What Combigan Eye Drops is and what it is used for?
Combigan Eye Drops is an eye drop that is used to control glaucoma. It contains two different medicines (brimonidine and timolol) that both reduce high pressure in the eye. Brimonidine belongs to a group of medicines called alpha-2 adrenergic receptor agonists. Timolol belongs to a group of medicines called beta-blockers.
Combigan Eye Drops is prescribed to reduce high pressure in the eye when beta-blocker eye drops used alone are not enough.
Your eye contains a clear, watery liquid that feeds the inside of the eye. Liquid is constantly being drained out of the eye and new liquid is made to replace this. If the liquid cannot drain out quickly enough, the pressure inside the eye builds up and could eventually damage your sight.
Combigan Eye Drops works by reducing the production of liquid and increasing the amount of liquid that is drained. This reduces the pressure inside the eye whilst still continuing to feed the eye.
What is Glaucoma?
Glaucoma is a common eye condition where the optic nerve, which connects the eye to the brain, becomes damaged.
It’s usually caused by fluid building up in the front part of the eye, which increases pressure inside the eye.
Your eye contains a clear, watery liquid that feeds the inside of the eye. Liquid is constantly being drained out of the eye and new liquid is made to replace this. If the liquid cannot drain out quickly enough, the pressure inside the eye builds up. This medicine works by increasing the amount of liquid that is drained. This reduces the pressure inside the eye. If the high pressure is not reduced, it could lead to a disease called glaucoma and eventually damage your sight.
Glaucoma can lead to loss of vision if it’s not diagnosed and treated early.
It can affect people of all ages, but is most common in adults in their 70s and 80s.
Glaucoma does not usually cause any symptoms to begin with.
It tends to develop slowly over many years and affects the edges of your vision (peripheral vision) first.
For this reason, many people do not realise they have glaucoma, and it’s often only picked up during a routine eye test.
If you do notice any symptoms, they might include blurred vision, or seeing rainbow-coloured circles around bright lights.
Both eyes are usually affected, although it may be worse in 1 eye.
Very occasionally, glaucoma can develop suddenly and cause:
Visit an opticians or a GP if you have any concerns about your vision.
If you have glaucoma, early diagnosis and treatment can help stop your vision getting worse.
Without treatment, glaucoma can eventually lead to blindness.
If you develop symptoms of glaucoma suddenly, go to your nearest eye casualty unit or A&E as soon as possible.
This is a medical emergency that may require immediate treatment.
There are several different types of glaucoma.
The most common is called primary open angle glaucoma. This tends to develop slowly over many years.
It’s caused by the drainage channels in the eye becoming gradually clogged over time.
Other types of glaucoma include:
acute angle closure glaucoma – an uncommon type caused by the drainage in the eye becoming suddenly blocked, which can raise the pressure inside the eye very quickly
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Always use this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure. COMBIGAN must not be used in infants below 2 years of age. COMBIGAN should not usually be used in children and adolescents (from 2 to 17 years).
The recommended dose is one drop of COMBIGAN, twice a day about 12 hours apart. Do not change the dose or stop taking it without speaking to your doctor.
If you have other eye drops as well as COMBIGAN, leave at least 5 minutes between using COMBIGAN and the other eye drops.
Instructions for use
You must not use the bottle if the tamper-proof seal on the bottle neck is broken before you first begin to use it.
Wash your hands before opening the bottle. Tilt your head back and look at the ceiling.
1. Gently pull down the lower eyelid until there is a small pocket.
2. Turn the bottle upside down and squeeze it to release one drop into each eye that needs treatment.
3. Let go of the lower lid, and close your eye.
4. Keep the eye closed and press your finger against the corner of your eye (the side where your eye meets your nose) for two minutes. This helps stop COMBIGAN getting into the rest of the body.
If a drop misses your eye, try again.
To avoid contamination, do not let the tip of the bottle touch your eye or anything else. Put the screw-cap back on to close the bottle, straight after you have used it.
If you use more COMBIGAN than you should
Adults
If you use more COMBIGAN than you should, it is unlikely to cause you any harm. Put your next drop in at the usual time. If you are worried, talk to your doctor or pharmacist.
Babies and Children
Several cases of overdose have been reported in babies and children receiving brimonidine (one of the ingredients of COMBIGAN) as part of medical treatment for glaucoma. Signs include sleepiness, floppiness, low body temperature, paleness and breathing difficulties. Should this happen, contact your doctor immediately.
Adults and Children
If COMBIGAN has been accidentally swallowed then you should contact your doctor immediately.
If you forget to use COMBIGAN
If you forget to use COMBIGAN, use a single drop in each eye that needs treatment as soon as you remember, and then go back to your regular routine. Do not take a double dose to make up for a forgotten dose.
If you stop using COMBIGAN eye drops
COMBIGAN eye drops should be used every day to work properly.
If you have any further questions on the use of this product, ask your doctor or pharmacist.
Delivery Options
Delivery options
All deliveries are subject to the availability of the product and product sale conditions been met.
