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This medication safety guide outlines the essential warnings and precautions for using Combigan (brimonidine/timolol) eye drops. It is crucial to adhere to these guidelines and discuss any concerns with your healthcare provider.

• Eye Application Only: Use Combigan exclusively as eye drops. Avoid contact between the bottle tip and any surfaces to prevent contamination. Do not swallow or inject this medication.

• Allergic Reactions: Be aware of potential allergic reactions to brimonidine, which may occur even months after starting the medication. Symptoms include itching, watery eyes, and eyelid swelling. Report any such reactions to your healthcare provider promptly.

• Respiratory Interaction: Timolol may interact with inhaled beta agonists, such as albuterol or levalbuterol, used for asthma or COPD, reducing their effectiveness. Inform your healthcare team if you have asthma or COPD, as an alternative medication may be necessary.

• Cardiac Concerns: Timolol can affect heart rate and blood pressure, potentially exacerbating heart conditions like heart failure. Notify your healthcare team about any cardiac history or current medications. Seek immediate medical attention if you experience symptoms like shortness of breath or swelling in the legs.

• Exacerbation of Other Conditions: Combigan may worsen conditions such as vascular insufficiency or muscle weakness, including eyelid drooping. Individuals with a history of serious allergic reactions, blood flow issues, depression, or muscle weakness should exercise caution.

• Diabetes Precaution: Timolol can mask symptoms of low blood sugar, such as a fast heartbeat or shakiness. If you have diabetes, monitor your blood sugar levels more frequently and know how to manage hypoglycemia. Seek medical assistance if you experience dizziness, sweating, or confusion.

• Thyroid Considerations: Symptoms of hyperthyroidism, like a rapid heartbeat or tremors, may be masked by Combigan. Inform your healthcare provider if you have hyperthyroidism.

Contraindications: Combigan should not be used if you have any of the following conditions without consulting your healthcare provider:

• Respiratory conditions like asthma or COPD
• Symptomatic heart failure
• Heart block (second or third degree)
• Bradycardia (slow heartbeat)
• Poor cardiac output
• Children under 2 years of age
• Allergy to brimonidine or timolol

For any immediate health concerns or signs of overdose, contact emergency services or seek urgent medical care.

Common side effects:

• Temporary blurred vision
• Eye redness
• Burning
• Stinging
• Itching
• Sensation of something in the eye
• Watery eyes
• Dry eyes
• Dry mouth
• Mild headaches
• Dizziness
• Drowsiness

Less common but important to monitor:

• Crusting or discharge from the eye
• Eyelid swelling
• Changes in vision
• Eye pain

Serious side effects:

• Persistent dizziness
• Trouble breathing
• Chest pain
• Weakness on one side of the body
• Trouble speaking
• Confusion
• Allergic reaction (rash, itching, swelling, severe dizziness, trouble breathing)

Interactions with high risk of serious adverse effects and should be avoided:

• oral beta blockers (such as Propranolol)
• certain antidepressants (SSRIs such as Fluoxetine, tricyclics such as Amitriptyline)
• Digoxin
• Epinephrine
• high blood pressure medications (such as Clonidine, Methyldopa)
• quinidine

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• opioid pain or cough relievers (such as codeine, hydrocodone)
• alcohol
• marijuana (cannabis)
• drugs for sleep or anxiety (such as Alprazolam, Lorazepam, Zolpidem)
• muscle relaxants (such as Carisoprodol, Cyclobenzaprine)
• antihistamines (such as Cetirizine, diphenhydramine)