Combigan

brimonidine tartrate/timolol maleate 0.2%/0.5% (Allergan)

• dual mechanism of action to lower IOP by reducing aqueous-humor production and enhancing aqueous-humor drainage/outflow
• BID dosing
• mean decrease from baseline IOP 4.4-7.6mm HG with Combigan (vs. 2.7-5.5 with brimonidine tartrate, vs. 3.9-6.3 with timolol)
• maintained mean IOP throughout day better than individual gtts
• mean daytime IOP was consistently <18>
• systemic absorption helps to control for crossover effects of the drugs and controls for asymmetric fluctuations of IOP b/w right and left eyes
• mean daytime decrease from baseline IOP was >20% in 42% of Combigan patients, 13% brimonidine, 27% timolol
• lower incidence of conjunctival follicles compared to brimonidine (but higher than timolol group)
• rate of discontinuation for adverse effects was 14% with Combigan (vs. 30.6 with brimonidine vs. 5.1% with timolol)
• rate of allergic conjunctivitis was 5.2% with Combigan (vs. 9.4% brimonidine vs. 0.3% timolol)
• contraindications: patients with bronchial asthma, sinus bradycardia, severe COPD, overt cardiac failure, cardiogenic shock, atrioventricular block