Order & Collect
Free next-day collection from In-Store
UK Delivery
Standard Delivery within the UK £3.50 Delivery time 3-4 days First Class Delivery within the UK £5.90 Delivery time 1-2 days Priority Delivery within the UK £7.10. Next day delivery by 1pm. Order must be placed by 1pm. Priority delivery is only available Monday to Thursday.
Europe Delivery
Standard Delivery within EEC from £12.50 Delivery time up to 5 days depending on the local delivery service within your country. Expedited Delivery within EEC £39.50 Delivery time 2 days. Delivery by DHL, UPS or TNT.
Rest of the World
Standard Delivery Rest of the World from £16.10 Delivery Time 10 – 15 Days Expedited Delivery Rest of the World £55.09 Delivery 5 days. Delivery service by DHL, TNT or UPS
if you are allergic (hypersensitive) to brimonidine tartrate, timolol, beta-blockers or any of the other ingredients of this medicine (listed in section 6). Symptoms of an allergic reaction may include swelling of the face, lips and throat, wheeziness, feeling faint, shortness of breath, itching or redness around the eye.
if you have now or have had in the past respiratory problems such as asthma, severe chronic obstructive bronchitis (severe lung disease which may cause wheeziness, difficulty in breathing and/or long-standing cough).
if you have heart problems such as low heart rate, heart failure, heart beat disorders (unless controlled by a pacemaker).
if you are taking monoamine oxidase (MAO) inhibitors or certain other antidepressant drugs.
If you think any of these points apply to you, do not use COMBIGAN until you have talked again to your doctor.
Warnings and precautions
Talk to your doctor before using COMBIGAN
if you have now or have had in the past
coronary heart disease (symptoms can include chest pain or tightness, breathlessness or choking), heart failure, low blood pressure
disturbances of heart rate such as slow heart beat
breathing problems, asthma or chronic obstructive pulmonary disease
poor blood circulation disease (such as Raynaud’s disease or Raynaud’s syndrome)
diabetes as timolol may mask signs and symptoms of low blood sugar levels
over activity of the thyroid gland as timolol may mask signs and symptoms
kidney or liver problems
tumour of the adrenal gland
eye surgery to lower the pressure in your eye
if you suffer or have suffered from any allergy (e.g. hayfever, eczema) or a severe allergic reaction be aware that the usual dose of adrenaline used to control a severe reaction may need to be increased.
Tell the doctor before you have an operation that you are using COMBIGAN, as the timolol may change effects of some medicines during anaesthesia.
Children and adolescents
COMBIGAN should not be used in children less than 2 years old and should not usually be used in children aged 2 to 17.
Other medicines and COMBIGAN
COMBIGAN can affect or be affected by other medicines you are using, including other eye drops for the treatment of glaucoma. Tell your doctor or pharmacist if you are taking, have recently taken or might take other medicines, including medicines for any condition, even if unrelated to your eye condition, including medicines obtained without a prescription. There are a number of medicines which may interfere with COMBIGAN, so it is particularly important to tell your doctor if you are taking:
pain killers
medicines to help you sleep or for anxiety
medicines to treat high blood pressure (hypertension)
medicines for heart conditions (for example an abnormal heartbeat) such as beta blockers, digoxin or quinidine (used to treat heart conditions and some types of malaria)
medicines to treat diabetes or high blood sugar
medicines for depression such as fluoxetine and paroxetine
another eye drop used to lower high pressure in the eye (glaucoma)
medicines to treat severe allergic reactions
medicines that affect some of the hormones in your body, like adrenaline and dopamine
medicines that affect the muscles in your blood vessels
medicines to treat heartburn or stomach ulcers
If the dose of any of your current medicines is changed or if you are regularly consuming alcohol you should tell your doctor.
If you are due to have an anaesthetic, you should tell the doctor or dentist that you are taking COMBIGAN.
Pregnancy and breast-feeding
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. Do not use COMBIGAN if you are pregnant unless your doctor considers it necessary.
Do not use COMBIGAN if you are breast-feeding. Timolol may get into your milk. Ask your doctor for advice before taking any medicine during breast-feeding.
Driving and using machines
COMBIGAN may cause drowsiness, tiredness or blurred vision in some patients. Do not drive or use any tools or machines until the symptoms have cleared. If you experience any problems, talk to your doctor.
COMBIGAN contains benzalkonium chloride
This medicine contains 0.25 mg benzalkonium chloride in each 5 ml of solution which is equivalent to 0.05 mg/ml.
Benzalkonium chloride may be absorbed by soft contact lenses and may change the colour of the contact lenses. You should remove contact lenses before using this medicine and put them back 15 minutes afterwards.
Benzalkonium chloride may also cause eye irritation, especially if you have dry eyes or disorders of the cornea (the clear layer at the front of the eye). If you feel abnormal eye sensation, stinging or pain in the eye after using this medicine, talk to your doctor
COMBIGAN contains phosphates:
This medicine contains 52.9 mg phosphates in each 5 ml of solution which is equivalent to 10.58 mg/ml.
If you suffer from severe damage to the clear layer at the front of the eye (the cornea), phosphates may cause in very rare cases cloudy patches on the cornea due to calcium build-up during treatment.
