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COSOPT PRESERVATION-FREE 20MG/ML + 5MG/ML EYE DROPS SOLUTION SINGLE DOSE CONTAINER

Active substance(s): DORZOLAMIDE / TIMOLOL

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PATIENT INFORMATION LEAFLET

2912
03.10.17[7]

Cosopt® Preservative-Free 20 mg/ml +
5 mg/ml eye drops, solution, single dose
container
(dorzolamide hydrochloride/ timolol maleate)
Your medicine will be referred to as Cosopt Preservative-Free throughout
the following leaflet.
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 side effects not listed in this leaflet. See section 4.
What is in this leaflet
1. What Cosopt Preservative-Free is and what it is used for
2. What you need to know before you use Cosopt Preservative-Free
3. How to use Cosopt Preservative-Free
4. Possible side effects
5. How to store Cosopt Preservative-Free
6. Contents of the pack and other information
1. What Cosopt Preservative-Free is and what it is used for
Cosopt Preservative-Free contains two medicines: dorzolamide and
timolol.
 Dorzolamide belongs to a group of medicines called “carbonic
anhydrase inhibitors”.
 Timolol belongs to a group of medicines called “beta blockers”.
These medicines lower pressure in the eye in different ways.
Cosopt Preservative-Free is prescribed to lower raised pressure in the
eye in the treatment of glaucoma when beta-blocker eye drop medicine
used alone is not adequate.
2. What you need to know before you use Cosopt Preservative-Free
Do not use Cosopt Preservative-Free
 if you are allergic to dorzolamide hydrochloride, timolol maleate or any
of the other ingredients of this medicine (listed in section 6).
 if you have now or had in the past respiratory problems, such as
asthma or severe chronic obstructive bronchitis (severe lung disease
which may cause wheeziness, difficulty in breathing and/or longstanding cough).
 if you have a slow heart beat, heart failure or disorders of heart rhythm
(irregular heartbeats).
 if you have severe kidney disease or problems, or a prior history of
kidney stones.
 if you have excess acidity of the blood caused by a build up of chloride
in the blood (hyperchloraemic acidosis).
If you are not sure whether you should use this medicine, contact your
doctor or pharmacist.
Warnings and precautions
Talk to your doctor before using Cosopt Preservative-Free
Tell your doctor about any medical or eye problems 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.
 overactivity of the thyroid gland as timolol may mask signs and
symptoms.
Tell your doctor before you have an operation that you are using Cosopt
Preservative-Free as timolol may change effects of some medicines used
during anaesthesia.
Also tell your doctor about any allergies or anaphylactic reactions.
Tell your doctor if you have muscle weakness or have been diagnosed as
having myasthenia gravis.
If you develop any eye irritation or any new eye problems such as redness of
the eye or swelling of the eyelids, contact your doctor immediately.

If you suspect that Cosopt Preservative-Free is causing an allergic reaction
or hypersensitivity (for example, skin rash, severe skin reaction, or redness
and itching of the eye), stop using this medicine and contact your doctor
immediately.
Tell your doctor if you develop an eye infection, receive an eye injury, have
eye surgery, or develop a reaction including new or worsening symptoms.
When Cosopt Preservative-Free is instilled into the eye it may affect the
entire body.
Cosopt Preservative-Free has not been studied in patients wearing
contact lenses. If you wear soft contact lenses, you should consult your
doctor before using this medicine.

Do not allow the single dose container to touch the eye or areas around
the eye. It could cause injury to your eye. It may also become
contaminated with bacteria that can cause eye infections leading to
serious damage of the eye, even loss of vision. To avoid possible
contamination of the single dose container, wash your hands before using
this medicine and keep the tip of the single dose container away from
contact with any surface. A new single dose container should be opened
immediately prior to each use; there is enough solution in each container
for both eyes if your doctor has told you to use the drops in both eyes
Discard the opened container with any remaining contents
immediately after use.
Instructions for use

Use in children
There is limited experience with Cosopt (preserved formulation) in infants
and children.

