Consumer medicine information

BrinzoQuin Eye Drops 1.0%

Brinzolamide

BRAND INFORMATION

Brand name

BrinzoQuin

Active ingredient

Brinzolamide

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using BrinzoQuin Eye Drops 1.0%.

What is in this leaflet

Please read this leaflet carefully before you use any BrinzoQuin Eye Drops.

This leaflet answers some common questions about BrinzoQuin. It does not contain all of the available information. It does not take the place of talking to your doctor or pharmacist.

The information in this leaflet was last updated on the date listed on the final page. More recent information on the medicine may be available.

You should ensure that you speak to your pharmacist or doctor to obtain the most up to date information on the medicine.

You can also download the most up to date leaflet from www.novartis.com.au The updates may contain important information about the medicine and its use of which you should be aware.

All medicines have risks and benefits. Your doctor has weighed the expected benefits of you taking Brinzoquin against the risks this medicine could have for you.

If you have any concerns about taking this medicine, ask your doctor or pharmacist.

Keep this leaflet with the medicine. You may need to read it again.

What BrinzoQuin is used for

BrinzoQuin Eye Drops contain the active ingredient brinzolamide, which belongs to a class of medicines known as "carbonic anhydrase inhibitors".

BrinzoQuin Eye Drops are used, either alone or in combination with other eye drops/medicines, to lower high pressure inside the eye(s) and to treat open-angle glaucoma or hypertension (high pressure) in the eye.

Glaucoma is a condition in which the pressure of fluid in the eye may be high. However, some people with glaucoma may have normal eye pressure.

Glaucoma is usually caused by a build up of the fluid which flows through the eye. This build up occurs because the fluid drains out of the eye more slowly than it is being pumped in. Since new fluid continues to enter the eye, joining the fluid already there, the pressure continues to rise. This raised pressure may damage the back of the eye resulting in gradual loss of sight. Damage can progress so slowly that the person is not aware of this gradual loss of sight. Sometimes even normal eye pressure is associated with damage to the back of the eye.

There are usually no symptoms of glaucoma. The only way of knowing that you have glaucoma is to have your eye pressure, optic nerve and visual field checked by an eye specialist or optometrist. If glaucoma is not treated, it can lead to serious problems, including total blindness. In fact, untreated glaucoma is one of the most common causes of blindness.

BrinzoQuin Eye Drops lower the pressure within the eye by reducing the production of fluid.

Although BrinzoQuin Eye Drops help to control your glaucoma, they do not cure it.

For more information about glaucoma, contact Glaucoma Australia Inc. (PO BOX 420, Crows Nest 1585 telephone 1800 500 880).

Ask your doctor if you have any questions about why BrinzoQuin has been prescribed for you. Your doctor may have prescribed it for another reason.

This medicine is only available with a doctor’s prescription.

BrinzoQuin Eye Drops are not addictive.

Use in Children

BrinzoQuin Eye Drops are not recommended for use in children. The safety and effectiveness of BrinzoQuin Eye Drops in children has not been established.

Before you use BrinzoQuin

When you must not use it

Do not use BrinzoQuin eye Drops if have an allergy to:

  • any medicine containing brinzolamide
  • any other carbonic anhydrase inhibitor
  • any of the other ingredients listed under "product description" at the end of this leaflet.

If you think you may be allergic, ask your doctor or healthcare provider for advice.

Some of the symptoms of an allergic reaction may include:

  • shortness of breath
  • wheezing or difficulty breathing
  • swelling of the face, lips, tongue or other parts of the body
  • rash, itching or hives on the skin.

Do not use BrinzoQuin Eye Drops if:

  • you have severe kidney disease
  • you have high levels of chloride in your blood (hyperchloraemia)

Do not use this medicine after the expiry date printed on the pack or if the seal around the pack is broken or shows signs of tampering. If it is has expired or is damaged, return it to your pharmacist for disposal.

Do not use this medicine if the eye drops are not a white or off-white suspension. Return it to your pharmacist.

If you are not sure whether you should start using this medicine talk to your doctor.

