Combigan (Brimonidine/Timolol)

Name: Combigan
Brand: Allergan
SKU: 2546
Availability: InStock

Type

Product

Manufacturer

Country

Dosage

Qty-Price (USD)

Type:

Product: Combigan

Manufacturer: Allergan

Country: Canada

Dosage: 0.2 %/0.5 %/10 ml

Qty-Price (USD):

Type:

Product: Combigan

Manufacturer: Allergan

Country: India

Dosage: 0.2 %/0.5 %/5 ml

Qty-Price (USD):

Type:

Product: Combigan (ON BACKORDER)

Manufacturer: Allergan

Country: Turkey

Dosage: 0.2 %/0.5 %/5 ml

Qty-Price (USD):

Type:

Product: Combigan (ON BACKORDER)

Manufacturer: Allergan

Country: United Kingdom

Dosage: 0.2 %/0.5 %/5 ml

Qty-Price (USD):

Generic Equivalent of Combigan

Type

Product

Manufacturer

Country

Dosage

Qty-Price (USD)

Type:

Product: Brimonidine/Timolol

Manufacturer: Generic

Country: Canada

Dosage: 0.2 %/0.5 %/10 ml

Qty-Price (USD):

Type:

Product: Brimonidine/Timolol

Manufacturer: Generic

Country: India

Dosage: 0.2 %/0.5 %/5 ml

Qty-Price (USD):

Combigan Information

medically reviewed by Carol Hou (BSc. Pharm) on May 5, 2025.

A licensed pharmacist (Licensed Community Pharmacies Directory | College of Pharmacists of British Columbia) with over 20 years of experience in medication management, specifically medication safety, she has reviewed the information for accuracy and completeness.

COMBIGAN and Brimonidine/Timolol at CanadaPharmacyOnline.com

Brand COMBIGAN (brimonidine/timolol), manufactured by Allergan, is available in many countries worldwide, including Canada, India, the United Kingdom, and Turkey.

Generic brimonidine/timolol is sourced from manufacturers that meet applicable regulatory standards. The specific manufacturer of your dispensed medication may vary.

Important Information about Generic Brimonidine/Timolol:

Generic brimonidine/timolol contains the same active ingredient as brand-name COMBIGAN and is required to meet the same safety, effectiveness, and quality standards. This means it is designed to work in the same way as COMBIGAN. Studies have demonstrated between generic and brand-name brimonidine/timolol, meaning they have comparable absorption rates and overall effects. However, individual responses to any medication can vary. Talk to your doctor or pharmacist, if you have any questions about using generic brimonidine/timolol.

For more information about generic drug approval and bioequivalence, you can visit the FDA website: https://www.fda.gov/drugs/buying-using-medicine-safely/generic-drugs

Dosage:

Brand COMBIGAN and generic brimonidine/timolol eye drops are commonly available in a concentration of 0.2% brimonidine and 0.5% timolol, with various fill volumes such as 5 ml and 10 ml.

Your doctor will determine the appropriate dose based on your individual needs and medical conditions.

Usage:

COMBIGAN (brimonidine tartrate/timolol maleate ophthalmic solution) is a prescription medication used to lower eye pressure, also called intraocular pressure (IOP), in patients with open-angle glaucoma or ocular hypertension who require additional or adjunctive IOP-lowering therapy. (refer to the product labeling information)

Mechanism of Action:
COMBIGAN is a combination eye drop medication containing two active ingredients: brimonidine tartrate and timolol maleate. Brimonidine belongs to the drug class of alpha-2 adrenergic agonists, which lowers intraocular pressure (IOP) primarily by decreasing aqueous humor production and secondarily by increasing uveoscleral outflow. Timolol belongs to the drug class of beta-adrenergic receptor blockers (beta-blockers), which primarily lowers IOP by reducing the production of aqueous humor. Therefore, COMBIGAN belongs to both the alpha-2 adrenergic agonist and beta-blocker drug classes, and it works by utilizing these dual mechanisms to achieve a greater reduction in IOP compared to either medication used alone, making it effective for treating open-angle glaucoma or ocular hypertension.

Take COMBIGAN exactly as your doctor prescribes, following the instructions in the product monograph in Canada. Consult your doctor for personalized guidance and safe use.

Side Effects:

The information below is not an exhaustive list of side effects; individual reactions can vary. Before starting COMBIGAN, it is crucial to discuss potential side effects and risks with your doctor or pharmacist.