Open the foil sachet which contains 15 individual single dose containers.
There are three strips of 5 single dose containers each in the sachet.
Write the date of first opening on the sachet.

Use in elderly
In studies with Cosopt (preserved formulation), the effects of Cosopt
(preserved formulation) were similar in both elderly and younger patients.

Every time you use COSOPT Preservative-Free

Use in patients with liver impairment
Tell your doctor about any liver problems you now have or have suffered
from in the past.

1.
2.
3.
4.
5.

Other medicines and Cosopt Preservative-Free
Cosopt Preservative-Free can affect or be affected by other medicines
you are using, including other eye drops for the treatment of glaucoma.
Tell your doctor if you are using or intend to use medicines to lower blood
pressure, heart medicine or medicines to treat diabetes. Tell your doctor
or pharmacist if you are using, have recently used or might use any other
medicines. This is particularly important if you are;
 taking medicine to lower blood pressure or to treat heart disease (such
as calcium channel blockers, beta-blockers or digoxin).
 taking medicines to treat a disturbed or irregular heartbeat such as
calcium channel blockers, beta-blockers or digoxin.
 using another eye drop that contains a beta-blocker.
 taking another carbonic anhydrase inhibitor such as acetazolamide.
 taking monoamine oxidase inhibitors (MAOIs).
 taking a parasympathomimetic medicine which may have been
prescribed to help you pass urine. Parasympathomimetics are also a
particular type of medicine which is sometimes used to help restore
normal movements through the bowel.
 taking narcotics such as morphine used to treat moderate to severe
pain.
 taking medicines to treat diabetes.
 taking antidepressants known as fluoxetine and paroxetine.
 taking a sulfa medicine.
 taking quinidine (used to treat heart conditions and some types of
malaria).

Wash your hands.
Take the strip of containers from the sachet.
Detach one single dose container from the strip.
Put the remaining strip back in the pouch and fold the edge to close
the pouch.
To open the container, twist off the tab.
Please note the opened single-dose container contains “fins” on
either side of the container tip.

Pregnancy and breast-feeding
Ask your doctor or pharmacist for advice before taking any medicine.
Use in pregnancy
Do not use Cosopt Preservative-Free if you are pregnant unless your
doctor considers it necessary.
Use in breast-feeding
Do not use Cosopt Preservative-Free 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
No studies on the effects on the ability to drive or use machines have
been performed. There are side effects associated with Cosopt
Preservative-Free, such as blurred vision, which may affect your ability to
drive and/or operate machinery. Do not drive or operate machinery until
you feel well or your vision is clear.
3. How to use Cosopt Preservative-Free
Always use this medicine exactly as your doctor has told you. Check with
your doctor or pharmacist if you are not sure. The appropriate dosage and
duration of treatment will be established by your doctor.
The recommended dose is one drop in the affected eye(s) in the morning
and in the evening.
If you are using Cosopt Preservative-Free with another eye drop, the
drops should be instilled at least 10 minutes apart.
Do not change the dose of the medicine without consulting your doctor.
If you have difficulty administering your eye drops, seek the assistance of
a family member or carer.

6.

Hold the container between your thumb and index finger. Note that
the tip of the container must not show more than 5 mm above the
edge of your index finger.

7.

Hold the single-dose container so that the fins located on the sides
of the container are aligned side-to-side to the corners of your eye,
horizontally. Tilt your head backwards or lie down. Place your hand
on your forehead. Your index finger should be aligned with your
eyebrow or resting on the bridge of the nose. Look up. Pull the lower
eyelid downwards with the other hand. Do not allow any part of the
container to touch your eye or any area around your eye. Gently
squeeze the container to let one drop fall into the space between the
lid and the eye. Do not blink while applying the drop to your eye.
Each single dose container contains enough solution for both eyes.