Before you start to use it

Tell your doctor if:

  • You have an allergy to sulfonamide medicines
    The active ingredient of BrinzoQuin Eye Drops, brinzolamide, is a sulfur-containing medicine (a sulfonamide). If you are allergic to sulfur medicines, such as some antibiotics, medicines used to treat diabetes and also diuretics (water tablets), you may be allergic to BrinzoQuin Eye Drops. Check with your doctor or pharmacist if you are not sure whether you are allergic to sulfonamides.
  • You are pregnant, or intend to become pregnant
    Your doctor will discuss the possible risks and benefits of using BrinzoQuin during pregnancy.
  • You are breast-feeding or intend to breast-feed
    Your doctor will discuss the possible risks and benefits of using BrinzoQuin during when you are breast-feeding.
  • You have or have had any medical conditions such as problems with your liver or kidneys.
  • You have impaired corneas which can occur in diabetes mellitus, low endothelial cell counts or in a condition called corneal dystrophies.
    If you are unsure if you have any of these conditions ask your doctor.
  • You have an allergy to any other medicines or any other substances, such as foods, preservatives or dyes.
  • If you have or have had any severe skin reactions like skin rash, skin peeling, blistering of the lips, eyes or mouth.

If you have not told your doctor about any of the above, tell them before you use BrinzoQuin Eye Drops.

  • Do not put BrinzoQuin Eye Drops into your eye(s) while you are wearing contact lenses.

The preservative in BrinzoQuin Eye Drops, benzalkonium chloride, may cause eye irritation and is also known to discolour soft contact lenses.

You can put your contact lenses back into your eyes 15 minutes after you have used BrinzoQuin Eye Drops.

Taking or using other medicines

  • Tell your doctor if you are taking or using any other medicines, including any that you buy without a prescription from your pharmacy, supermarket or health food shop.

Some medicines and BrinzoQuin Eye Drops may interfere with each other.

These include:

  • Aspirin, in high doses
  • High dose of salicylate-containing medicines which are used to relieve pain
  • Other medicines known as "carbonic anhydrase inhibitors" that you take to treat glaucoma.

These medicines may be affected by BrinzoQuin Eye Drops, or may affect how well it works. You may need different amounts of your medicines, or you may need to take different medicines.

If you are taking another carbonic anhydrase inhibitor (acetazolamide or dorzolamide) or medicines that are nonsteroidal anti-inflammatory drugs (NSAIDs) or salicylates, talk to your doctor or healthcare provider.

Your doctor or pharmacist has more information on medicines to be careful with or avoid while using this medicine.

How to use BrinzoQuin

Use BrinzoQuin Eye Drops only as prescribed by your doctor.

Follow all directions given to you by your doctor or healthcare provider carefully.

They may differ from the information contained in this leaflet.

If you do not understand the instructions on the box ask your doctor or pharmacist for help.

How much to use

The usual dose of BrinzoQuin Eye Drops is one drop in the affected eye(s) twice a day. This will normally be in the morning and at night. Your doctor will tell you how many drops you need to use each day.

After using BrinzoQuin Eye Drops wait at least 5 minutes before putting any other eye drops in your eye(s). Eye ointment should be administered last.

If you are being changed from one eye drop to another, follow your doctor’s instructions carefully as to when to stop the old drops and when to start the new drops.

If you are unsure about when, or how, to stop using BrinzoQuin Eye Drops you should talk to your doctor.

Do not use BrinzoQuin Eye Drops more often than your doctor or pharmacist has told you.

How to use BrinzoQuin

Follow these steps to use BrinzoQuin Eye Drops:

  1. Wash your hands thoroughly.
  2. Immediately before using a bottle for the first time, break the safety seal around the neck area and throw the loose plastic ring away.
  3. Shake the bottle.
  4. Remove the cap from the bottle.
  5. Hold the bottle upside down in one hand between your thumb and middle finger (see Diagram 1).

  1. Tilt your head back and look up.
  2. Using your other hand, gently pull down your lower eyelid to form a pouch/pocket.

  1. Place the dropper tip close to, but not touching, your eye. Release one drop into the pouch/pocket formed between your eye and eyelid by gently tapping or pressing the base of the bottle with your forefinger (see Diagrams 2 and 3).
  2. Close your eye gently without blinking and press on the inside corner of the eye with the pad of your index finger for two minutes.
  3. If necessary, repeat steps 4-8 for your other eye.
  4. Replace the cap on the bottle, closing it tightly.
  5. Wash your hands again with soap and water to remove any residue.

