Alpha-2 agonist + beta-blocker eye drops Pregnancy: SPC §4.6: there are no adequate data for the brimonidine/timolol fixed combination in pregnant women; should not be used during pregnancy unless clearly necessary. If administered in pregnancy up to the time of delivery, the neonate should be carefully monitored during the first days of life (beta-blockade: bradycardia, hypotension, respiratory distress, hypoglycaemia). Should not be used by women breast-feeding infants.

Brimonidine with timolol

Brand names: Combigan

This fixed-combination eye drop combines brimonidine, a selective alpha-2 adrenergic agonist, with timolol, a non-selective beta-blocker, to lower intraocular pressure in open-angle glaucoma and ocular hypertension when monotherapy is inadequate.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One drop in the affected eye(s)

Route: Topical ocular (eye drops, solution — brimonidine tartrate 2 mg/ml + timolol 5 mg/ml)

Frequency: Twice daily, approximately 12 hours apart

SPC §4.2 'Recommended dosage in adults (including the elderly)': one drop of brimonidine tartrate/timolol in the affected eye(s) twice daily, approximately 12 hours apart. No separate elderly dose is given. If more than one topical ophthalmic product is used, instil the different products at least 5 minutes apart. To reduce possible systemic absorption, compress the lachrymal sac at the medial canthus (punctal occlusion) or close the eyelids for two minutes immediately after each drop. Paediatric: contraindicated in neonates and infants (less than 2 years of age); safety and effectiveness in children and adolescents 2–17 years have not been established, so use is not recommended in children or adolescents. Children 2 years and above, especially 2–7 years and/or weighing ≤20 kg, should be treated with caution and closely monitored due to the high incidence and severity of somnolence (§4.4). No UK SPC §4.5 text was present in the fetched bundle; interactions listed below are taken from §4.3. The US (openFDA) record retrieved for this id was LUMIFY Redness Reliever Eye Drops (brimonidine alone, OTC redness product) — single component and different indication, so not used.

Dose adjustments

Renal

SPC §4.2: has not been studied in patients with hepatic or renal impairment; caution should be used in treating such patients. No numeric dose adjustment is stated.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substances or to any of the excipients
Reactive airway disease including bronchial asthma or a history of bronchial asthma; severe chronic obstructive pulmonary disease
Sinus bradycardia, sick sinus syndrome, sino-atrial block, second or third degree atrioventricular block not controlled with a pacemaker; overt cardiac failure; cardiogenic shock
Use in neonates and infants (less than 2 years of age)
Patients receiving monoamine oxidase (MAO) inhibitor therapy
Patients on antidepressants which affect noradrenergic transmission (e.g. tricyclic antidepressants and mianserin)

Side effects

Conjunctival hyperaemia (very common; approximately 15% of patients)
Burning sensation in the eye (very common; approximately 11% of patients)
Stinging sensation in the eye, allergic conjunctivitis, corneal erosion, superficial punctate keratitis, eye pruritus (common)
Somnolence and headache (common)
Oral dryness (common)
Hypertension (common); depression (common)

Interactions

Monoamine oxidase (MAO) inhibitors — contraindicated (SPC §4.3)
Antidepressants affecting noradrenergic transmission, e.g. tricyclic antidepressants and mianserin — contraindicated (SPC §4.3)
Other topical ophthalmic products — instil at least 5 minutes apart (SPC §4.2)

Clinical monograph

How it works

Brimonidine lowers aqueous production and boosts uveoscleral outflow through alpha-2 stimulation, while timolol reduces aqueous secretion via beta-blockade, producing additive intraocular pressure reduction.

Prescribing in practice

The timolol content contraindicates use in asthma, bronchospasm, severe COPD, marked bradycardia, heart block and uncontrolled heart failure; counsel on systemic beta-blocker effects.
Brimonidine must be avoided in neonates and infants owing to the risk of apnoea and CNS depression, and may cause drowsiness, dry mouth and allergic conjunctivitis.
Use caution with CNS depressants, antihypertensives and monoamine oxidase inhibitors, and recommend punctal occlusion to limit systemic absorption.

Monitoring

Monitor intraocular pressure, observe for brimonidine-related ocular allergy, and assess cardiorespiratory tolerance in vulnerable patients.

Counselling the patient

Instil twice daily and press on the inner corner of the eye for a short time after each drop.
It may make you drowsy or give a dry mouth; take care when driving.
Tell your clinician about breathing problems or a slow heartbeat, and report a red or itchy eye.

Evidence & guidelines

NICE glaucoma guidance and specialist practice support fixed brimonidine/timolol combinations to simplify regimens and improve adherence once single-agent therapy fails.

Reference: NICE NG81; RCOphth; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways