Combigan® 2mg/ml and 5mg/ml Eye Drops, Solution

(Brimonidine tartrate and timolol)

Your medicine is known by the above name, but will be referred to as Combigan throughout this:

Patient Information Leaflet

What is in this leaflet:

1)    What Combigan is and what it is used for

2)    What you need to know before you use Combigan

3)    How to use Combigan

4)    Possible side effects

5)    How to store Combigan

6)    Contents of the pack and other information

1)    What Combigan is and what it is used for

Combigan is an eye drop that is used to control glaucoma. It contains two different medicines (brimonidine and timolol) that both reduce high pressure in the eye. Brimonidine belongs to a group of medicines called alpha-2 adrenergic receptor agonists. Timolol belongs to a group of medicines called beta-blockers. Combigan is prescribed to reduce high pressure in the eye when beta-blocker eye drops used alone are not enough.

Your eye contains a clear, watery liquid that feeds the inside of the eye. Liquid is constantly being drained out of the eye and new liquid is made to replace this. If the liquid cannot drain out quickly enough, the pressure inside the eye builds up and could eventually damage your sight. Combigan works by reducing the production of liquid and increasing the amount of liquid that is drained. This reduces the pressure inside the eye whilst still continuing to feed the eye.

2)    What you need to know before you use Combigan Do not use Combigan eye drops solution:

•    if you are allergic (hypersensitive) to brimonidine tartrate, timolol,

beta-blockers or any of the other ingredients of this medicine (listed in section 6). Symptoms of an allergic reaction may include swelling of the face, lips and throat, wheeziness, feeling faint, shortness of breath, itching or redness around the eye

•    if you have now or have had in the past respiratory problems such as asthma, severe chronic obstructive bronchitis (severe lung disease which may cause wheeziness, difficulty in breathing and/or long-standing cough)

•    if you have heart problems such as low heart rate, heart failure, heart beat disorders (unless controlled by a pacemaker)

•    if you are taking monoamine oxidase (MAO) inhibitors or certain other antidepressant drugs

Combigan should not be used in children less than 2 years old and should not usually be used in children aged 2 to 17.

If you think any of these points apply to you, do not use Combigan until you have talked again to your doctor.

Warnings and precautions

Talk to your doctor before using Combigan

•    if you have now or have had in the past

-    coronary heart disease (symptoms can include chest pain or tightness, breathlessness or choking), heart failure, low blood pressure

-    disturbances of heart rate such as slow heart beat

-    breathing problems, asthma or chronic obstructive pulmonary disease

-    poor blood circulation disease (such as Raynaud's disease or Raynaud's syndrome)

-    diabetes as timolol may mask signs and symptoms of low blood sugar levels

-    over activity of the thyroid gland as timolol may mask signs and symptoms

-    kidney or liver problems

-    tumour of the adrenal gland

-    eye surgery to lower the pressure in your eye

•    if you suffer or have suffered from any allergy (e.g. hayfever, eczema) or a severe allergic reaction be aware that the usual dose of adrenaline used to control a severe reaction may need to be increased.

Tell the doctor before you have an operation that you are using Combigan, as the timolol may change effects of some medicines during anaesthesia.

Other medicines and Combigan

Combigan can affect or be affected by other medicines you are using, including other eye drops for the treatment of glaucoma. Tell your doctor or pharmacist if you are taking, have recently taken or might take other medicines, including medicines for any condition, even if unrelated to your eye condition, including medicines obtained without a prescription. There are a number of medicines which may interfere with Combigan, so it is particularly important to tell your doctor if you are taking:

•    pain killers

•    medicines to help you sleep or for anxiety

•    medicines to treat high blood pressure (hypertension)

•    medicines for heart conditions (for example an abnormal heartbeat) such as beta blockers, digoxin or quinidine (used to treat heart conditions and some types of malaria)

•    medicines to treat diabetes or high blood sugar

•    medicines for depression such as fluoxetine and paroxetine

•    another eye drop used to lower high pressure in the eye (glaucoma)

•    medicines to treat severe allergic reactions

•    medicines that affect some of the hormones in your body, like adrenaline and dopamine

•    medicines that affect the muscles in your blood vessels

•    medicines to treat heartburn or stomach ulcers If the dose of any of your current medicines is changed or if you are regularly consuming alcohol you should tell your doctor.

If you are due to have an anaesthetic, you should tell the doctor or dentist that you are taking Combigan.

Pregnancy and breast-feeding

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. Do not use Combigan if you are pregnant unless your doctor considers it necessary.

Do not use Combigan if you are breast-feeding. Timolol may get into your milk. Ask your doctor for advice before taking any medicine during breastfeeding.

Driving and using machines

Combigan may cause drowsiness, tiredness or blurred vision in some patients. Do not drive or use any tools or machines until the symptoms have cleared. If you experience any problems, talk to your doctor.

Important information about some of the ingredients of Combigan Contact Lenses

•    Do not use Combigan while your contact lenses are in your eyes. Wait at least 15 minutes after using Combigan before putting your lenses back in.

•    A preservative in Combigan (benzalkonium chloride) may cause eye irritation and is also known to discolour soft contact lenses.

3) How to use Combigan

Always use this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure. Combigan must not be used in infants below 2 years of age. Combigan should not usually be used in children and adolescents (from 2 to 17 years).

The recommended dose is one drop of Combigan, twice a day about 12 hours apart. Do not change the dose or stop taking it without speaking to your doctor.

If you have other eye drops as well as Combigan, leave at least 5 minutes between using Combigan and the other eye drops.

Instructions for use

You must not use the bottle if the tamper-proof seal on the bottle neck is broken before you first begin to use it.

Wash your hands before opening the bottle. Tilt your head back and look at the ceiling.

1.    Gently pull down the lower eyelid until there is a small pocket.

2.    Turn the bottle upside down and squeeze it to release one drop into each eye that needs treatment.

3.    Let go of the lower lid, and close your eye.

4.    Keep the eye closed and press your finger against the corner of your eye (the side where your eye meets your nose) for two minutes. This helps stop Combigan getting into the rest of the body.

If a drop misses your eye, try again.

To avoid contamination, do not let the tip of the bottle touch your eye or anything else. Put the screw-cap back on to close the bottle, straight after you have used it.

If you use more Combigan than you should

Adults

If you use more Combigan than you should, it is unlikely to cause you any harm. Put your next drop in at the usual time. If you are worried, talk to your doctor or pharmacist.

Babies and Children

Several cases of overdose have been reported in babies and children receiving brimonidine (one of the ingredients of Combigan) as part of medical treatment for glaucoma. Signs include sleepiness, floppiness, low body temperature, paleness and breathing difficulties. Should this happen, contact your doctor immediately.

Adults and Children

If Combigan has been accidentally swallowed then you should contact your doctor immediately.

If you forget to use Combigan

If you forget to use Combigan, use a single drop in each eye that needs treatment as soon as you remember, and then go back to your regular routine. Do not take a double dose to make up for a forgotten dose.

If you stop using Combigan

Combigan should be used every day to work properly.

If you have any further questions on the use of this product, ask your doctor or pharmacist.

4) Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

If you experience any of the following side effects, please contact your doctor immediately:

•    Heart failure (eg. chest pain) or irregular heart rate

•    Increased or decreased heart rate or low blood pressure

Affecting the eye

Very common (may affect more than 1 in 10 people):

•    Eye redness or burning

Common (may affect up to 1 in 10 people):

•    Stinging or pain in the eye

•    Allergic reaction in the eye or on the skin around the eye

•    Small breaks in the surface of the eye (with or without inflammation)

•    Swelling, redness or inflammation of the eyelid

•    Irritation, or a feeling of something in the eye

•    Itching of the eye and eyelid

•    Follicles or white spots on the see through layer which covers the surface of the eye

•    Vision disturbance

•    Tearing

•    Eye dryness

•    Sticky eyes

Uncommon (may affect up to 1 in 100 people):

•    Difficulty in seeing clearly

•    Swelling or inflammation of the see-through layer which covers the surface of the eye

•    Tired eyes

•    Sensitivity to light

•    Eyelid pain

•    Whitening of the see-through layer which covers the surface of the eyes

•    Swelling or areas of inflammation under the surface of the eye

•    Floaters in front of the eyes

Not known (frequency cannot be estimated from the available data):

•    Blurred vision

Affecting the body:

Common (may affect up to 1 in 10 people):

•    High blood pressure

•    Depression

•    Sleepiness

•    Headache

•    Dry mouth

•    General weakness

Uncommon (may affect up to 1 in 100 people):

•    Heart failure

•    Irregular heart rate

•    Light-headedness

•    Fainting

•    Dry nose

•    Taste disturbance

•    Nausea

•    Diarrhoea

Not known (frequency cannot be estimated from the available data):

•    Increased or decreased heart rate

•    Low blood pressure

•    Face redness

Some of these effects may be due to an allergy to any of the ingredients. Additional side effects have been seen with brimonidine or timolol and therefore may potentially occur with Combigan.

