DORZOLAMIDE HYDROCHLORIDE AND TIMOLOL MALEATE- dorzolamide hydrochloride and timolol maleate_solution

Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free) is comprised of two components: dorzolamide hydrochloride and timolol maleate. Each of these two components decreases elevated intraocular pressure, whether or not associated with glaucoma, by reducing aqueous humor secretion. Elevated intraocular pressure is a major risk factor in the pathogenesis of optic nerve damage and glaucomatous visual field loss. The higher the level of intraocular pressure, the greater the likelihood of glaucomatous field loss and optic nerve damage. Dorzolamide hydrochloride is an inhibitor of human carbonic anhydrase II. Inhibition of carbonic anhydrase in the ciliary processes of the eye decreases aqueous humor secretion, presumably by slowing the formation of bicarbonate ions with subsequent reduction in sodium and fluid transport. Timolol maleate is a beta 1 2 Clinical Studies (14) Dorzolamide Hydrochloride When topically applied, dorzolamide reaches the systemic circulation. To assess the potential for systemic carbonic anhydrase inhibition following topical administration, drug and metabolite concentrations in RBCs and plasma and carbonic anhydrase inhibition in RBCs were measured. Dorzolamide accumulates in RBCs during chronic dosing as a result of binding to CA-II. The parent drug forms a single N-desethyl metabolite, which inhibits CA-II less potently than the parent drug but also inhibits CA-I. The metabolite also accumulates in RBCs where it binds primarily to CA-I. Plasma concentrations of dorzolamide and metabolite are generally below the assay limit of quantitation (15nM). Dorzolamide binds moderately to plasma proteins (approximately 33%). Dorzolamide is primarily excreted unchanged in the urine; the metabolite also is excreted in urine. After dosing is stopped, dorzolamide washes out of RBCs nonlinearly, resulting in a rapid decline of drug concentration initially, followed by a slower elimination phase with a half-life of about four months. To simulate the systemic exposure after long-term topical ocular administration, dorzolamide was given orally to eight healthy subjects for up to 20 weeks. The oral dose of 2 mg twice daily closely approximates the amount of drug delivered by topical ocular administration of dorzolamide 2% three times daily. Steady state was reached within 8 weeks. The inhibition of CA-II and total carbonic anhydrase activities was below the degree of inhibition anticipated to be necessary for a pharmacological effect on renal function and respiration in healthy individuals. Timolol Maleate In a study of plasma drug concentrations in six subjects, the systemic exposure to timolol was determined following twice daily topical administration of timolol maleate ophthalmic solution 0. The mean peak plasma concentration following morning dosing was 0.

Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free) is indicated for the reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension who are insufficiently responsive to beta-blockers (failed to achieve target IOP determined after multiple measurements over time). The IOP-lowering of Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution administered twice a day was slightly less than that seen with the concomitant administration of 0. 5% timolol administered twice a day and 2% dorzolamide administered three times a day [see Clinical Studies (14. 1) Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free) is a carbonic anhydrase inhibitor with a beta-adrenergic receptor blocking agent indicated for the reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension who are insufficiently responsive to beta-blockers. The IOP-lowering of COSOPT twice daily was slightly less than that seen with the concomitant administration of 0. 5% timolol twice daily, and 2% dorzolamide three times daily.

DOSAGE AND ADMINISTRATION
The dose is one drop of Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free) in the affected eye(s) two times daily. If more than one topical ophthalmic drug is being used, the drugs should be administered at least five minutes apart [see Drug Interactions (7. 3) The dose is one drop of Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.
Instructions for Use
Read these instructions before using your Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free) and each time you get a refill. There may be new information. This leaflet does not take the place of talking with your doctor about your medical condition or your treatment. Important: Dorzolamide hydrochloride and timolol maleate ophthalmic solution (preservative free) is for the eye only. Do not swallow Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free). Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free) single-use containers are packaged in a foil pouch. Write down the date you open the foil pouch in the space provided on the pouch. Every time you use Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free): Step 1. Figure A (Figure A) Step 6. Figure B (Figure B) Step 7. Figure C (Figure C) Step 9. Figure D (Figure D) Step 11. If your doctor has told you to use drops in both eyes, repeat steps 7 to 11 for your other eye. There is enough Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free) in 1 single-use container for 1 or both of your eyes. Throw away the opened single-use container with any remaining Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free) right away. This Patient Information and Instructions for Use have been approved by the U. Food and Drug Administration. Distributed by: Manufactured by: Rev 01/25 Figure A Figure B Figure C Figure D.