which may cause difficulty swallowing or breathing, hives or itchy rash,
localised and generalised rash, itchiness, severe sudden life-threatening
allergic reaction.
The following adverse reactions have been reported with Cosopt
Preservative-Free or one of its components either during clinical trials or
during post-marketing experience:
Very common (may affect more than 1 in 10 people):
Burning and stinging of the eyes, taste perversion.
Common (may affect up to 1 in 10 people):
Redness in and around the eye(s), watering or itching of the eye(s),
corneal erosion (damage to the front layer of the eyeball), swelling and/or
irritation in and around the eye(s), feeling of having something in the eye,
decreased corneal sensitivity (not realizing of getting something in the eye
and not feeling pain), eye pain, dry eyes, blurred vision, headache,
sinusitis (feeling of tension or fullness to the nose), nausea, weakness/
tiredness, and fatigue.
Uncommon (may affect up to 1 in 100 people):
Dizziness, depression, inflammation of the iris, visual disturbances
including refractive changes (due to withdrawal of miotic therapy in some
cases), slow heartbeat, fainting, difficulty breathing (dyspnoea),
indigestion, and kidney stones.

8.

Close your eye and press the inner corner of the eye with your finger
for about two minutes. This helps to stop the medicine from getting
into the rest of the body.

If you are not sure how to administer your medicine, ask your doctor,
pharmacist or nurse.

Rare (may affect up to 1 in 1,000 people):
Systemic lupus erythematosus (an immune disease which may cause an
inflammation of internal organs), tingling or numbness of the hands or
feet, insomnia, nightmares, memory loss, an increase in signs and
symptoms of myasthenia gravis (muscle disorder), decreased sex drive,
stroke, temporary short sightedness which may resolve when treatment is
stopped, detachment of the layer below the retina that contains blood
vessels following from filtration surgery which may cause visual
disturbances, drooping of the eyelids (making the eye stay half closed),
double vision, eyelid crusting, swelling of the cornea (with symptoms of
visual disturbances), low pressure in the eye, ringing noises in your ear,
low blood pressure, changes in the rhythm or speed of the heartbeat,
congestive heart failure (heart disease with shortness of breath and
swelling of feet and legs due to fluid build up), oedema (fluid build up),
cerebral ischaemia (reduced blood supply to the brain), chest pain,
palpitations (a quicker and/or irregular heartbeat), heart attack, Raynaud’s
phenomenon, swelling or coldness of your hands and feet and reduced
circulation in your arms and legs, leg cramps and/or leg pain when
walking (claudication), shortness of breath, respiratory failure, rhinitis,
nose bleed, constriction of the airways in the lungs, cough, throat
irritation, dry mouth, diarrhoea, contact dermatitis, hair loss, skin rash with
white silvery coloured appearance (psoriasiform rash), Peyronie’s disease
(which may cause a curvature of the penis), allergic type reactions such
as rash, hives, itching, in rare cases possible swelling of the lips, eyes
and mouth, wheezing, or severe skin reactions (Stevens Johnsons
syndrome, toxic epidermal necrolysis).
Like other medicines applied into your eyes, timolol is absorbed into the
blood. This may cause similar side effects as seen with 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 additional side effects include reactions seen within the class of
beta-blockers when used for treating eye conditions:

If you use more Cosopt Preservative-Free than you should
If you put too many drops in your eye or swallow any of the contents of
the container, among other effects, you may become light-headed, have
difficulty breathing, or feel that your heart rate has slowed. Contact your
doctor immediately.

Not known (side effects have been reported. However, it is not known
how often these occur):
Low blood glucose levels, heart failure, a type of heart rhythm disorder,
abdominal pain, vomiting, muscle pain not caused by exercise, sexual
dysfunction.

If you forget to use Cosopt Preservative-Free
It is important to use this medicine as prescribed by your doctor.
If you miss a dose, use it as soon as possible. However, if it is almost
time for the next dose, skip the missed dose and go back to your regular
dosing schedule.
Do not use a double dose to make up for the forgotten dose.

Reporting of side effects
If you get any side effects, talk to your doctor or pharmacist. This includes
any possible side effects not listed on this leaflet. You can also report side
effects directly via the Yellow Card Scheme at:
www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the
Google Play or Apple App Store. By reporting side effects, you can help
provide more information on the safety of this medicine.

