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Insert - Combigan® - UK - MOH Submission

Difficulty in sleeping (insomnia), nightmares, memory loss
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 pre-existing 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:
In very rare cases, some patients with severe damage to the clear layer at the front of the eye (the cornea) have developed
cloudy patches on the cornea due to calcium build up during treatment.
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
HPRA Pharmacovigilance
Earlsfort Terrace
IRL - Dublin 2
Tel: +353 1 6764971
Fax: +353 1 6762517
By reporting side effects you can help provide more information on the safety of this medicine.
5. 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.

6. Contents of the pack and other information
What COMBIGAN 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

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).
What COMBIGAN looks like and contents of the pack
COMBIGAN is a clear, greenish-yellow eye drop solution in a plastic bottle with a screw-cap. Each bottle is about half full
and contains 5 ml of solution. Packs are available containing either 1 or 3 bottles. Not all pack sizes may be marketed.
Marketing Authorisation Holder and Manufacturer
Allergan Pharmaceuticals Ireland, Castlebar Road, Westport, Co Mayo, Ireland
For any information about this medicinal product, please contact the local representative of the Marketing
Authorisation Holder:
Allergan Ltd, The Parkway, Marlow, Bucks, SL7 1YL United Kingdom
Tel: +44 (0)1628 494026 e-mail:
This leaflet was last revised in 08/2015.

® marks owned by Allergan, Inc.
© 2015 Allergan, Inc., Irvine CA 92612


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.
Important information about some of the ingredients of COMBIGAN
Contact Lenses

Do not use COMBIGAN while your contact lenses are in your eyes. Wait at least 15 minutes after using COMBIGAN
before putting your lenses back in.

A preservative in COMBIGAN (benzalkonium chloride) may cause eye irritation and is also known to discolour soft
contact lenses.
3. How to use COMBIGAN
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.




Gently pull down the lower eyelid until there is a small pocket.
Turn the bottle upside down and squeeze it to release one drop into each eye that needs treatment.
Let go of the lower lid, and close your eye.
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
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.

Artwork created at 100%
Drop all keylines and notes before printing
Part Number: 71458MD020G
Drawing Number: 0106701

Package leaflet:
Information for the user

2 mg/ml + 5 mg/ml eye drops, solution
Brimonidine tartrate and timolol

Read all of this leaflet carefully before you start using this medicine because it contains important information for you.

Keep this leaflet. You may need to read it again.

If you have any further questions, ask your doctor or pharmacist.

This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of
illness are the same as yours.

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this
leaflet. See section 4.
What is in this leaflet:
1. What COMBIGAN is and what it is used for
2. What you need to know before you use COMBIGAN
3. How to use COMBIGAN
4. Possible side effects
5. How to store COMBIGAN
6. Contents of the pack and other information
1. What COMBIGAN is and what it is used for
COMBIGAN 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 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 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.
2. What you need to know before you use COMBIGAN
Do not use COMBIGAN eye drops solution:

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

COMBIGAN should not be used in children less than 2 years old and should not usually be used in children aged 2 to 17.
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.
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.

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
COMBIGAN 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.
4. Possible 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


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




Dry mouth

General weakness
Uncommon (may affect up to 1 in 100 people):

Heart failure

Irregular heart rate



Dry nose

Taste disturbance


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

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