Simbrinza (Brinzolamide/Brimonidine)

Simbrinza is a prescription eye drop combining brinzolamide (a carbonic anhydrase inhibitor) and brimonidine (an alpha-2 agonist) for lowering intraocular pressure (IOP) in patients with glaucoma or ocular hypertension.

How It Works

Simbrinza combines two mechanisms:

Brinzolamide (carbonic anhydrase inhibitor):

• Reduces aqueous humor (eye fluid) production
• Same mechanism as dorzolamide

Brimonidine (alpha-2 agonist):

• Reduces fluid production
• Increases uveoscleral outflow
• May have neuroprotective properties

Together, these provide significant pressure reduction through complementary pathways.

Common Uses

• Open-angle glaucoma
• Ocular hypertension
• When prostaglandins are contraindicated or not tolerated
• As add-on therapy to prostaglandins
• When avoiding iris color changes is important

How to Use

• Dosing: One drop in affected eye(s) twice daily (approximately 12 hours apart)
• Shake well before each use
• Contact lenses: Contains preservative; remove contacts before use, wait 15 minutes
• Technique: Standard drop instillation
• Multiple drops: Wait at least 5 minutes between different medications

What to Expect

Pressure Reduction

• Typically lowers IOP by 6-8 mmHg
• Additive effect when used with prostaglandins
• Consistent effect with continued use

Initial Experience

• May notice blurred vision briefly after instillation
• Taste changes possible (bitter taste)
• Eye redness or discomfort possible

Side Effects

Common

• Blurred vision (temporary after instillation)
• Eye redness
• Bitter or unusual taste (from drainage into throat)
• Eye discomfort
• Dry mouth
• Fatigue/drowsiness

Less Common

• Allergic reaction (especially to brimonidine)
• Eye itching
• Headache
• Dizziness

Brimonidine Allergy

• Can develop even after months of use
• Signs: Increased redness, itching, swelling
• May need to discontinue if this occurs

Important Note on Drowsiness

Brimonidine can cause drowsiness, especially in children. Simbrinza is not recommended for children due to potential for significant sedation.

Precautions

• Children: Not recommended—risk of serious side effects
• Sulfa allergy: Brinzolamide is a sulfonamide (discuss with doctor if sulfa allergic)
• MAO inhibitors: Avoid concurrent use
• Cardiovascular conditions: Use with caution
• Raynaud's phenomenon: Use with caution
• Contact lenses: Remove before use
• Driving: May cause drowsiness

Cost and Insurance

• Brand-name medication
• Generic may become available
• Insurance coverage varies
• May require prior authorization

Simbrinza vs. Other Options

Situation	Option
First-line therapy	Usually a prostaglandin
Can't use prostaglandins	Simbrinza or other combinations
Need add-on to prostaglandin	Simbrinza or other second agents
Avoiding iris color change	Simbrinza (no prostaglandin)

Frequently Asked Questions

Why would I use Simbrinza instead of a prostaglandin?

Prostaglandins are usually first-line, but Simbrinza may be preferred if you:

• Can't tolerate prostaglandins
• Have contraindications to prostaglandins
• Want to avoid iris color changes
• Need additional lowering beyond a prostaglandin

Why do I taste something bitter after using Simbrinza?

Eye drops can drain through tear ducts into your nose and throat. The brinzolamide component has a bitter taste. Pressing on the inner corner of your eye after instillation can reduce this.

Can I use Simbrinza with other glaucoma drops?

Yes, Simbrinza is often used as add-on therapy to prostaglandin drops. This combination can provide significant IOP lowering.

What if I'm allergic to sulfa drugs?

Brinzolamide is a sulfonamide. While cross-reactivity with sulfa antibiotics is debated, inform your doctor of any sulfa allergy. They'll weigh the risks and benefits.

Why is Simbrinza not for children?

The brimonidine component can cause serious drowsiness and other CNS effects in children. Simbrinza is contraindicated in pediatric patients.

Will Simbrinza change my eye color?

No, Simbrinza doesn't cause iris color changes. This is a side effect specific to prostaglandin drops, which Simbrinza doesn't contain.