You may feel a slight burning sensation in the eye shortly after using BrinzoQuin Eye Drops. If this persists, or is very uncomfortable, contact your doctor or pharmacist.

Do not touch the tip of the dropper to your eye or to any other surface. This will help to prevent your eye drops becoming dirty or contaminated.

When to use it

Use BrinzoQuin Eye Drops at about the same time every day unless your doctor tells you otherwise.

Using your eye drops at the same time each day will have the best effect on your eye pressure. It will also help you remember when to use the eye drops.

How long to use it

BrinzoQuin Eye Drops help control your condition but will not cure it. BrinzoQuin Eye Drops must be used every day. Continue using BrinzoQuin Eye Drops for as long as your doctor prescribes.

If you forget to use it

If you forget to use BrinzoQuin Eye Drops you should put the drops that you missed in your eye(s) as soon as you remember and then go back to using them as recommended by your doctor.

If it is almost time for your next dose, skip the dose you missed and use your next dose when you are meant to.

Otherwise, use the drops as soon as you remember, and then go back to using them as you would normally.

If you are not sure whether to skip the dose, talk to your doctor or pharmacist.

Do not use double the amount to make up for the dose that you missed. Using multiple doses may cause unwanted side effects.

If you use too much (overdose)

If you accidentally put several drops in your eye(s), immediately rinse your eye(s) with warm water.

If you think that you or anyone else may have swallowed any or all of the contents of a bottle of BrinzoQuin Eye Drops, immediately telephone your doctor or Poisons Information Centre on 131126 for advice or go to Accident and Emergency at your nearest hospital.

Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention.

While you are using BrinzoQuin

Things you must do

To make sure that BrinzoQuin is working properly, have your eye pressure checked regularly.

Keep all your doctor’s appointments so that your progress can be checked.

If you develop an eye infection, receive an eye injury or have eye surgery tell your doctor.

If you notice signs of serious reactions or hypersensitivity including severe skin reaction such as skin rash, red skin, blistering of the lips, eyes or mouth, skin peeling and fever (signs of Stevens-Johnson syndrome or toxic epidermal necrolysis) discontinue the use of this medication and seek medical attention immediately.

You doctor may tell you to use a new container of BrinzoQuin because of possible contamination of the old one, or may advise you to stop your treatment with BrinzoQuin Eye Drops.

Tell your doctor if you become pregnant while you are using BrinzoQuin Eye Drops.

Tell your doctor and pharmacist that you are using BrinzoQuin Eye Drops before you start taking or using any other medicines.

Things you must not do

Do not stop using BrinzoQuin Eye Drops without first asking your doctor.

Do not use this medicine to treat other complaints unless your doctor or pharmacist tell you to.

Do not give this medicine to anyone else, even if they appear to have the same condition as you.

Do not let children handle BrinzoQuin Eye Drops. If a child accidentally swallows any of the drops read the instructions under "If you use too much (overdose)"

Things to be careful of

Be careful of driving or operating machinery until you know how BrinzoQuin Eye Drops affect you and your vision. As with any eye medicine, temporary blurred vision or other visual disturbances may affect the ability to drive and use machinery in some people. If blurred vision occurs when you use your drops, wait until your vision is clear before driving or operating machinery.

Side Effects

Tell your doctor as soon as possible if you do not feel well while you are using BrinzoQuin Eye Drops.

All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects.

Most side effects from BrinzoQuin Eye Drops occur in, or around, the eye. These include:

  • Blurred or abnormal vision
  • Discomfort, irritation or feeling of something in the eye(s)
  • Redness of the eye(s)
  • Dry eye(s)
  • Eye pain
  • Discharge from the eye(s)
  • Itchy eye(s)
  • Watering of the eye(s).

Additional side effects that are noticed more rarely in the eye include:

  • Swelling of the clear front part of the eye(s)
  • Red, itchy, irritated, crusty, swollen eyelid(s)
  • Swelling of the skin around the eye(s)
  • Crusty eyelashes
  • Sticky sensation in the eye(s)
  • Tired eye(s)
  • Sensitivity to bright lights
  • Double vision
  • Seeing flashes or sparks of light
  • Eye numbness.

