Elevated IOP in open-angle glaucoma or ocular hypertension
1 drop in the affected eye(s) TID
Lowers IOP 4.2 to 5.6 mmHg across peak and trough, matching dorzolamide with less stinging.
OFF-LABELNot in the FDA label for this product
Cystoid macular edema in inherited retinal dystrophy
1 drop TID
Case series · n=7
Weak, case-series level. Retrospective single-center chart review of 7 children (4 X-linked retinoschisis, 2 retinitis pigmentosa, 1 Leber congenital amaurosis), all prescribed TID, 6 treated: 4 of 6 showed a mild decrease in central macular thickness and all 6 had improved acuity at a mean 33 months, and the authors state that further study is needed. The larger carbonic anhydrase inhibitor evidence base in this setting was built on topical dorzolamide and oral acetazolamide, not on brinzolamide.
Hypersensitivity to any component of this product.
Available Forms
1% (brinzolamide 10 mg/mL) ophthalmic suspension, 10 mL, 15 mL
Mechanism of Action
Topical carbonic anhydrase II inhibitor. Inhibiting the enzyme in the ciliary processes slows bicarbonate ion formation, with a subsequent reduction in sodium and fluid transport, so aqueous humor secretion and IOP fall.
Warnings & Precautions
Sulfonamide hypersensitivity: A sulfonamide that is absorbed systemically despite topical dosing, so the reactions attributable to sulfonamides can occur, rarely fatal, including Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, agranulocytosis, aplastic anemia, and other blood dyscrasias. Sensitization may recur when a sulfonamide is readministered by any route; discontinue immediately at the first sign of a serious reaction or hypersensitivity.
Corneal endothelium: Carbonic anhydrase activity is present in the corneal endothelium, and patients with low endothelial cell counts have an increased potential for corneal edema.
Severe renal impairment: Not studied at CrCl below 30 mL/min and not recommended there, since parent drug and metabolite are excreted predominantly by the kidney.
Acute angle-closure glaucoma: Not studied in this setting, which needs therapeutic intervention beyond an ocular hypotensive agent.
Oral carbonic anhydrase inhibitors: Concomitant use is not recommended; the systemic effects of carbonic anhydrase inhibition are potentially additive.
High-dose salicylate therapy: Acid-base and electrolyte alterations were not reported in the brinzolamide trials, but rare instances have occurred with oral carbonic anhydrase inhibitors plus high-dose salicylates; consider the same potential.
Transient blurred vision: Vision may blur after dosing, which matters for driving and machinery.
Contact lens wear: The benzalkonium chloride preservative may be absorbed by soft lenses; remove lenses before instillation and reinsert 15 minutes after.
Tip contamination: Common bacteria that cause ocular infections can contaminate the container; keep the dispensing tip off the eye and adnexa.
Common Side Effects
Ocular, 5% to 10%: Blurred vision.
Systemic, 5% to 10%: Bitter, sour, or unusual taste.
Ocular, 1% to 5%: Blepharitis, dry eye, foreign body sensation, hyperemia, ocular discharge, ocular discomfort, keratitis, ocular pain, ocular pruritus.
Systemic, 1% to 5%: Headache, dermatitis, rhinitis.
Ocular, under 1%: Conjunctivitis, keratoconjunctivitis, keratopathy, diplopia, eye fatigue, tearing, lid margin crusting.
Postmarketing: Stevens-Johnson syndrome and toxic epidermal necrolysis, attributed to the sulfonamide component; frequency not estimable.
Pregnancy & Lactation
Pregnancy: No adequate and well-controlled studies in pregnant women. Oral dosing in rats produced decreased fetal body weight with reduced skeletal ossification at 375 times the recommended human ophthalmic dose, no-effect level 125 times; no treatment-related fetal effects at any dose in rabbits.
Lactation: No data on presence in human milk, effects on the breastfed infant, or effects on milk production; detected in the milk of lactating rats.
Pediatric Use
IOP-lowering efficacy not demonstrated from 4 weeks to 5 years of age.
Available Forms
Mechanism of Action
Pregnancy & Lactation
Pediatric Use