Do not use COMBIGAN:

• 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.

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.

Children and adolescents

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

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 breast-feeding.

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.

COMBIGAN contains benzalkonium chloride

This medicine contains 0.25 mg benzalkonium chloride in each 5 ml of solution which is equivalent to 0.05 mg/ml.

• Benzalkonium chloride may be absorbed by soft contact lenses and may change the colour of the contact lenses. You should remove contact lenses before using this medicine and put them back 15 minutes afterwards.
• Benzalkonium chloride may also cause eye irritation, especially if you have dry eyes or disorders of the cornea (the clear layer at the front of the eye). If you feel abnormal eye sensation, stinging or pain in the eye after using this medicine, talk to your doctor

COMBIGAN contains phosphates:

This medicine contains 52.9 mg phosphates in each 5 ml of solution which is equivalent to 10.58 mg/ml.

If you suffer from severe damage to the clear layer at the front of the eye (the cornea), phosphates may cause in very rare cases cloudy patches on the cornea due to calcium build-up during treatment.