Occasionally some people notice unwanted effects in the rest of their body as a result of using BrinzoQuin Eye Drops. These effects may include:

  • Headache
  • Chest pain, shortness of breath
  • Unusual tiredness or weakness
  • Dry mouth and/or nose
  • Blocked or running nose
  • Bleeding nose
  • Sore throat, irritation and/or coughing
  • Mucous in the chest
  • Nausea, indigestion, diarrhoea and/or upset stomach
  • Tingling, numbness and/or dizziness
  • Depression
  • Abnormal dreams
  • Muscle stiffness
  • Agitation
  • Change in sensation of taste
  • Loss of memory
  • Nervousness
  • Rash, itchy skin
  • Hair loss
  • Persistent noises in the ear(s)
  • Impotence
  • Kidney pain.

Stop using BrinzoQuin and tell your doctor immediately or go to Accident and Emergency at your nearest hospital if any of the following happen:

  • Generalised itching and/or hives
  • Chest pain
  • Shortness of breath
  • Severe and sudden onset of pinkish, itchy swelling on the skin, also called hives or nettle rash.
  • Skin rash, red skin, skin peeling, blistering of the lips, eyes or mouth, fever or any combination of these (Stevens-Johnson syndrome / toxic epidermal necrolysis)

These are hypersensitivity reactions and are very serious side effects. You may need urgent medical attention or hospitalisation. These side effects are very rare.

Tell your doctor if you notice any other effects.

Other side effects not listed above may also occur in some patients.

Do not be alarmed by the list of possible side effects. You may not experience any of them.

After using BrinzoQuin

Storage

Keep your eye drops in a cool place where the temperature stays below 25°C. Do not freeze the eye drops.

Do not leave BrinzoQuin Eye Drops in the car, the bathroom or in other warm, damp places. Heat and dampness can destroy some medicines.

A locked cupboard at least one and a half metres above ground is good place to store medicines.

Keep it where children cannot reach it.

Put the top back on the bottle right away after use to avoid contaminating the eye drops. Do not leave the top off the bottle for any length of time.

Disposal

Write the date on the bottle when you open the eye drops and throw out any remaining solution after four weeks.

Open a new bottle every four weeks. Eye drops contain a preservative which helps prevent germs growing in the solution for the first four weeks after opening the bottle. After this time there is a greater risk that the drops may become contaminated and cause an eye infection.

If your doctor tells you to stop using the eye drops or they have passed their expiry date, ask your pharmacist what to do with any remaining solution.

Product Description

What it looks like

BrinzoQuin Eye Drops is a sterile suspension that comes in a 5mL dropper bottle with screw cap. The safety seal must be removed before use.

Ingredients

The active ingredient in BrinzoQuin is brinzolamide 10 mg/mL (1.0%).

It also contains the inactive ingredients:

  • mannitol
  • carbomer 974P
  • sodium chloride
  • tyloxapol
  • disodium edetate
  • sodium hydroxide and/or hydrochloric acid (to adjust pH)
  • purified water
  • benzalkonium chloride 0.1 mg/mL (as a preservative)

Supplied by

BrinzoQuin is supplied in Australia by:

Novartis Pharmaceuticals Australia Pty Limited
ABN 18 004 244 160
54 Waterloo Road
Macquarie Park NSW 2113
Telephone: 1-800-671-203
Web site: www.novartis.com.au

Australian registration number

AUST R No. 99179

This leaflet was prepared in November 2023.

® Registered Trademark

© Novartis Pharmaceuticals Australia Pty Limited 2022

Internal document code
(brq091123c) based on PI (brq091123i)

Published by MIMS December 2023

BRAND INFORMATION

Brand name

BrinzoQuin

Active ingredient

Brinzolamide

Schedule

S4

 

1 Name of Medicine

Brinzolamide.

2 Qualitative and Quantitative Composition

The eye drops suspension contains 10 mg/mL (1%) brinzolamide and also 0.1 mg/1 mL benzalkonium chloride as a preservative.
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

Eye drops.
BrinzoQuin is a white to off-white, uniform suspension.

4 Clinical Particulars

4.1 Therapeutic Indications

BrinzoQuin Eye Drops 1.0% are indicated to decrease intraocular pressure in: ocular hypertension, open-angle glaucoma.