The most frequently reported adverse reactions were taste perversion (bitter, sour, or unusual taste) or ocular burning and/or stinging in up to 30% of patients. Conjunctival hyperemia, blurred vision, superficial punctate keratitis or eye itching were reported between 5-15% of patients. ( 6 To report SUSPECTED ADVERSE REACTIONS, contact Allucent at 1-866-511-6754 or FDA at 1-800-FDA-1088 or www. gov/medwatch. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. COSOPT and Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free) COSOPT and Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free) were evaluated in patients with elevated intraocular pressure treated for open-angle glaucoma or ocular hypertension for up to 15 months. Approximately 5% of all patients discontinued therapy because of adverse reactions. The most frequently reported adverse reactions occurring in up to 30% of patients were taste perversion (bitter, sour, or unusual taste) or ocular burning and/or stinging. The following adverse reactions were reported in 5 to 15% of patients: conjunctival hyperemia, blurred vision, superficial punctate keratitis or eye itching. The following adverse reactions were reported in 1 to 5% of patients: abdominal pain, back pain, blepharitis, bronchitis, cloudy vision, conjunctival discharge, conjunctival edema, conjunctival follicles, conjunctival injection, conjunctivitis, corneal erosion, corneal staining, cortical lens opacity, cough, dizziness, dryness of eyes, dyspepsia, eye debris, eye discharge, eye pain, eye tearing, eyelid edema, eyelid erythema, eyelid exudate/scales, eyelid pain or discomfort, foreign body sensation, glaucomatous cupping, headache, hypertension, influenza, lens nucleus coloration, lens opacity, nausea, nuclear lens opacity, pharyngitis, post-subcapsular cataract, sinusitis, upper respiratory infection, urinary tract infection, visual field defect, vitreous detachment. Other adverse reactions that have been reported with the individual components are listed below: Dorzolamide 2% Angioedema, asthenia/fatigue, bronchospasm, contact dermatitis, epistaxis, eyelid crusting, ocular discomfort, photophobia, signs and symptoms of ocular allergic reaction, transient myopia. Timolol (ocular administration) Body as a Whole: Nervous System/Psychiatric: Skin: Hypersensitivity: Endocrine: The following adverse reactions have been identified during post-approval use of COSOPT or Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free). Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure: bradycardia, cardiac failure, cerebral vascular accident, chest pain, choroidal detachment following filtration surgery, depression, diarrhea, dry mouth, dyspnea, heart block, hypotension, iridocyclitis, myocardial infarction, nasal congestion, Stevens-Johnson syndrome, toxic epidermal necrolysis, paresthesia, photophobia, respiratory failure, skin rashes, urolithiasis, and vomiting. Timolol (oral administration) The following additional adverse reactions have been reported in clinical experience with ORAL timolol maleate or other ORAL beta-blocking agents and may be considered potential effects of ophthalmic timolol maleate: Allergic: Body as a Whole: Cardiovascular: Digestive: Hematologic: Endocrine: Skin: Musculoskeletal: Nervous System/Psychiatric: Respiratory: Urogenital:.

Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free) is contraindicated in patients with: Bronchial asthma or a history of bronchial asthma, severe chronic obstructive pulmonary disease. 1 Sinus bradycardia, second or third degree atrioventricular block, overt cardiac failure, cardiogenic shock. 2 Hypersensitivity to any component of this product. 3 Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free) is contraindicated in patients with bronchial asthma, a history of bronchial asthma, or severe chronic obstructive pulmonary disease [see Warnings and Precautions (5. 1) Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free) is contraindicated in patients with sinus bradycardia, second or third degree atrioventricular block, overt cardiac failure, and cardiogenic shock [see Warnings and Precautions (5. 2) Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free) is contraindicated in patients who are hypersensitive to any component of this product [see Warnings and Precautions (5.

Teratogenic Effects. Teratogenicity studies with timolol in mice, rats, and rabbits at oral doses up to 50 mg/kg/day (7,000 times the systemic exposure following the maximum recommended human ophthalmic dose) demonstrated no evidence of fetal malformations. Although delayed fetal ossification was observed at this dose in rats, there were no adverse effects on postnatal development of offspring. Doses of 1000 mg/kg/day (142,000 times the systemic exposure following the maximum recommended human ophthalmic dose) were maternotoxic in mice and resulted in an increased number of fetal resorptions. Increased fetal resorptions were also seen in rabbits at doses of 14,000 times the systemic exposure following the maximum recommended human ophthalmic dose, in this case without apparent maternotoxicity. There are no adequate and well-controlled studies in pregnant women. Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free) should be used during pregnancy, only if the potential benefit justifies the potential risk to the fetus. It is not known whether dorzolamide is excreted in human milk. Timolol maleate has been detected in human milk following oral and ophthalmic drug administration. Because of the potential for serious adverse reactions from Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free) in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. The safety and effectiveness of dorzolamide hydrochloride ophthalmic solution and timolol maleate ophthalmic solution have been established when administered individually in pediatric patients aged 2 years and older. Use of these drug products in these children is supported by evidence from adequate and well-controlled studies in children and adults. Safety and efficacy in pediatric patients below the age of 2 years have not been established. No overall differences in safety or effectiveness have been observed between elderly and younger patients.

