Brimolol Drug Interactions

There is possibility of an addictive or potentiating effect with CNS depressants (alcohol, barbiturates, opiates, sedatives or anaesthetics) should be considered.
There is potential for additive effects resulting in hypotension, and/or marked bradycardia when beta-blocker eye drops are administered concomitantly with oral calcium channel blockers, guanethidine, beta-blocking agents, anti-arrhythmics (including amiodarone), digitalis glycosides parasympathomimetics and other anti-hypertensives. Caution is advised when using YSP BRIMOLOL EYE DROP with systemic antihypertensives. Although timolol has little or no effect on the size of the pupil, mydriasis has occasionally been reported when timolol has been used with mydriatic agents such as adrenaline. Beta-blockers may increase the hypoglycaemic effect of antidiabetic agents. Beta-blockers can mask the signs and symptoms of hypoglycaemia.
The hypertensive reaction to sudden withdrawal of clonidine can be potentiated when taking beta-blockers. Potentiated systemic beta-blockade (e.g. decreased heart rate, depression) has been reported during combined treatment with CYP2D6 inhibitors [e.g., quinidine, selective serotonin reuptake inhibitors (SSRIs)] and timolol, possibly because quinidine inhibits the metabolism of timolol via the P450 enzyme, CYP2D6.
Concomitant use of a beta-blocker with anaesthetic drugs may attenuate compensatory tachycardia and increase the risk of hypotension and therefore the anaesthetist must be informed if the patient is using YSP BRIMOLOL EYE DROP. Caution must be exercised if YSP BRIMOLOL EYE DROP is used concomitantly with iodine contrast products or intravenously administered lidocaine. Cimetidine, hydralazine and alcohol may increase the plasma concentrations of timolol.
The hypertensive reaction to sudden withdrawal of clonidine can be potentiated when taking beta-blockers. No data on the level of circulating catecholamines after YSP BRIMOLOL EYE DROP administration are available. Caution however is advised in patients taking tricyclic antidepressants which can affect the metabolism and uptake of circulating amines e.g. chlorpromazine, methylphenidate, reserpine.
Caution is advised when initiating (or changing the dose of) a concomitant systemic agent (irrespective of pharmaceutical form) which may interact with α-adrenergic agonists or interfere with their activity i.e. agonists or antagonists of the adrenergic receptor (e.g. isoprenaline, prazosin).
Although specific drug interactions studies have not been conducted with YSP BRIMOLOL EYE DROP, the theoretical possibility of an additive IOP lowering effect with prostamides, prostaglandins, carbonic anhydrase inhibitors and pilocarpine should be considered. Concomitant administration of MAO inhibitors is contraindicated. Patients who have been receiving MAOI therapy should wait 14 days after discontinuation before commencing treatment with YSP BRIMOLOL EYE DROP.
Patients who are receiving a systemic (e.g., oral or intravenous) beta-adrenergic blocking agent and YSP BRIMOLOL EYE DROP should be observed for potential additive effects of beta-blockade both systemic and on intraocular pressure.