4.2 Dose and Method of Administration

The recommended dosage is one drop of BrinzoQuin in the conjunctival sac of the affected eye(s) twice daily.
When substituting for another ophthalmic anti-glaucoma agent with BrinzoQuin, the other agent should be discontinued and BrinzoQuin should be started on the following day.

Concomitant therapy.

BrinzoQuin has been used concomitantly with other agents e.g. travoprost, latanoprost, timolol (see Section 5.1 Pharmacodynamic Properties, Clinical trials). In case of concomitant therapy with more than one topical ophthalmic medicinal product being used, the eye drops must be administered with an interval of at least five minutes. Eye ointments should be administered last.

Method of administration.

For ocular use. Patients should be instructed to shake the bottle well prior to use.
To avoid contamination, the dropper tip should not touch any surface. The dropper tip should also not come into contact with the eye as this may cause injury to the eye. Patients should be instructed to keep the bottle tightly closed when not in use.
Instillation of eye drops may cause initial discomfort (see Section 4.8 Adverse Effects (Undesirable Effects)).
Nasolacrimal occlusion and closing the eyelid for two minutes, after instillation is recommended. This may result in a decrease in systemic side effects and an increase in local activity.
Patients must be instructed to remove soft contact lenses prior to application of BrinzoQuin and to wait fifteen minutes after instillation of the dose before reinsertion.

4.3 Contraindications

BrinzoQuin is contraindicated in patients with a known hypersensitivity to brinzolamide, sulfonamides or any of the excipients in the product (see Section 6.1 List of Excipients).
BrinzoQuin is also contraindicated in patients with severe renal impairment and in patients with hyperchloraemic acidosis.

4.4 Special Warnings and Precautions for Use

Not for injection or oral ingestion.
The management of patients with acute angle-closure glaucoma requires therapeutic interventions in addition to ocular hypotensive agents. BrinzoQuin has not been studied in patients with acute angle-closure glaucoma.
Brinzolamide is a sulfonamide and, although administered topically, is absorbed systemically. The same types of adverse reactions or hypersensitivity that are attributable to sulfonamides may, therefore, occur with topical administration. Hypersensitivity reactions reported with sulfonamide derivatives, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), can occur in patients receiving BrinzoQuin. At the time of prescription, patient should be advised of the signs and symptoms and monitored closely for skin reactions. BrinzoQuin should be discontinued immediately if signs of serious reactions or hypersensitivity occur.
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 BrinzoQuin. The concomitant administration of BrinzoQuin and oral carbonic anhydrase inhibitors has not been studied and is not recommended.
Acid-base disturbances have been reported with oral carbonic anhydrase inhibitors. BrinzoQuin should be used with caution in patients with risk of renal impairment because of the possible risk of metabolic acidosis.
The possible role of brinzolamide on corneal endothelial function has not been investigated in patients with compromised corneas (particularly in patients with low endothelial cell count). Carbonic anhydrase inhibitors may affect corneal hydration, which may lead to a corneal decompensation and oedema. Careful monitoring of patients with compromised corneas, such as patients with diabetes mellitus or corneal dystrophies, is recommended.
BrinzoQuin contains benzalkonium chloride which may cause eye irritation and is known to discolour soft contact lenses. Avoid contact with soft contact lenses. Patients must be instructed to remove contact lenses prior to application of BrinzoQuin and wait at least 15 minutes before reinsertion.

Contact lenses.

If patients continue to wear soft (hydrophilic) contact lenses while under treatment with BrinzoQuin, they should remove their lens(es) prior to instilling BrinzoQuin in the affected eye(s) and should not insert their lens(es) until 15 minutes after instillation of the eye drops.

Use in hepatic impairment.

BrinzoQuin has not been studied in patients with hepatic impairment. Caution should, therefore, be exercised if a decision is made to commence therapy with BrinzoQuin in such patients.

Use in renal impairment.

BrinzoQuin has not been studied in patients with severe renal impairment (CrCl < 30 mL/min) or in patients with hyperchloraemic acidosis. Brinzolamide and its main metabolite are predominantly excreted by the kidney; BrinzoQuin is, therefore, contraindicated in such patients (see Section 4.3 Contraindications).

Use in the elderly.

