Page 45 - 21st Century Perspective - Glaucoma Supplement

prescribing a combination drug to a patient is senseless unless both drugs are known to be needed
and efficacious.

Three combination drugs are available ​(Figure 26)​:

● 0.5% timolol with 0.2% brimonidine (Combigan);
● 0.5% timolol with 2% dorzolamide (Cosopt); and
● 0.2% brimonidine with 1% brinzolamide ophthalmic suspension (Simbrinza).

Figure 26.​ Combigan and Cosopt ophthalmic solutions and Simbrinza ophthalmic suspension.

Combigan

Let’s look at Combigan, a combination of 0.5% timolol and 0.2% brimonidine: First, it would be more
ideal to have a high-technology combination drop dispenser in which the dual dose (the
combination) is administered first thing in the morning, and then the next dose (the late afternoon

dose) would only dispense the brimonidine drop, considering that a beta-blocker only needs to be
used once daily. Second, we wish we had the option to prescribe such a combination drop with
0.25% timolol.

To be sensitive to cost, we sometimes have the patient instill Combigan (expensive) in the morning,
and then use generic 0.2% brimonidine (relatively inexpensive) for the afternoon dose, because

twice-daily timolol is not medically needed.

Cosopt

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