CAI + beta-blocker eye drops Pregnancy: SPC §4.6: there are no adequate data on ophthalmic brinzolamide and timolol in pregnant women; AZARGA should not be used during pregnancy unless clearly necessary. If administered until delivery, the neonate should be carefully monitored during the first days of life (beta-blockade: bradycardia, hypotension, respiratory distress, hypoglycaemia). Breast-feeding: a risk to the suckling child cannot be excluded — decide whether to discontinue breast-feeding or AZARGA therapy.

Brinzolamide with timolol

Brand names: Azarga

This fixed-combination eye drop combines brinzolamide, a topical carbonic anhydrase inhibitor, with timolol, a non-selective beta-blocker, to lower intraocular pressure in open-angle glaucoma and ocular hypertension inadequately controlled by monotherapy.

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 of AZARGA in the conjunctival sac of the affected eye(s)

Route: Topical ocular (AZARGA 10 mg/ml + 5 mg/ml eye drops, suspension — brinzolamide + timolol)

Frequency: Twice daily

Max: The dose should not exceed one drop in the affected eye(s) twice daily

SPC §4.2 'Use in adults, including the elderly': one drop in the conjunctival sac of the affected eye(s) twice daily. Using nasolacrimal occlusion or closing the eyelids reduces systemic absorption. If a dose is missed, treatment should be continued with the next dose as planned. When substituting another ophthalmic antiglaucoma medicinal product with AZARGA, discontinue the other product and start AZARGA the following day. Shake the bottle well before use; if the tamper-evident snap collar is loose after removing the cap, remove it before use. If more than one topical ophthalmic medicinal product is used, administer at least 5 minutes apart; eye ointments last. Paediatric: safety and efficacy in children and adolescents aged 0 to 18 years have not yet been established (no data available). Hepatic impairment: no dosage adjustment necessary, but use with caution in severe hepatic impairment (§4.4). No UK SPC §4.5 text was present in the fetched bundle, so no interactions list is given. The US (openFDA) record retrieved for this id was Azopt (brinzolamide alone) — a single component of this fixed combination, so it was not used.

Dose adjustments

Renal

SPC §4.2/§4.3: no dosage adjustment necessary in patients with mild to moderate renal impairment; contraindicated in severe renal impairment. Not studied in severe renal impairment (creatinine clearance <30 ml/min) or in hyperchloraemic acidosis, as brinzolamide and its main metabolite are excreted predominantly by the kidney.

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
Hypersensitivity to other beta-blockers
Hypersensitivity to sulphonamides
Reactive airway disease including bronchial asthma or a history of bronchial asthma, or severe chronic obstructive pulmonary disease
Sinus bradycardia, sick sinus syndrome, sino-atrial block, second or third degree atrioventricular block not controlled with pacemaker; overt cardiac failure; cardiogenic shock
Severe allergic rhinitis
Hyperchloraemic acidosis
Severe renal impairment

Side effects

Blurred vision, eye irritation and eye pain (most common; approximately 2% to 7% of patients)
Punctate keratitis (common)
Dysgeusia (common)
Keratitis, dry eye, eye discharge, eye pruritus, foreign body sensation, ocular/conjunctival hyperaemia (uncommon)
Insomnia (rare); white blood cell count decreased (uncommon)
Beta-blocker class effects noted in §4.4: bronchospasm in asthma (including death), masking of hypoglycaemia and hyperthyroidism, potentiation of muscle weakness; sulphonamide reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis

Clinical monograph

How it works

Brinzolamide reduces aqueous humour production by inhibiting ciliary-body carbonic anhydrase, while timolol further suppresses aqueous secretion through beta-blockade, producing additive intraocular pressure lowering.

Prescribing in practice

Because of the timolol component, avoid in asthma, bronchospasm, severe COPD, sinus bradycardia, heart block and uncontrolled heart failure, and counsel on systemic beta-blocker effects.
Brinzolamide is a sulfonamide derivative, so avoid in patients with sulfonamide hypersensitivity, and expect transient blurred vision and a bitter taste after instillation.
Use cautiously in marked renal or hepatic impairment, advise punctal occlusion, and remove contact lenses before instillation.

Monitoring

Monitor intraocular pressure for efficacy and assess for sulfonamide reactions and, in susceptible patients, heart rate and respiratory tolerance.

Counselling the patient

Instil twice daily; shake well and press on the inner corner of the eye afterwards.
Brief blurred vision and a bitter taste are common after each dose.
Report breathing difficulty, wheeze or a slow heartbeat, and mention any sulfa allergy.

Evidence & guidelines

NICE glaucoma guidance supports fixed carbonic anhydrase inhibitor/beta-blocker combinations to enhance pressure control and adherence when monotherapy is inadequate.

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