The following are some common side effects of COMBIGAN, but others are possible. Contact your doctor promptly if any side effects are persistent, worsening, or concerning or if you experience any other concerning symptoms.

The following side effect percentages are based on clinical trial data submitted to regulatory authorities for approval. These percentages may reflect specific study populations, and individual experiences can vary.

Common side effects (may affect 5% to 15% of patients based on clinical trials for COMBIGAN) may include:
• Allergic inflammation of the eye (allergic conjunctivitis- this involves redness, itching, swelling, and increased tearing due to an allergic reaction in the eye.);
• Burning or stinging of the eye (a temporary discomfort or irritation felt in the eye upon application);
• Eye redness (ocular hyperemia - increased blood flow to the surface of the eye, causing it to appear red or bloodshot);
• Itching of the eye (ocular pruritus - an uncomfortable sensation leading to the urge to rub the eye);
• Small bumps on the lining of the eyelid (conjunctival follicles - these are small, typically benign, elevations on the conjunctiva, the clear membrane covering the white part of the eye and the inside of the eyelids)

Less common side effects (may affect 1% to 5% of patients based on clinical trials for COMBIGAN) may include:
• Blurred vision (temporary difficulty in seeing clearly);
• Changes in blood pressure (this medication can cause fluctuations in blood pressure. While decreases in blood pressure are more commonly associated with the beta-blocker component (timolol), transient increases, particularly upon initial use, can occur due to the alpha-adrenergic agonist component (brimonidine). Regular monitoring may be advised, especially if you have pre-existing blood pressure issues);
• Depression (a persistent feeling of sadness, loss of interest, or other mood disturbances);
• Dry eye (xerophthalmia) (a condition where the eyes do not produce enough tears to stay lubricated, leading to discomfort and potential vision problems.
• Dry mouth (xerostomia): Reduced saliva production, causing a dry feeling in the mouth);
• Drowsiness (a feeling of sleepiness or reduced alertness. While the risk may be higher in children due to potentially increased systemic absorption of brimonidine, adults can also experience drowsiness with COMBIGAN. Use caution when driving or operating machinery if you experience this side effect. Consult your doctor for specific concerns regarding children);
• Eye pain or irritation (general discomfort, soreness, or a feeling of something being wrong in the eye);
• Eyelid irritation, swelling, or redness (inflammation of the eyelids or surrounding tissues. While it might resemble blepharitis (a more chronic condition), it's described here as a potential reaction to the medication.
• Foreign body sensation in the eye: The feeling that something is in the eye even when nothing is there);
• Headache (pain in the head, which can vary in intensity and location)
• Watery eyes (lacrimation increased - excessive tear production)

Serious side effects - Seek immediate medical attention if you experience any of the following:
• Allergic reaction: Symptoms include hives, difficulty breathing, swelling of the face, lips, tongue, or throat.
• Breathing problems: Shortness of breath, wheezing, tightness in the chest.
• Dizziness or fainting (syncope): A sudden loss of consciousness due to a temporary drop in blood flow to the brain.
• Eye problems: Severe eye pain, sudden vision changes, increased watering or discharge from the eye, sensitivity to light (photophobia).
• Heart problems: Slow or irregular heartbeat (bradycardia or arrhythmia), chest pain, shortness of breath. While swelling in the legs or feet (edema) and sudden weight gain can be signs of underlying heart issues, the more direct cardiac concerns with COMBIGAN relate to heart rate and rhythm.
• Low blood pressure (hypotension): Symptoms include dizziness, lightheadedness, and fainting.
• Mental/mood changes: New or worsening depression, confusion, memory problems.
• Muscle weakness: New or worsening muscle weakness, drooping eyelids (ptosis), double vision (diplopia).
• Symptoms that could be masked by the beta-blocker component (timolol) if you are experiencing low blood sugar: Be aware that timolol could potentially mask some typical symptoms of hypoglycemia, such as cold sweat, pale skin, and headache. This is less likely with a topical eye drop compared to oral beta-blockers, but individuals with diabetes should still monitor their blood sugar closely and be aware of potential atypical symptoms.

Contraindications:

The following is not an exhaustive list of contraindications. It is crucial to discuss all your medical conditions, past and present, and all medications you are taking with your doctor or pharmacist before starting COMBIGAN. This list is not exhaustive.