9.

Wipe off any excess solution from the skin around the eye.

If your doctor has told you to use drops in both eyes, repeat steps 7 to 9
for your other eye.
After putting the drop into the eye(s), throw away the used single dose
container even if there is solution remaining to avoid contamination of the
preservative free solution.
Store the remaining containers in the foil sachet; the remaining containers
must be used within 15 days after opening of the sachet. If there are any
containers left 15 days after opening the sachet they should be safely
thrown away and a fresh sachet opened. It is important to continue to use
the eye drops as prescribed by your doctor.

If you stop using Cosopt Preservative-Free
If you want to stop using this medicine talk to your doctor first.
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.
You can usually carry on taking the drops, unless the effects are serious.
If you’re worried, talk to a doctor or pharmacist. Do not stop using Cosopt
Preservative-Free without speaking to your doctor.
Generalised allergic reactions including swelling beneath the skin can
occur in areas such as the face and limbs, and can obstruct the airway

5. How to store Cosopt Preservative-Free
Keep out of the sight and reach of children.
Do not use the unopened sachets of Cosopt Preservative-Free after the
expiry date shown by the six digits following EXP on the foil package. The
first two digits indicate the month; the last four digits indicate the year.
The expiry date refers to the last day of that month.
Do not store above 30°C. Do not freeze. Store in the original package in
order to protect from light.
Use no longer than 15 days after first opening the sachet.
Discard any unused single-dose containers after that time.
Discard the opened single dose container immediately after first use.

If the eye drops become discoloured or show signs of any deterioration
you should seek the advice of your pharmacist.
Medicines should not be disposed of via wastewater or household waste.
Ask your pharmacist how to dispose of medicines no longer required.
These measures will help to protect the environment.
6. Contents of the pack and other information
What Cosopt Preservative-Free contains
The active substances are dorzolamide and timolol.
Each ml contains 20 mg dorzolamide (as dorzolamide hydrochloride) and
5 mg timolol (as timolol maleate).
The other ingredients are hydroxyethylcellulose, mannitol, sodium citrate,
sodium hydroxide and water for injections.
What Cosopt Preservative-Free looks like and contents of the pack
Cosopt Preservative-Free is a clear, colourless to nearly colourless
slightly viscous solution. Each aluminium sachet contains 15 low density
polyethylene single dose containers containing 0.2 ml of solution.
Pack size: 60 x 0.2 ml (4 sachets with 15 single dose containers)
Manufacturer and Product Licence Holder
Manufactured by Santen Oy, Niittyhaankatu 20, 33720 Tampere, Finland.
Procured from the EU by Product Licence holder Star Pharmaceuticals
Ltd., 5 Sandridge Close, Harrow, Middlesex HA11XD. Repackaged by
Servipharm Ltd.
POM

PL 20636/2912

Leaflet revision and issue date (Ref.) 03.10.17[7]
Cosopt is a trademark of Merck Sharp & Dohme Corp.
HOW CAN YOU OBTAIN MORE INFORMATION ABOUT COSOPT
PRESERVATIVE-FREE, INCREASED EYE PRESSURE OR
GLAUCOMA?
This leaflet gives the most important information about Cosopt
Preservative-Free. If you have any questions after you have read it, ask
your doctor or pharmacist, who can give you more information
Further information about glaucoma is available from:
International Glaucoma Association (IGA)
Woodcote House, 15 Highpoint Business Village
Henwood
Ashford
Kent, TN24 8DH
Tel: 01233 648170
Registered Charity number 274681.
Alternatively, if you or someone you know has problems with their vision,
and you require further advice or information, please phone the Royal
National Institute for the Blind (RNIB) Helpline on 0303 123 9999, Monday
to Friday 8.45am to 5.30pm, calls charged at local rate.
(The IGA and RNIB are independent UK charities and are not associated
with Santen Oy.)

Blind or partially sighted?
Is this leaflet hard to see or read?
Call 020 8423 2111 to obtain the
leaflet in a format suitable for you

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