Azarga eye drops (Timolol, brinzolamide)
How does it work?
Azarga eye drops contain two active ingredients, timolol and brinzolamide. These are both medicines that decrease raised pressure within the eye.
The pressure within the eyeball is normally maintained by a continuous flow of liquid called aqueous humour through the eyeball. Aqueous humour is produced by a part of the eye called the ciliary body. If aqueous humour builds up inside the eyeball, this increases the pressure within the eyeball. This pressure needs to be reduced, as otherwise it can damage the optic nerve and impair vision.
Timolol and brinzolamide work in different ways to reduce the production of aqueous humour and so decrease its build-up inside the eyeball. They both therefore decrease the pressure in the eyeball.
Timolol is a type of medicine called a beta-blocker. These medicines block beta receptors in various parts of the body. Blocking the beta receptors in the eye reduces the amount of aqueous humour that is produced.
Brinzolamide is a type of medicine called a carbonic anhydrase inhibitor. It works by blocking the action of an enzyme in the body called carbonic anhydrase. Carbonic anhydrase is usually responsible for the production of a salt called bicarbonate in the body. Bicarbonate is needed for the production of the aqueous humour. By decreasing the production of bicarbonate, brinzolamide also decreases the production of aqueous humour.
Azarga eye drops are used to treat glaucoma when treatment with a beta-blocker eye drop on its own has not lowered the pressure in the eye sufficiently.
What is it used for?
- Raised pressure in the eye (ocular hypertension).
- Open angle glaucoma.
How do I use it?
- Azarga eye drops contain the preservative benzalkonium chloride, which can be absorbed by soft contact lenses and cause eye irritation. If you wear soft contact lenses, you should remove them before putting in these eye drops. You should wait at least 15 minutes after using the drops before putting your contact lenses back in.
- Shake the bottle well before use.
- One drop should be put into the affected eye(s) twice a day. Click here for instructions on how to put in the eye drops.
- When using the eye drops you should take care to not touch the dropper tip to any surface, or to your eye, in order to avoid contaminating the eye drops with germs that could cause eye infections.
- It is recommended that you press on the tear duct (at the corner of the eye closest to your nose), or gently close your eyes for about two minutes after putting in these drops, in order to minimise the amount of medicine absorbed into the bloodstream and increase the local effect in the eye.
- This medicine must not be taken by mouth.
- This medicine may cause temporary blurred vision after you have applied it into the eye(s). If affected, do not drive or operate machinery until this has worn off. You should also take into account that this medicine can sometimes cause other visual disturbances, eg double vision, dizziness or fatigue, all of which may affect your ability to drive or operate machinery.
- Azarga eye drops are sterile until opened. The eye drops contain a preservative that helps keep the eye drops sterile when in use. Any medicine remaining in the bottle four weeks after the first opening should be carefully disposed of, as after this time it is likely to be contaminated with germs. You may find it helpful to write the date of first opening on the bottle. Dispose of carefully, preferably by returning to your pharmacy.
- Beta-blockers such as timolol can be absorbed into the bloodstream after being applied into the eye. They may mask the symptoms of low blood sugar (hypoglycaemia) such as increased heart rate, sweating, tremor and nausea. For this reason, people with diabetes should carefully monitor their blood sugar while using these eye drops.
- Beta-blockers such as timolol can increase sensitivity to substances that cause allergy and the seriousness of severe allergic reactions (anaphylaxis). People who experience an anaphylactic reaction while using this medicine may need larger than normal doses of adrenaline to treat the reaction. Seek further medical advice from your doctor if you have a history of allergies.
- If you go into hospital or to the dentist to have an operation you should tell the person treating you that you are using this medicine. This is because your blood pressure may fall too low if you are given certain types of anaesthetics while using this medicine.
- While using this medicine you should have regular eye examinations.
Use with caution in
- People with a history of heart disease.
- People with a severe form of angina pectoris, not caused by exertion (Prinzmetal's angina).
- People with slowed conduction of electrical messages between the chambers of the heart (1st degree heart block).
- Low blood pressure (hypotension).
- People with poor blood circulation in the arteries of the extremities, eg hands and feet (peripheral arterial disorders such as Raynaud's syndrome or intermittent claudication).
- People with mild to moderate chronic obstructive pulmonary disease (COPD).
- Decreased liver function.
- History of allergies (see warning section above).
- Diabetes mellitus (timolol may mask the symptoms of low blood sugar, such as increased heart rate and tremor, and the dose of your diabetes medicine may need adjusting – see warning section above).
- People with a history of sudden drops in blood sugar levels (hypoglycaemia).
- Overactive thyroid gland (hyperthyroidism).
- Abnormal muscle weakness (myaesthenia gravis).
- People with conditions affecting the front of the eyeball (cornea).
- People with dry eyes.
- People who wear contact lenses.
- Glaucoma caused by accumulation of pigment particles in the drainage channels of the eye (pigmentary glaucoma).
- Glaucoma caused as a result of a disorder of part of the eyeball called the ciliary body (pseudoexfoliative glaucoma).
Not to be used in
- People who are allergic to beta-blocker medicines, eg atenolol, or sulphonamide medicines, eg sulfamethoxazole.
