Combigan D

indicated in the treatment of hypertension. it may be employed alone or concomitantly with other antihypertensive agents.

Combigan D and Timolol (Combigan D) ophthalmic (eye) drops are used to treat increased pressure in the eye caused by glaucoma or a condition called hypertension of the eye. Both conditions are caused by high pressure in your eye and can lead to pain from pressure in your eye and then can eventually harm your vision. Combigan D and Timolol (Combigan D) can help you keep your sight by reducing the pressure in your eye and stopping eye pain.

Combigan D and Timolol (Combigan D) is available only with your doctor's prescription.

Usual Adult Dose for Glaucoma

1 drop in the affected eye(s) twice per day, approximately 12 hours apart

Comments:

-If more than one topical ophthalmic drug is being used, the different drugs should be instilled at least 5 minutes apart.

Use: To lower elevated intraocular pressure (IOP) in patients with glaucoma or ocular hypertension who require adjunctive or replacement therapy due to inadequately controlled IOP

Usual Adult Dose for Intraocular Hypertension

1 drop in the affected eye(s) twice per day, approximately 12 hours apart

Comments:

-If more than one topical ophthalmic drug is being used, the different drugs should be instilled at least 5 minutes apart.

Use: To lower elevated intraocular pressure (IOP) in patients with glaucoma or ocular hypertension who require adjunctive or replacement therapy due to inadequately controlled IOP

Usual Pediatric Dose for Glaucoma

2 years or older:

1 drop in the affected eye(s) twice per day, approximately 12 hours apart

Comments:

-If more than one topical ophthalmic drug is being used, the different drugs should be instilled at least 5 minutes apart.

Use: To lower elevated intraocular pressure (IOP) in patients with glaucoma or ocular hypertension who require adjunctive or replacement therapy due to inadequately controlled IOP

Usual Pediatric Dose for Intraocular Hypertension

2 years or older:

1 drop in the affected eye(s) twice per day, approximately 12 hours apart

Comments:

-If more than one topical ophthalmic drug is being used, the different drugs should be instilled at least 5 minutes apart.

Use: To lower elevated intraocular pressure (IOP) in patients with glaucoma or ocular hypertension who require adjunctive or replacement therapy due to inadequately controlled IOP

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Safety and efficacy have not been established in patients younger than 2 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Patient advice:

-Pressure should be applied to the tear duct immediately following administration of the drug.

-To avoid contamination of the eye or eye drops, the dropper tip should not come into contact with any surface.

Storage requirements:

-Protect from light

See also:
What is the most important information I should know about Combigan D?

should not be used in patients with known hypersensitivity to clonidine

Use Combigan D drops as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Combigan D drops is only for the eye. Do not get it in your nose or mouth.
• Soft contact lenses may absorb a chemical in Combigan D drops. Remove contact lenses before you use Combigan D drops; lenses may be placed back in the eyes 15 minutes after use of Combigan D drops.
• To use Combigan D drops in the eye, first, wash your hands. Tilt your head back. Using your index finger, pull the lower eyelid away from the eye to form a pouch. Drop the medicine into the pouch and gently close your eyes. Immediately use your finger to apply pressure to the inside corner of the eye for 1 to 2 minutes. Do not blink. Remove excess medicine around your eye with a clean, dry tissue, being careful not to touch your eye. Wash your hands to remove any medicine that may be on them.
• To prevent germs from contaminating your medicine, do not touch the applicator tip to any surface, including the eye. Keep the container tightly closed.
• Do NOT overtighten the cap on the bottle. This may damage the bottle or cap.
• Do NOT try to make the hole of the medicine dropper larger.
• If you use any other medicines in the eye, they should be used at least 5 minutes before or after Combigan D drops.
• Use Combigan D drops on a regular schedule to get the most benefit from it. Using it at the same time each day will help you remember.
• Continue to use Combigan D drops even if your condition improves. Do not miss any doses.
• If you miss a dose of Combigan D drops, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Combigan D drops.

Clonidine may potentiate the CNS-depressive effects of alcohol, barbiturates or other sedating drugs. If a patient receiving clonidine hydrochloride is also taking tricyclic antidepressants, the hypotensive effect of clonidine may be reduced, necessitating an increase in the clonidine dose.

Due to a potential for additive effects such as bradycardia and AV block, caution is warranted in patients receiving clonidine concomitantly with agents known to affect sinus node function or AV nodal conduction, e.g., digitalis, calcium channel blockers and beta-blockers.

Amitriptyline in combination with clonidine enhances the manifestation of corneal lesions in rats.

Serious adverse events, including death, have been reported in concomitant use with methylphenidate in patients with underlying cardiovascular conditions, although no association for the combination has been established. The safety of using clonidine in combination with methylphenidate has not been systematically evaluated.

Toxicology

In several studies with oral clonidine hydrochloride, a dose-dependent increase in the incidence and severity of spontaneous retinal degeneration was seen in albino rats treated for six months or longer. Tissue distribution studies in dogs and monkeys showed a concentration of clonidine in the choroid.

In view of the retinal degeneration seen in rats, eye examinations were performed during clinical trials in 908 patients before, and periodically after, the start of clonidine therapy. In 353 of these 908 patients, the eye examinations were carried out over periods of 24 months or longer. Except for some dryness of the eyes, no drug-related abnormal ophthalmological findings were recorded and, according to specialized tests such as electroretinography and macular dazzle, retinal function was unchanged.

In combination with amitriptyline, clonidine hydrochloride administration led to the development of corneal lesions in rats within 5 days.

See also:
What are the possible side effects of Combigan D?

Applies to Combigan D / Timolol (Combigan D) ophthalmic: ophthalmic solution

In addition to its needed effects, some unwanted effects may be caused by Combigan D / Timolol (Combigan D) ophthalmic. In the event that any of these side effects do occur, they may require medical attention.

Major Side Effects

You should check with your doctor immediately if any of these side effects occur when taking Combigan D / Timolol (Combigan D) ophthalmic:

More common:

• Burning, dry, or itching eyes
• discharge or excessive tearing
• redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
• stinging in the eyes
• tiny bumps on lining of the eyelid

• Blurred or loss of vision
• disturbed color perception
• dizziness
• double vision
• feeling of having something in the eye
• halos around lights
• headache
• nervousness
• night blindness
• pounding in the ears
• sensitivity of the eyes to light
• slow, fast, or irregular heartbeat
• tunnel vision
• watery eyes

If any of the following symptoms of overdose occur while taking Combigan D / Timolol (Combigan D) ophthalmic, get emergency help immediately:

Symptoms of overdose:

• Chest pain or discomfort
• cough
• difficulty breathing
• lightheadedness, dizziness or fainting
• no blood pressure or pulse
• noisy breathing
• stopping of heart
• tightness in the chest
• unconsciousness

Minor Side Effects

Some of the side effects that can occur with Combigan D / Timolol (Combigan D) ophthalmic may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

Less common:

• Dry mouth
• feeling sad or empty
• irritability
• lack of appetite
• lack or loss of strength
• loss of interest or pleasure
• sleepiness or unusual drowsiness
• trouble concentrating
• trouble sleeping