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Alpha-2 agonist + beta-blocker eye drops

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.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

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. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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