COMBIGAN should not be used if:
• You are allergic or hypersensitive to brimonidine tartrate, timolol maleate, or any of the other ingredients in this medication. An allergic reaction could be severe;
• You currently have or have a history of bronchial asthma, or you have severe chronic obstructive pulmonary disease (COPD). The beta-blocker component (timolol) can worsen these conditions due to its potential to cause bronchospasm;
• You have a very serious heart condition that causes a significant slowing of heart rate, such as sinus bradycardia (markedly slow heart rate), second- or third-degree atrioventricular (AV) block (without a functioning pacemaker), overt cardiac failure (uncontrolled heart failure with symptoms), or cardiogenic shock (a sudden, severe drop in blood pressure due to heart failure). The beta-blocker component (timolol) can further depress heart function;
• COMBIGAN is contraindicated in neonates and infants (under 2 years of age) due to the potential for significant systemic absorption of brimonidine, which has been associated with a higher incidence and severity of central nervous system (CNS) depression (e.g., coma, lethargy, and apnea) in this age group.

Tell your doctor about your medical conditions, past and present, before starting COMBIGAN. It’s crucial because certain conditions may affect whether COMBIGAN is right for you. These conditions may include, but are not limited to:
• Less severe respiratory issues (mild to moderate COPD or a history of bronchospastic disease (other than asthma)).
• Cardiovascular disease (severe or unstable heart disease, coronary heart disease, Prinzmetal's angina, low blood pressure, orthostatic hypotension, or history of heart failure);
• Vascular insufficiency (conditions affecting blood circulation, such as Raynaud's phenomenon or thromboangiitis obliterans);
• Depression (beta-blockers may worsen depressive symptoms);
• Diabetes mellitus (beta-blockers may mask the signs and symptoms of hypoglycemia (low blood sugar) such as tremor and increased heart rate);
• History of severe allergic reactions (patients with a history of atopy or severe anaphylactic reactions may be more reactive to allergens while using beta-blockers and may not respond to usual doses of epinephrine);
• Hyperthyroidism (beta-blockers may mask certain signs of hyperthyroidism such as tachycardia);
• Liver or kidney impairment (COMBIGAN has not been studied extensively in these populations and dosage adjustments may be necessary);
• Myasthenia gravis (beta-blockers can potentiate muscle weakness);
• Patients undergoing surgery with general anesthesia (Timolol (a beta-blocker) may interact with certain anesthetic medications, potentially leading to hypotension)

Drug Interactions:

. Before taking COMBIGAN, it is essential to discuss all potential risks and interactions with your doctor or pharmacist. For complete and up-to-date information, refer to the official COMBIGAN website.

Provide your doctor with a complete list of all your medications, including prescriptions, over-the-counter (OTC) drugs, vitamins, and herbal supplements. COMBIGAN can interact with many medications, including (but not limited to):
• Adrenergic Agonists (may interfere with the IOP-lowering effect of COMBIGAN);
• Antihypertensives and Cardiac Glycosides (e.g., digoxin): COMBIGAN may lower blood pressure and heart rate, so caution is advised when using it with other blood pressure-lowering medications or cardiac glycosides, as this could lead to additive hypotensive or bradycardic effects;
• Calcium Channel Blockers (oral or intravenous) - Concomitant use may lead to atrioventricular conduction disturbances, left ventricular failure, and hypotension, especially in patients with impaired cardiac function. This combination should generally be avoided;
• Catecholamine-Depleting Drugs (such as reserpine - Using COMBIGAN with these drugs may result in additive effects, leading to hypotension and/or marked bradycardia (slow heart rate), potentially causing dizziness, fainting, or postural hypotension;
• Central Nervous System (CNS) Depressants (e.g., alcohol, barbiturates, opiates, sedatives, anesthetics): Although specific studies with topical COMBIGAN haven't extensively evaluated these interactions, additive CNS depressant effects (such as increased drowsiness or dizziness) are theoretically possible due to systemic absorption of brimonidine;
• CYP2D6 Inhibitors (e.g., quinidine, certain SSRIs like fluoxetine and paroxetine): May increase the systemic exposure to timolol, potentially leading to bradycardia (slowed heart rate) or depression;
• Certain Anesthetics Beta-blockers like timolol can increase the hypotensive effects of some anesthetic agents. Inform your anesthesiologist that you are using COMBIGAN before surgery;
• Digitalis and Calcium Antagonists (the combination may have additive effects in prolonging atrioventricular conduction time);
• Insulin and Oral Antidiabetic Medications (beta-blockers may mask some signs and symptoms of hypoglycemia);
• Monoamine Oxidase Inhibitors (MAOIs) ((e.g., phenelzine, tranylcypromine, isocarboxazid, selegiline) - Using COMBIGAN with MAOIs can lead to clinically significant hypotension. Some MAOIs might also enhance the systemic absorption of brimonidine;
• Nonsteroidal Anti-inflammatory Drugs (NSAIDs) (systemic)- Some NSAIDs may decrease the effectiveness of beta-blockers in lowering blood pressure; the clinical significance for topical timolol is not fully established but caution is advised;
• Other Beta-Blockers (oral or other topical) - Using COMBIGAN with oral or other topical beta-blockers can increase the risk of systemic beta-blockade effects, such as a slowed heart rate and low blood pressure. The concurrent use of two topical beta-adrenergic blocking agents is generally not recommended; • Other glaucoma medications (topical) - Using COMBIGAN with other topical glaucoma medications should be done with caution. If using more than one topical ophthalmic drug, the drugs should be administered at least 5 minutes apart to prevent one drug from washing out the other. COMBIGAN itself is a combination of two glaucoma medications (a beta-blocker and an alpha-agonist), so using additional medications of the same class may increase the risk of side effects without necessarily providing additional benefit;
• Tricyclic Antidepressants (Tricyclic antidepressants may interfere with the hypotensive effect of alpha-2 adrenergic agonists like brimonidine by affecting norepinephrine levels. Caution is advised due to the potential for these drugs to reduce brimonidine's efficacy or increase the risk of cardiovascular side effects).