Potential additive effect of oral carbonic anhydrase inhibitor with Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free). 1 Potential acid-base and electrolyte disturbances. 2 Concomitant use with systemic beta-blockers may potentiate systemic beta-blockade. 3 Oral or intravenous calcium antagonists may cause atrioventricular conduction disturbances, left ventricular failure, and hypotension. 4 Catecholamine-depleting drugs may have additive effects and produce hypotension and/or marked bradycardia. 5 Digitalis and calcium antagonists may have additive effects in prolonging atrioventricular conduction time. 6 CYP2D6 inhibitors may potentiate systemic beta-blockade. 7 There is a potential for an additive effect on the known systemic effects of carbonic anhydrase inhibition in patients receiving an oral carbonic anhydrase inhibitor and Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. The concomitant administration of dorzolamide hydrochloride and timolol maleate ophthalmic solution (preservative free) and oral carbonic anhydrase inhibitors is not recommended. Although acid-base and electrolyte disturbances were not reported in the clinical trials with dorzolamide hydrochloride ophthalmic solution, these disturbances have been reported with oral carbonic anhydrase inhibitors and have, in some instances, resulted in drug interactions (e. , toxicity associated with high-dose salicylate therapy). Therefore, the potential for such drug interactions should be considered in patients receiving Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. Patients who are receiving a beta-adrenergic blocking agent orally and Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free) should be observed for potential additive effects of beta-blockade, both systemic and on intraocular pressure. The concomitant use of two topical betaadrenergic blocking agents is not recommended. Caution should be used in the coadministration of beta-adrenergic blocking agents, such as Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free), and oral or intravenous calcium antagonists because of possible atrioventricular conduction disturbances, left ventricular failure, and hypotension. In patients with impaired cardiac function, coadministration should be avoided. Close observation of the patient is recommended when a beta-blocker is administered to patients receiving catecholamine-depleting drugs such as reserpine, because of possible additive effects and the production of hypotension and/or marked bradycardia, which may result in vertigo, syncope, or postural hypotension. The concomitant use of beta-adrenergic blocking agents with digitalis and calcium antagonists may have additive effects in prolonging atrioventricular conduction time. Potentiated systemic beta-blockade (e. , decreased heart rate, depression) has been reported during combined treatment with CYP2D6 inhibitors (e. , quinidine, SSRIs) and timolol. Oral beta-adrenergic blocking agents may exacerbate the rebound hypertension which can follow the withdrawal of clonidine. There have been no reports of exacerbation of rebound hypertension with ophthalmic timolol maleate.

