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Brimonidine-Timolol

Drug Information

Common brand names:

Combigan

Summary of Interactions with Vitamins, Herbs, & Foods

Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • none

Reduce Side Effects

  • Coenzyme Q10

    In a group of 16 glaucoma patients treated with a timolol eye preparation, six weeks of oral coenzyme Q10 (90 mg per day) was reported to reduce timolol-induced cardiovascular side effects without affecting intraocular pressure treatment.1

Support Medicine

  • none

Reduces Effectiveness

  • Yohimbe

    The active ingredients in yohimbine can block the actions of brimonidine in certain human tissues,2 thus reducing the drug’s beneficial effects. Adequate human studies involving the eye are lacking, and until more information is available, yohimbine should be avoided in people using brimonidine.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Potential Negative Interaction

  • Pleurisy Root

    As pleurisy root and other plants in the Aesclepius genus contain cardiac glycosides, it is best to avoid use of pleurisy root with heart medications such as beta-blockers.3

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Potassium

    Some beta-adrenergic blockers (called “nonselective” beta blockers) decrease the uptake of potassium from the blood into the cells,4 leading to excess potassium in the blood, a potentially dangerous condition known as hyperkalemia.5 People taking beta-blockers should therefore avoid taking potassium supplements, or eating large quantities of fruit (e.g., bananas), unless directed to do so by their doctor.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Explanation Required 

  • none

The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a new supplement with your doctor or pharmacist.

References

1. Takahashi N, Iwasaka T, Sugiura T, et al. Effect of coenzyme Q10 on hemodynamic response to ocular timolol. J Cardiovasc Pharmacol 1989;14:462-8.

2. Berlan M, LeVerge R, Galitzky J, LeCorre P. Alpha 2-adrenoceptor antagonist potencies of two hydroxylated metabolites of yohimbine. Br J Pharmacol 1993;108:927-32.

3. Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-Care Professionals. London: Pharmaceutical Press, 1996, 213-4.

4. Rosa RM, Silva P, Young JB, et al. Adrenergic modulation of extrarenal potassium disposal. N Engl J Med 1980;302:431-4.

5. Lundborg P. The effect of adrenergic blockade on potassium concentrations in different conditions. Acta Med Scand Suppl 1983;672:121-6 [review].

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