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Topical carbonic anhydrase inhibitor (IOP reduction) Pregnancy: Avoid — insufficient safety data; sulfonamide class risks.

Brinzolamide 1% Eye Drops (Azopt)

Brand names: Azopt

Adult dose

Dose: 1 drop in affected eye(s) twice daily (or three times daily if monotherapy)
Route: Ophthalmic
Frequency: Twice daily (adjunct); three times daily (monotherapy)
Max: 3 drops per eye per day
Open-angle glaucoma or ocular hypertension when beta-blockers are contraindicated or as adjunct therapy. Shake suspension before use. As adjunct to a beta-blocker: 1 drop twice daily. Monotherapy: 1 drop three times daily.

Paediatric dose

Route: Ophthalmic
Frequency: Twice to three times daily
Max: 1 drop per eye three times daily
Safety and efficacy in children not fully established; used under specialist supervision. Same instillation technique as adults.

Dose adjustments

Renal

Avoid if eGFR <30 mL/min/1.73m² — risk of systemic carbonic anhydrase inhibition.

Hepatic

Use with caution; no specific dose reduction but monitor.

Clinical pearls

  • Preferred over dorzolamide in patients who experience stinging — brinzolamide pH closer to physiological (7.2 vs 5.5 for dorzolamide)
  • Always shake the suspension before use — settling causes underdosing
  • Avoid in sulfonamide-allergic patients due to shared structural moiety
  • Useful when beta-blockers are contraindicated (asthma, heart block)
  • Fixed combination: Azarga (brinzolamide 1% + timolol 0.5%) — once daily for convenience

Contraindications

  • Hypersensitivity to sulfonamides (cross-sensitivity possible)
  • Severe renal impairment (eGFR <30)
  • Hyperchloraemic acidosis

Side effects

  • Transient blurred vision after instillation (shake well to minimise)
  • Ocular stinging and discomfort
  • Bitter or unusual taste (nasolacrimal drainage)
  • Dry eye
  • Systemic carbonic anhydrase effects (rare with topical): electrolyte disturbance, fatigue

Interactions

  • Oral carbonic anhydrase inhibitors (acetazolamide) — additive systemic inhibition; avoid combination
  • High-dose salicylates — risk of carbonic anhydrase toxicity

Monitoring

  • IOP
  • Serum electrolytes (prolonged use, high-risk patients)
  • Renal function

Reference: BNFc; BNF; Azopt SPC; EGS Glaucoma Guidelines 2020. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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