In clinical studies conducted with brinzolamide 1.0%, the probability of having an adverse reaction was independent of age. No differences in patients experiencing adverse reactions were noted when patients less than 65 years of age were compared to patients greater than 65 years of age. There are no modifications to the recommended dosing regimen for elderly patients.

Paediatric use.

The safety and effectiveness of BrinzoQuin in paediatric patients have not been established.

Effects on laboratory tests.

No data available.

4.5 Interactions with Other Medicines and Other Forms of Interactions

Specific drug interaction studies have not been performed with BrinzoQuin. In clinical studies, however, brinzolamide 1.0% were used concomitantly with the following medications without evidence of adverse interactions: timolol maleate eye drops, systemic medications including ACE inhibitors, calcium-channel blockers, diuretics, non-steroidal anti-inflammatory drugs including aspirin, and hormones (e.g. oestrogen, insulin, thyroxine).
Association between BrinzoQuin and miotics or adrenergic agonists has not been fully evaluated during adjunctive glaucoma therapy.
Brinzolamide is a carbonic anhydrase inhibitor and, although administered topically, is absorbed systemically. In clinical studies, brinzolamide was not associated with acid-base disturbances. These disturbances have, however, been reported with oral carbonic anhydrase inhibitors and have, in some instances, resulted in drug interactions (e.g. nonsteroidal anti-inflammatory drugs (NSAIDs) and toxicity associated with high-dose salicylate therapy). The potential for such drug interactions should, therefore, be considered in patients receiving BrinzoQuin.
There is potential for an additive effect on the known systemic effects of carbonic anhydrase inhibition in patients receiving an oral carbonic anhydrase inhibitor and BrinzoQuin. The concomitant administration of BrinzoQuin and oral carbonic anhydrase inhibitors is not recommended.

4.6 Fertility, Pregnancy and Lactation

Effects on fertility.

A fertility and early embryonic study, in which male and female rats were dosed by oral gavage with brinzolamide at doses up to 18 mg/kg/day, showed no effects on fertility or reproductive capacity. Studies have not been performed to evaluate the effect of topical ocular administration of brinzolamide on human fertility.
(Category B3)
Studies in animals with brinzolamide have shown reproductive toxicity following systemic administration. Radioactivity was found to cross the placenta and was present in the foetal tissues and blood following oral administration of 14C-brinzolamide to pregnant rats.
Developmental toxicity studies in rabbits at oral doses up to 6 mg/kg/day brinzolamide produced maternal toxicity at 6 mg/kg/day and a significant increase in the number of foetal variations, such as accessory skull bones; at 1 and 6 mg/kg/day the incidence was only slightly higher than seen historically. In rats, statistically significant decreased bodyweights of foetuses from dams receiving oral doses of 18 mg/kg/day during gestation were proportional to the reduced maternal weight gain, with no statistically significant effects on organ or tissue development. No treatment-related malformations were seen.
No studies of the use of ophthalmic brinzolamide have been conducted in pregnant women. BrinzoQuin should be used during pregnancy only if the potential benefit justifies the potential risk to the foetus.
Studies in animals have shown that following oral administration brinzolamide is excreted in breast milk. Following oral administration of 14C-brinzolamide to lactating rats, radioactivity was found in milk at concentrations below those in the blood and plasma. Decreases in pup bodyweights were observed at 15 mg/kg/day in a pre- and postnatal study in which rats were given brinzolamide by oral gavage at doses up to 15 mg/kg/day.
It is not known whether brinzolamide is transferred into human milk following topical ocular administration. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from brinzolamide, 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 developmental and health benefits of breast-feeding should be considered along with the mother's clinical need for BrinzoQuin and any potential adverse effects on the breast-fed child from BrinzoQuin.

4.7 Effects on Ability to Drive and Use Machines

As with other ophthalmic medications, patients should be advised to exercise caution if they experience transient blurred vision or other visual disturbances following instillation of eye drops; patients should wait until their vision clears before driving or using machinery.
Additionally, nervous system disorders have been reported with the use of the product which may affect the ability to drive or use machines (see Section 4.8 Adverse Effects (Undesirable Effects)).