Pregnancy and Breastfeeding

COMBIGAN is generally not recommended during pregnancy due to the potential risks to the fetus from systemic absorption of both brimonidine and timolol. Animal studies with both components have shown some evidence of reproductive toxicity at high systemic doses. There are limited or no adequate and well-controlled studies in pregnant women. Discuss alternative treatments with your doctor if you are pregnant or planning to become pregnant. Breastfeeding is usually discouraged while using COMBIGAN due to the possibility of timolol being excreted in breast milk and causing adverse effects in the nursing infant, such as bradycardia and respiratory depression. It is unknown if brimonidine is excreted in human milk. Discuss alternative treatments with your doctor if you are breastfeeding.

Frequently Asked Questions about COMBIGAN at Canada Pharmacy Online:

Why is COMBIGAN more affordable in Canada than in the United States?

Prescription drug prices, including COMBIGAN, are generally lower in Canada than in the US due to a combination of factors, primarily government price regulations, differing market dynamics, and other economic considerations. In Canada, provincial and federal governments negotiate drug prices with pharmaceutical companies, which often results in lower costs compared to the U.S., where market forces play a more significant role. For more information, see the FAQs on Prescription Drug Importation from the Kaiser Family Foundation (KFF): https://www.kff.org/health-costs/issue-brief/faqs-on-prescription-drug-importation/

How much is the shipping?

Our shipping fee is a flat rate of $10.00 per order. Our pharmacy focuses on offering the lowest prices on high-quality products.

How do I order from your pharmacy?

Ordering from us is very simple. You can purchase online or call Customer Service at 1866.920.3784; for more information or to learn about the ordering process, visit our How to Order page.

Is there a limit on how many COMBIGAN I am allowed to order at one time?

CanadaPharmacyOnline.com can only dispense a maximum of a three-month supply of COMBIGAN at once, per your doctor's prescription.

Can I buy COMBIGAN over the counter from you?

No, COMBIGAN requires a valid prescription from your doctor. We do not sell this product without a valid prescription.

Do you ship to the United States?

Yes, we do. It usually takes 7 and 18 business days to receive your order from our pharmacy.

How do I use COMBIGAN?

The usual dose is one drop in the affected eye(s) twice a day, approximately 12 hours apart. Follow your eye doctor's instructions carefully.

What if I use other eye drops?

If you use more than one type of eye drop, wait at least 5 minutes between applying each medication to allow for proper absorption.

What if I wear contact lenses?

Remove your contact lenses before using COMBIGAN and wait at least 15 minutes before putting them back in. This is because a preservative in COMBIGAN (benzalkonium chloride) can be absorbed by soft contact lenses.

How should I store COMBIGAN?

Store COMBIGAN at room temperature, away from light and moisture. Keep it out of reach of children. Do not use the eye drops if the solution changes color or looks cloudy. Do not use it after the expiration date printed on the bottle.

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The information on this page is sourced from independent third parties contracted by CanadaPharmacyOnline. While we cannot guarantee its medical accuracy, we strongly recommend consulting a healthcare professional for personalized advice regarding medications or medical conditions.

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