- People with a history of asthma.
- Severe chronic obstructive pulmonary disease (COPD).
- People with a slow heart rate caused by the pacemaker of the heart (sinus bradycardia).
- A problem common in the elderly, related to poor control of the working of the heart (sick sinus syndrome).
- People with a serious defect in the heart's electrical message pathways resulting in decreased function of the heart (sino-atrial block or 2nd or 3rd degree heart block).
- Uncontrolled heart failure.
- Failure of the heart to maintain adequate circulation of blood (cardiogenic shock).
- Severely decreased kidney function.
- People with high levels of chloride in the blood, resulting in high acid levels in the blood (hyperchloraemic acidosis).
- People with severe allergic rhinitis (hayfever).
- The safety and efficacy of this medicine in children has not yet been established and the manufacturer does not recommended it for children under 18 years of age.
- These eye drops are not recommended for the treatment of narrow angle glaucoma.
This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine can pass into the bloodstream after application into the eye and could potentially have harmful effects on a developing baby. The eye drops should not be used during pregnancy unless your doctor thinks they are essential and that the benefits of the medicine outweigh any risks to the baby. If you are pregnant and your doctor has asked you to use these eye drops, you should make sure you always press on your tear duct (at the corner of the eye closest to your nose), or gently close your eyes for about two minutes after putting in the drops, in order to minimise the amount of medicine absorbed into your bloodstream. If these eye drops are continued until delivery, the baby's heart rate and blood sugar should be carefully monitored for the first three to five days following birth. Seek further medical advice from your doctor.
- It is not known if brinzolamide passes into breast milk, however beta-blockers do pass into breast milk in small amounts. These eye drops should only be used in mothers who are breastfeeding if considered essential by your doctor. If you are breastfeeding and your doctor has asked you to use these eye drops, you should make sure you always press on your tear duct (at the corner of the eye closest to your nose), or gently close your eyes for about two minutes after putting in the drops, in order to minimise the amount of medicine that could pass into your breast milk. Seek further medical advice from your doctor.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
Common (affect between 1 in 10 and 1 in 100 people)
- Blurred vision.
- Eye irritation, such as burning, stinging, watering or itching.
- Pain in the eye.
- Sensation of something in the eye.
- Bitter taste in the mouth.
Uncommon (affect between 1 in 100 and 1 in 1000 people)
- Itchy eyelids.
- Crusting on the eyelids.
- Inflammation of the eyelids (blepharitis).
- Inflammation of the membrane that lines the inside of the eyelids and outside of the eyeball, causing redness and discharge (conjunctivitis).
- Disorders of the front layer of the eye (cornea).
- Inflammation of the surface of the eye (keratitis).
- Dry, itchy or tired eyes.
- Discharge from the eyes.
- Redness of the eyes.
- Low blood pressure (hypotension).
- Difficulty sleeping (insomnia).
- Sore throat.
- Runny nose.
- Chronic lung disease.
- Hair disorders.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with these eye drops, please read the information provided with the medicine or consult your doctor or pharmacist. You can also click on the links to the single ingredient products at the end of this page.
How can this medicine affect other medicines?
The timolol and brinzolamide in these eye drops can be absorbed into the bloodstream after application to the eye and it is possible they could affect other medicines that you are taking by mouth. It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while using this one, to make sure that the combination is safe.
If you are using more than one type of eye drop you should administer them at least five minutes apart, to prevent the second drop washing away the first. Use eye gels or ointments last.
Timolol may have an additive effect with medicines that decrease blood pressure, particularly medicines that are used to treat high blood pressure (antihypertensives). This may cause dizziness, which can usually be relieved by lying down until the symptoms pass. If you feel dizzy while using this medicine in combination with medicines that can lower blood pressure you should let your doctor know, as your doses may need adjusting.
There may be an increased risk of a slowed heart rate or drop in blood pressure if these eye drops are used in combination with any of the following medicines:
- medicines for an abnormal heartbeat (antiarrhythmics), eg amiodarone, quinidine
- beta-blocker medicines taken by mouth, eg atenolol, propranolol
- calcium channel blockers such as diltiazem, nifedipine or verapamil
If this medicine is used with clonidine, there is a risk of a rebound increase in blood pressure if the clonidine is stopped suddenly. If the clonidine needs to be stopped, this medicine should be stopped several days before slowly stopping the clonidine.
In people with diabetes, timolol can prolong the lowering of blood sugar (hypoglycaemia) caused by insulin or other antidiabetic medicines. People with diabetes should monitor their blood sugar, as timolol can also mask the signs of hypoglycaemia.
The following medicines may prevent the breakdown of brinzolamide in the body, thus increasing the risk of side effects:
These eye drops are not recommended for use in combination with acetazolamide taken by mouth, or with other beta-blocker or carbonic anhydrase inhibitor eye drops.
Other medicines containing the same active ingredients
There are currently no other medicines available in the UK that contain both timolol and brinzolamide as the active ingredients.
Timoptol eye drops, Timoptol-LA gel-forming eye drops and Nyogel contain just timolol.
Azopt eye drops contain just brinzolamide.