4.8 Adverse Effects (Undesirable Effects)

In well-controlled clinical studies, undesirable effects related to brinzolamide 1.0% were non-serious, generally mild to moderate, and usually did not lead to discontinuation of therapy. Tabulated adverse reaction data (considered to be possibly, probably or definitely related to treatment), providing comparisons to placebo and other active comparators (to an incidence 1% or greater), which have been generated from all clinical studies with brinzolamide 1.0%, are provided in Table 1.
Uncommon ophthalmic events (incidence < 1% and ≥ 0.1%) not detailed in Table 1 included blepharitis, conjunctivitis, lid margin crusting, sticky sensation, eye fatigue, abnormal vision, keratopathy, keratoconjunctivitis, corneal staining, eye disorder, photophobia, diplopia, meibomitis, vision changes, irritation, glare and lid disorder.
Uncommon non-ocular events (incidence < 1% and ≥ 0.1%) not detailed in Table 1 included:

Body as a whole.

Chest pain, asthenia and pain.

Digestive.

Dry mouth, nausea, dyspepsia, diarrhoea, gastrointestinal disturbance.

Nervous.

Paraesthesia, depression, dizziness, dream abnormality, hypertonia, agitation, amnesia, depersonalisation, nervousness.

Respiratory.

Dyspnoea, pharyngitis, bronchitis, dry nose, epistaxis.

Skin and appendages.

Dermatitis, alopecia, urticaria, pruritus.

Special senses.

Tinnitus.

Urogenital.

Kidney pain, impotence.

Postmarketing experience.

The following adverse reactions have been reported during clinical studies with BrinzoQuin and are classified according to the subsequent convention: very common (≥ 1/10), common (≥ 1/100 to < 1/10), uncommon (≥ 1/1,000 to < 1/100), rare (≥ 1/10,000 to < 1/1,000) and very rare (< 1/10,000). Within each frequency-grouping, adverse reactions are presented in order of decreasing seriousness.

Eye disorders.

Common (≥ 1% to < 10%): vision blurred, eye irritation, eye pain, dry eye, eye discharge, ocular discomfort, ocular hyperaemia.
Uncommon (≥ 0.1% to < 1%): corneal erosion, punctate keratitis, keratitis, conjunctivitis, conjunctivitis allergic, blepharitis, visual acuity reduced, photophobia, asthenopia, periorbital oedema, eye pruritus, lacrimation increased, eyelid margin crusting.
Rare (≥ 0.01% to < 0.1%): corneal oedema, diplopia, reduced visual acuity, photopsia, hypoaesthesia eye, periorbital oedema.

Psychiatric disorders.

Uncommon (≥ 0.1% to < 1%): depression.
Rare (≥ 0.01% to < 0.1%): insomnia.

Nervous system disorders.

Common (≥ 1% to < 10%): headache, dysgeusia.
Uncommon (≥ 0.1% to < 1%): dizziness, paresthesia.
Rare (≥ 0.01% to < 0.1%): memory impairment, somnolence.

Cardiac disorders.

Rare (≥ 0.01% to < 0.1%): angina pectoris, heart rate irregular.

Respiratory, thoracic and mediastinal disorders.

Uncommon (≥ 0.1% to < 1%): dyspnoea, epistaxis, rhinorrhoea, oropharyngeal pain, upper airway cough syndrome, throat irritation.
Rare (≥ 0.01% to < 0.1%): bronchial hyperreactivity, upper respiratory tract congestion, sinus congestion, nasal congestion, cough, nasal dryness.

Gastrointestinal disorders.

Uncommon (≥ 0.1% to < 1%): nausea, diarrhoea, dyspepsia, abdominal discomfort, dry mouth.

Skin and subcutaneous tissue disorders.

Uncommon (≥ 0.1% to < 1%): rash.
Rare (≥ 0.01% to < 0.1%): urticaria, alopecia, pruritus generalised.

General disorders and administration site conditions.

Uncommon (≥ 0.1% to < 1%): fatigue, irritability.
Rare (≥ 0.01% to < 0.1%): feeling jittery, asthenia.
See Table 2.

Reporting suspected adverse effects.

Reporting suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions at www.tga.gov.au/reporting-problems.

4.9 Overdose

No information on systemic overdosage is available in humans. Treatment should be symptomatic and supportive. Electrolyte imbalance, development of an acidotic state, and possible nervous system effects may occur. Serum electrolyte levels (particularly potassium) and blood pH levels should be monitored.
A topical overdose of BrinzoQuin may be flushed from the eyes with warm tap water.
In Australia, contact Poisons Information Centre on 13 11 26 for advice on management.
For information on the management of overdose, contact the Poisons Information Centre on 13 11 26 (Australia).

