Excretion:

Brimonidine: Urine (74%).

Brinzolamide: Urine (predominantly as unchanged drug and metabolites).

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Simbrinza;
  • (AR) Argentina: Simbrinza;
  • (AT) Austria: Simbrinza;
  • (AU) Australia: Simbrinza;
  • (BD) Bangladesh: Azobrin plus | Benozol br | Brindin | Genazopt plus | Xolamid b | Zoladin;
  • (BE) Belgium: Simbrinza;
  • (BG) Bulgaria: Simbrinza;
  • (BR) Brazil: Simbrinza;
  • (CH) Switzerland: Simbrinza;
  • (CO) Colombia: Bridine | Simbrinza;
  • (CZ) Czech Republic: Simbrinza;
  • (DE) Germany: Simbrinza;
  • (DO) Dominican Republic: Simbrinza;
  • (EC) Ecuador: Simbrinza;
  • (EE) Estonia: Simbrinza;
  • (EG) Egypt: Alphabrinzima | Simbrinza;
  • (ES) Spain: Simbrinza;
  • (ET) Ethiopia: Simbrinza;
  • (FI) Finland: Simbrinza;
  • (FR) France: Simbrinza;
  • (GB) United Kingdom: Simbrinza;
  • (GR) Greece: Simbrinza;
  • (HK) Hong Kong: Simbrinza;
  • (HR) Croatia: Simbrinza;
  • (HU) Hungary: Simbrinza;
  • (ID) Indonesia: Simbrinza;
  • (IE) Ireland: Simbrinza;
  • (IN) India: B2doc | Brivex | Sentibrim bz | Simbrinza | Tregmon;
  • (IT) Italy: Simbrinza;
  • (JP) Japan: Ailamide;
  • (KR) Korea, Republic of: Simbrinza;
  • (KW) Kuwait: Simbrinza;
  • (LB) Lebanon: Simbrinza;
  • (LT) Lithuania: Simbrinza;
  • (LU) Luxembourg: Simbrinza;
  • (MX) Mexico: Simbrinza;
  • (MY) Malaysia: Simbrinza;
  • (NG) Nigeria: Simbrinza;
  • (NL) Netherlands: Simbrinza;
  • (NO) Norway: Simbrinza;
  • (PH) Philippines: Simbrinza;
  • (PK) Pakistan: Simbrinza;
  • (PL) Poland: Simbrinza;
  • (PR) Puerto Rico: Simbrinza;
  • (PT) Portugal: Simbrinza;
  • (QA) Qatar: Simbrinza;
  • (RO) Romania: Simbrinza;
  • (SA) Saudi Arabia: Simbrinza;
  • (SE) Sweden: Simbrinza;
  • (SG) Singapore: Simbrinza;
  • (SI) Slovenia: Simbrinza;
  • (SK) Slovakia: Simbrinza;
  • (SR) Suriname: Simbrinza;
  • (TH) Thailand: Simbrinza;
  • (TR) Turkey: Simbrinza;
  • (TW) Taiwan: Simbrinza;
  • (UA) Ukraine: Simbrinza;
  • (UY) Uruguay: Simbrinza;
  • (ZW) Zimbabwe: Simbrinza
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