OVERDOSAGE
Symptoms consistent with systemic administration of beta-blockers or carbonic anhydrase inhibitors may occur, including electrolyte imbalance, development of an acidotic state, dizziness, headache, shortness of breath, bradycardia, bronchospasm, cardiac arrest and possible central nervous system effects. Serum electrolyte levels (particularly potassium) and blood pH levels should be monitored. [See Adverse Reactions (6)
NONCLINICAL TOXICOLOGY
In a two-year study of dorzolamide hydrochloride administered orally to male and female Sprague-Dawley rats, urinary bladder papillomas were seen in male rats in the highest dosage group of 20 mg/kg/day (250 times the recommended human ophthalmic dose). Papillomas were not seen in rats given oral doses equivalent to approximately 12 times the recommended human ophthalmic dose. No treatment-related tumors were seen in a 21-month study in female and male mice given oral doses up to 75 mg/kg/day (~900 times the recommended human ophthalmic dose). The increased incidence of urinary bladder papillomas seen in the high-dose male rats is a class-effect of carbonic anhydrase inhibitors in rats. Rats are particularly prone to developing papillomas in response to foreign bodies, compounds causing crystalluria, and diverse sodium salts. No changes in bladder urothelium were seen in dogs given oral dorzolamide hydrochloride for one year at 2 mg/kg/day (25 times the recommended human ophthalmic dose) or monkeys dosed topically to the eye at 0.4 mg/kg/day (~5 times the recommended human ophthalmic dose) for one year. In a two-year study of timolol maleate administered orally to rats, there was a statistically significant increase in the incidence of adrenal pheochromocytomas in male rats administered 300 mg/kg/day (approximately 42,000 times the systemic exposure following the maximum recommended human ophthalmic dose). Similar differences were not observed in rats administered oral doses equivalent to approximately 14,000 times the maximum recommended human ophthalmic dose. In a lifetime oral study of timolol maleate in mice, there were statistically significant increases in the incidence of benign and malignant pulmonary tumors, benign uterine polyps and mammary adenocarcinomas in female mice at 500 mg/kg/day, (approximately 71,000 times the systemic exposure following the maximum recommended human ophthalmic dose), but not at 5 or 50 mg/kg/day (approximately 700 or 7,000, respectively, times the systemic exposure following the maximum recommended human ophthalmic dose). In a subsequent study in female mice, in which post-mortem examinations were limited to the uterus and the lungs, a statistically significant increase in the incidence of pulmonary tumors was again observed at 500 mg/kg/day. The increased occurrence of mammary adenocarcinomas was associated with elevations in serum prolactin which occurred in female mice administered oral timolol at 500 mg/kg/day, but not at doses of 5 or 50 mg/kg/day. An increased incidence of mammary adenocarcinomas in rodents has been associated with administration of several other therapeutic agents that elevate serum prolactin, but no correlation between serum prolactin levels and mammary tumors has been established in humans. Furthermore, in adult human female subjects who received oral dosages of up to 60 mg of timolol maleate (the maximum recommended human oral dosage), there were no clinically meaningful changes in serum prolactin. The following tests for mutagenic potential were negative for dorzolamide: (1) in vivo (mouse) cytogenetic assay; (2) in vitro chromosomal aberration assay; (3) alkaline elution assay; (4) V-79 assay; and (5) Ames test. Timolol maleate was devoid of mutagenic potential when tested in vivo (mouse) in the micronucleus test and cytogenetic assay (doses up to 800 mg/kg) and in vitro in a neoplastic cell transformation assay (up to 100 mcg/mL). In Ames tests the highest concentrations of timolol employed, 5,000 or 10,000 mcg/plate, were associated with statistically significant elevations of revertants observed with tester strain TA100 (in seven replicate assays), but not in the remaining three strains. In the assays with tester strain TA100, no consistent dose response relationship was observed, and the ratio of test to control revertants did not reach 2. A ratio of 2 is usually considered the criterion for a positive Ames test. Reproduction and fertility studies in rats with either timolol maleate or dorzolamide hydrochloride demonstrated no adverse effect on male or female fertility at doses up to approximately 100 times the systemic exposure following the maximum recommended human ophthalmic dose.
CLINICAL STUDIES
Clinical studies of 3 to 15 months duration were conducted to compare the IOP-lowering effect over the course of the day of COSOPT twice daily (dosed morning and bedtime) to individually- and concomitantly-administered 0. 5% timolol twice daily and 2. 0% dorzolamide twice and three times daily. The IOP-lowering effect of COSOPT twice daily was greater (1 to 3 mmHg) than that of monotherapy with either 2. 0% dorzolamide three times daily or 0. 5% timolol twice daily. The IOP lowering effect of COSOPT twice daily was approximately 1 mmHg less than that of concomitant therapy with 2. 0% dorzolamide three times daily and 0. Open-label extensions of two studies were conducted for up to 12 months. During this period, the IOP lowering effect of COSOPT twice daily was consistent during the 12 month follow-up period. In an active-treatment controlled, parallel, double-masked study in 261 patients with elevated intraocular pressure >=22 mmHg in one or both eyes, Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0. 5% (preservative free) had an IOP-lowering effect equivalent to that of COSOPT.
Patient Information
Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution 2%/0.5% Read this information before you start using Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) and each time you get a refill. There may be new information. This information does not take the place of talking to your doctor about your medical condition or your treatment. What is Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free)? Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) is a prescription sterile eye drop solution that contains 2 medicines, dorzolamide hydrochloride (a sulfonamide carbonic anhydrase inhibitor) and timolol maleate (a beta-adrenergic blocker). Dorzolamide hydrochloride and timolol maleate ophthalmic solution (preservative free) is used to lower the pressure in the eye (intraocular pressure) in people with open-angle glaucoma or ocular hypertension, when their eye pressure is too high and beta-adrenergic blocker medicines alone have not adequately lowered the pressure. It is not known if Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) is safe and effective in children under 2 years of age. Who should not use Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free)? Do not use Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) if you: have or have had asthma have or have had severe lung problems (chronic obstructive pulmonary disease) have heart problems, including slow or irregular heartbeat or heart failure are allergic to dorzolamide hydrochloride, timolol maleate, or any of the ingredients in Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free). See the end of this leaflet for a complete list of ingredients in Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free). Talk to your healthcare provider before taking this medicine if you have any of these conditions. What should I tell my doctor before using Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free)? Before you use Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free), tell your doctor if you: have problems with muscle weakness (myasthenia gravis) have diabetes or problems with low blood sugar (hypoglycemia) have thyroid, kidney, or liver problems are planning to have surgery are allergic to sulfa drugs have or have had eye problems, including any surgery on your eye or eyes, or are using any other eye medicines have any other medical problems are pregnant or plan to become pregnant. It is not known if Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) will harm your unborn baby. If you become pregnant while using Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) talk to your doctor right away are breastfeeding or plan to breastfeed. It is not known whether dorzolamide passes into your breast milk however, timolol has been detected in breast milk. Talk to your doctor about the best way to feed your baby if you use Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free). Tell your doctor about all the medicines you take, Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) and other medicines may affect each other causing side effects. Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) may affect the way other medicines work, and other medicines may affect how Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) works. Know the medicines you take. Keep a list of them to show your doctor and pharmacist when you get a new medicine. How should I use Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free)? Read the Instructions for Use at the end of this Patient Information leaflet for additional instructions about the right way to use Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free). Use Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) exactly as your doctor tells you. Use 1 drop of Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) in your eye (or eyes ) in the morning and 1 drop in the evening. If you use other medicines in your eye, wait at least 5 minutes between using Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) and your other eye medicines. Use your Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) right away after opening. Each Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) single-use container is sterile and is to be used 1 time then thrown away. Do not save any Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) that may be left over after you use a single-use container. Using Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) that is not sterile may cause other eye problems. What are the possible side effects of Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free)? Dorzolamide hydrochloride and timolol maleate ophthalmic solution (preservative free) may cause serious side effects including: severe breathing problems. heart failure. shortness of breath irregular heartbeat (palpitations) swelling of your ankles or feet sudden weight gain severe allergic reactions. Stop taking dorzolamide hydrochloride and timolol maleate ophthalmic solution (preservative free) and call your doctor right away or get emergency help if you get any of these symptoms of an allergic reaction: swelling of your face, lips, mouth, or tongue trouble breathing wheezing severe itching skin rash, redness, or swelling dizziness or fainting fast heartbeat or pounding in your chest (tachycardia) sweating worsening muscle weakness. kidney problems. swelling of your eye (cornea) The most common side effects of Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) include: a bitter, sour, or unusual taste in your mouth after using Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) burning, stinging, redness, or itching of the eye blurred vision painful, red, watery eyes with increased sensitivity (superficial punctate keratitis) Tell your doctor if you have any new eye problems while using Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) including: an eye injury an eye infection a sudden loss of vision eye surgery swelling and redness of and around your eye (conjunctivitis) problems with your eyelids Tell your doctor if you have any other side effects that bother you. These are not all the possible side effects of Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free). For more information, ask your doctor or pharmacist. Call your doctor about medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. What should I do in case of an overdose? If you swallow the contents of the container, contact your doctor immediately. Among other effects, you may feel light-headed, have difficulty breathing, or feel your heart rate has slowed. How should I store Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free)? Store Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) at 20° to 25°C (68° to 77°F) [See USP controlled room temperature]. Do not freeze. Keep the Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) single-use containers in their original foil pouch to protect from light. Write down the date you open the foil pouch in the space provided on the pouch. Throw away all unused Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) single-use containers 15 days after first opening the pouch. Keep Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) and all medicines out of the reach of children. General information about the safe and effective use of Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free). Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) for a condition for which it was not prescribed. Do not give Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free)to other people, even if they have the same symptoms you have. It may harm them. This Patient Information leaflet summarizes the most important information about Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free). If you would like more information, talk with your doctor. You can ask your pharmacist or doctor for information about Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free) that is written for health professionals. What are the ingredients in Dorzolamide Hydrochloride and Timolol Maleate Ophthalmic Solution, 2%/0.5% (preservative free)? Active ingredients: Inactive ingredients:

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DORZOLAMIDE HYDROCHLORIDE AND TIMOLOL MALEATE- dorzolamide hydrochloride and timolol maleate_solution Product manual source documgent