Private Simbrinza (brinzolamide/brimonidine) glaucoma drops

Simbrinza is a twice-daily fixed-combination eye drop that combines brinzolamide 10 mg/ml (a carbonic anhydrase inhibitor) with brimonidine 2 mg/ml (an alpha-2 adrenergic agonist) to lower intraocular pressure in open-angle glaucoma and ocular hypertension. It is used when a single drop has not lowered pressure enough, and is a useful prostaglandin-free, beta-blocker-free option for patients who cannot tolerate those classes. Our consultant glaucoma specialists confirm suitability, prescribe it and monitor your pressure and optic nerve.

What Simbrinza is

Simbrinza pairs two pressure-lowering medicines with complementary actions in a single bottle. Brinzolamide, a carbonic anhydrase inhibitor, reduces the production of aqueous fluid inside the eye. Brimonidine, an alpha-2 agonist, both reduces fluid production and increases its drainage through the uveoscleral route. Because the two act in different ways, the combination lowers eye pressure more than either drop alone — without using a prostaglandin or a beta-blocker.

It is prescribed for adults with open-angle glaucoma or ocular hypertension whose pressure stays too high on a single medicine, and is particularly helpful for people who cannot use a beta-blocker (for example because of asthma or certain heart conditions) or who have not tolerated a prostaglandin. For a prostaglandin-based fixed combination, compare Roclanda.

How to use it

The dose is one drop in the affected eye(s) twice daily, morning and evening. Shake the bottle before use. If you use other eye drops, leave at least five minutes between them, and remove contact lenses before instilling the drop (they can be replaced after 15 minutes). Gently pressing the inner corner of the eye for a minute after the drop reduces the amount absorbed into the body. Taking it at the same times each day gives the steadiest pressure control.

Suitability & side effects

Simbrinza suits people who need more pressure reduction than one drop provides and who want to avoid — or cannot take — a prostaglandin or beta-blocker. The most common effects are blurred vision just after instilling, eye irritation or redness, an unusual or bitter taste, and dry mouth. Because it is a carbonic anhydrase inhibitor, brinzolamide is a sulfonamide and should be avoided if you are allergic to sulfonamide medicines; it is also not suitable in severe kidney impairment. Brimonidine can occasionally cause drowsiness and is not used in young children, and care is needed with certain antidepressants (MAOIs). Your consultant weighs these against the benefit of avoiding surgery and reviews alternatives — including SLT laser and glaucoma surgery — if drops are not tolerated or not enough.

Cost of private Simbrinza treatment

The drop itself is a standard prescription medicine dispensed at pharmacy cost; the main private cost is the specialist care around it. A consultant glaucoma assessment from £240 covers your pressure check, optic-nerve and visual-field assessment, the prescription and a monitoring plan. Because glaucoma needs lifelong follow-up, most patients arrange periodic reviews. See the full glaucoma price guide, the glaucoma treatment prices, or the overall price guide.

Frequently asked questions