How to store COMBIGAN
Keep this medicine out of the sight and reach of children.
Keep the bottle in the outer carton to protect it from light.
You should only use one bottle at a time.
Do not use this medicine after the expiry date which is stated on the label of the bottle and the carton after EXP:. The expiry date refers to the last day of that month.
You must throw away the bottle four weeks after you first opened it, even if there are still some drops left. This will help to prevent infections. To help you remember, write down the date that you opened it in the space on the carton.
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.
Side Effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
If you experience any of the following side effects, please contact your doctor immediately:
Heart failure (eg. chest pain) or irregular heart rate
Increased or decreased heart rate or low blood pressure
Affecting the eye
Very common (May affect more than 1 in 10 people) :
Eye redness or burning.
Common (May affect up to 1 in 10 people):
Stinging or pain in the eye
Allergic reaction in the eye or on the skin around the eye
Small breaks in the surface of the eye (with or without inflammation)
Swelling, redness or inflammation of the eyelid
Irritation, or a feeling of something in the eye
Itching of the eye and eyelid
Follicles or white spots on the see through layer which covers the surface of the eye
Vision disturbance
Tearing
Eye dryness
Sticky eyes
Uncommon (May affect up to 1 in 100 people):
Difficulty in seeing clearly
Swelling or inflammation of the see-through layer which covers the surface of the eye
Tired eyes
Sensitivity to light
Eyelid pain
Whitening of the see-through layer which covers the surface of the eyes
Swelling or areas of inflammation under the surface of the eye
Floaters in front of the eyes
Not known (Frequency cannot be estimated from the available data):
Blurred vision
Affecting the body:
Common (May affect up to 1 in 10 people):
High blood pressure
Depression
Sleepiness
Headache
Dry mouth
General weakness
Uncommon (May affect up to 1 in 100 people):
Heart failure
Irregular heart rate
Light-headedness
Fainting
Dry nose
Taste disturbance
Nausea
Diarrhoea
Not known (Frequency cannot be estimated from the available data):
Increased or decreased heart rate
Low blood pressure
Face redness
Some of these effects may be due to an allergy to any of the ingredients. Additional side effects have been seen with brimonidine or timolol and therefore may potentially occur with COMBIGAN.
The following additional side effects have been seen with brimonidine:
Inflammation within eye, small pupils, difficulty sleeping cold-like symptoms shortness of breath, symptoms involving the stomach and digestion, general allergic reactions, skin reactions including redness, face swelling itching rash and widening of blood vessels.
Like other medicines applied into eyes, COMBIGAN (brimonidine/timolol) is absorbed into the blood. Absorption of timolol, a beta blocker component of COMGIBAN, may cause similar side effects as seen with intravenous” and /or “oral” beta-blocking agents. Incidence of side effects after topical ophthalmic administration is lower than when medicines are for example, taken by mouth or injected. Listed side effects include reactions seen within the class of beta-blockers when used for treating eye conditions:
Generalised allergic reactions, including swelling beneath the skin (that can occur in areas such as the face and limbs, and can obstruct the airway which may cause difficulty swallowing or breathing), hives (or itchy rash), localised and generalised rash, itchiness, severe sudden life threatening allergic reaction
Low-blood glucose levels
Difficulty in sleeping (insomnia), nightmares, memory loss, hallucination
Stroke, reduced blood supply to the brain, increased signs and symptoms of myasthenia gravis (muscle disorder), unusual sensations (like pins and needles).
Inflammation in the cornea, detachment of the layer below the retina that contains blood vessels following filtration surgery which may cause visual disturbances, decreased corneal sensitivity, corneal erosion (damage to the front layer of the eyeball), drooping of the upper eyelid (making the eye half closed), double vision
Chest pain, oedema (fluid build up), changes in the rhythm or speed of the heartbeat, a type of heart rhythm disorder, heart attack, heart failure
Raynaud’s phenomenon, cold hands and feet
Constriction of the airways in the lung (predominantly in patients with preexisting disease) difficulty breathing, cough
Indigestion , abdominal pain, vomiting
Hair loss, skin rash with white silvery coloured appearance (psoriasiform rash) or worsening of psoriasis, skin rash
Muscle pain not caused by exercise
Sexual dysfunction, decreased libido
Muscle weakness/tiredness
Other side effects reported with eye drops containing phosphates:
Cases of corneal calcification have been reported very rarely in association with the use of phosphate containing eye drops in some patients with significantly damaged cornea.
Reporting of side effects
If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via:
United Kingdom
Yellow Card Scheme
Website: www.mhra.gov.uk/yellowcard
Ingredients
What COMBIGAN eye drops contains
The active substances are brimonidine tartrate and timolol.
One millilitre of solution contains 2 milligrams of brimonidine tartrate and timolol maleate equivalent to 5 milligrams of timolol.
The other ingredients are benzalkonium chloride (a preservative), sodium phosphate monobasic monohydrate, sodium phosphate dibasic heptahydrate and purified water.
Small amounts of hydrochloric acid or sodium hydroxide may be added to bring the solution to the correct pH (a measure of the acidity or alkalinity of the solution).
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