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The medical landscape is constantly changing, and eye care providers have a new medication in their arsenal to fight glaucoma with the introduction of Simbrinza (Alcon).  Want a refresher on glaucoma? Simbrinza is a combination drop containing the carbonic anhydrase inhibitor brinzolamide with the alpha 2 adrenergic agonist brimonidine.  These medications individually have been used in glaucoma treatment for years, and with a combination of the two, the hope is that a patient will get the combined method-of-action effects of these two drugs with a lower frequency of daily dosing.

What You Need to Know:

Early FDA studies show Simbrinza to have a high efficacy in the lowering of IOP (intraocular pressure) with a reported 21-35% reduction.  The recommended dosage is 3 x a day for maximum effect.  Not surprisingly, side effects and contraindications are indicative of what we would find with each individual drug:

Most common side effects: blurred vision, eye irritation, unpleasant taste, dry mouth, and eye allergy

Price:  Around $100/ bottle for cash pay patients; coupon cards available through Alcon
      -- At this time I do not know the average copay with medical insurance to expect, but I will try to update this when I receive the information!

When Not to Use:

Like all CAIs, Simbrinza is not recommended for patients with known sulfa allergies, significant corneal endothelial loss (it can result in corneal edema in patients with conditions like Fuch's Dystrophy), or in conjunction with oral CAIs.

Like all alpha 2 adrenergic agonists, there is a risk of hypotension when combined with anti-hypertensives, an increased risk of side-effects when taken concurrently with MAO Inhibitors, and lethargy in children under 6 years of age (in as high as 50-83% of pediatric glaucoma patients! -- most specialists highly advise against pediatric dosing of this drug as a result).

The drug is Pregnancy Class C, meaning it is not advisable unless the benefits outweigh the potential risks.

Why This is Exciting News for our Industry

Any time we get new glaucoma medication, it is a step in the right direction.  Even though this particular drug only combines two existing therapies, combination drugs already on the market are so effective because they require less dosage for patients.  Imagine you were taking brimonidine and a CAI individually.  You have 2 different bottles to buy every month and as many as 6 drops to instill a day (up to 3 x a day each).  Then imagine getting just 1 bottle to keep track of for the month, and dosing half as often.  It may not seem like much of a difference, but studies routinely show that poor drop compliance is a huge reason glaucoma patients suffer progressive damage.  Glaucoma is a painless and symptomless disease, and remembering to put 6 drops in a day is probably not going to happen unless you are the most vigilant of patients.  By making your patient's drops easier to remember to take, and less of a drain on their day, you can make it easier for them to keep their pressure controlled every day of the year!