The following additional side effects have been seen with brimonidine:

- Inflammation within eye, small pupils, difficulty sleeping, cold-like symptoms, shortness of breath, symptoms involving the stomach and digestion, general allergic reactions, skin reactions including redness, face swelling, itching, rash and widening of blood vessels

Like other medicines applied into eyes, Combigan (brimonidine/timolol) is absorbed into the blood. Absorption of timolol, a beta blocker component of Combigan, may cause similar side effects as seen with intravenous” and /or “oral” beta-blocking agents. Incidence of side effects after topical ophthalmic administration is lower than when medicines are for example, taken by mouth or injected. Listed side effects include reactions seen within the class of beta-blockers when used for treating eye conditions:

-    Generalised allergic reactions, including swelling beneath the skin (that can occur in areas such as the face and limbs, and can obstruct the airway which may cause difficulty swallowing or breathing), hives (or itchy rash), localised and generalised rash, itchiness, severe sudden life threatening allergic reaction

-    Low-blood glucose levels

-    Difficulty in sleeping (insomnia), nightmares, memory loss

-    Stroke, reduced blood supply to the brain, increased signs and symptoms of myasthenia gravis (muscle disorder), unusual sensations (like pins and needles)

-    Inflammation in the cornea, detachment of the layer below the retina that contains blood vessels following filtration surgery which may cause visual disturbances, decreased corneal sensitivity, corneal erosion (damage to the front layer of the eyeball), drooping of the upper eyelid (making the eye half closed), double vision

-    Chest pain, oedema (fluid build up), changes in the rhythm or speed of the heartbeat, a type of heart rhythm disorder, heart attack, heart failure

-    Raynaud's phenomenon, cold hands and feet

-    Constriction of the airways in the lung (predominantly in patients with pre-existing disease) difficulty breathing, cough

-    Indigestion, abdominal pain, vomiting

-    Hair loss, skin rash with white silvery coloured appearance (psoriasiform rash) or worsening of psoriasis, skin rash

-    Muscle pain not caused by exercise

-    Sexual dysfunction, decreased libido

-    Muscle weakness/tiredness

Other side effects reported with eye drops containing phosphates:

In very rare cases, some patients with severe damage to the clear layer at the front of the eye (the cornea) have developed cloudy patches on the cornea due to calcium build up during treatment.

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine.

5)    How to store Combigan

•    Keep all medicines out of the sight and reach of children.

•    Do not use Combigan after the expiry date printed on the carton, label or bottle label. The expiry date refers to the last day of that month.

•    Keep the bottle in the outer carton to protect it from light.

•    You should only use one bottle at a time.

•    You must throw away the bottle four weeks after you first opened it, even if there are still some drops left. This will help to prevent infections. To help you remember, write down the date that you opened it in the space on the carton.

•    Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

6)    Contents of the pack and other information What Combigan contains:

•    The active substances are brimonidine tartrate and timolol.

•    Each millilitre of solution contains 2 milligrams of brimonidine tartrate and timolol maleate equivalent to 5 milligrams of timolol.

•    The other ingredients are benzalkonium chloride (a preservative), sodium phosphate monobasic monohydrate, sodium phosphate dibasic heptahydrate and purified water. Small amounts of hydrochloric acid or sodium hydroxide may be added to bring the solution to the correct pH (a measure of the acidity or alkalinity of the solution).

What Combigan looks like and contents of the pack

Combigan is a clear, greenish-yellow eye drop solution in a plastic bottle with a nozzle and a screw cap.

Each bottle is about half full and contains 5 ml of solution.

Combigan is available as a 5ml bottle.

PL 10383/1946 Combigan 2mg/ml and 5mg/ml Eye Drops, Solution |POM| Who makes and repackages your medicine

Your medicine is manufactured by Allergan Pharmaceuticals Ireland, Castlebar Road, Westport, Co Mayo, Ireland. Procured from within the EU and repackaged by Product Licence Holder: Primecrown Ltd, 4/5 Northolt Trading Estate, Belvue Road, Northolt, Middlesex, UB5 5QS.

Leaflet date: 08.04.2016

Combigan® is a registered trademark of Allergan Inc., USA.