5 Pharmacological Properties

5.1 Pharmacodynamic Properties

Mechanism of action.

Brinzolamide is a carbonic anhydrase inhibitor. When instilled in the eye, BrinzoQuin has the action of reducing elevated intraocular pressure, whether or not accompanied by glaucoma.
Glaucoma is defined as an optic neuropathy resulting in optic nerve head damage and visual field loss. The pathogenesis of glaucoma is multi-factorial, however, the primary risk factors are considered to be sustained elevated intraocular pressure and poor ocular perfusion. The ocular hypotensive action of brinzolamide is mediated through inhibition of carbonic anhydrase in the ciliary processes of the eye which decreases aqueous humour secretion, presumably by slowing the formation of bicarbonate ions with subsequent reduction in sodium and fluid transport.
Carbonic anhydrase is an enzyme found in many tissues of the body, including the eye. Carbonic anhydrase catalyses the reversible reaction involving the hydration of carbon dioxide and the dehydration of carbonic acid. In humans, carbonic anhydrase exists as a number of isoenzymes, the most active being CA-II, found primarily in red blood cells (RBCs), but also in other tissues. Brinzolamide is an inhibitor of carbonic anhydrase II (CA-II), which is the predominant iso-enzyme in the eye, with an in vitro IC50 of 3.2 nanoM and a Ki of 0.13 nanoM against CA-II. Brinzolamide has also been shown to have a low affinity for 34 receptors or second messenger systems, indicating selectivity for CA-II.

Clinical trials.

In two randomised, double-masked studies of 3 month duration, monotherapy with brinzolamide eye drops 1.0% produced a significant reduction in intraocular pressure when dosed twice daily; this intraocular pressure reduction was equivalent to that of dorzolamide 2% dosed three times daily (see Table 3). No additional clinically or statistically significant benefit was evident following administration of brinzolamide eye drops three times daily.
In a long-term (18 month study) comparing brinzolamide 1.0% (n = 94) with timolol maleate 0.5% (n = 49; both twice daily), the mean absolute changes in intraocular pressure (mmHg) at 18 months were -4.0 (95% CI: -4.6, -3.4) and -5.5 (95% CI: -6.4, -4.7) respectively. Eighty-one patients completed the study; the results indicated that the intraocular pressure lowering effect of brinzolamide 1.0% does not diminish over time.
Thirty volunteers with a diagnosis of asthma or chronic obstructive pulmonary disease were enrolled in a masked, cross-over design study to compare the acute effects of brinzolamide 1.0% versus timolol maleate 0.5% on pulmonary function as measured by forced expiratory volume in one second (FEV1). Within 15 minutes of the instillation of a single drop of timolol maleate 0.5%, statistically significant decreases in mean FEV1 were observed (compared to both baseline and brinzolamide 1.0%); these continued for up to 3 hours following instillation. No effect was observed on FEV1 following the instillation of brinzolamide 1.0%.
Two masked, well-controlled studies, each of one-week duration, were designed to compare the comfort of brinzolamide 1.0% twice daily to dorzolamide eye drops 2.0% three times daily. Each of these studies indicated that a significantly greater (p < 0.001) percentage of patients experienced no discomfort following repeated instillation of brinzolamide 1.0%, as shown in Table 4.

Concomitant therapy.

Two phase IV clinical studies assessed the efficacy and safety of brinzolamide when added concomitantly to prostaglandins (i.e. travoprost and latanoprost). The available data support a lowering of IOP when brinzolamide is added to these agents.
One 12-week, double-masked, randomised study in which 215 patients with ocular hypertension or primary open-angle glaucoma were enrolled, was conducted. A total of 201 patients were randomised and 192 were included in the per protocol analysis. The primary objective of the study was to compare the efficacy and safety of brinzolamide 1% and timolol 0.5%, each administered twice daily when added to travoprost 0.004% administered once daily in the evening. Patients who were considered inadequately controlled on monotherapy (travoprost, latanoprost or bimatoprost) were eligible to be enrolled in this study. The primary endpoint was mean diurnal IOP.
There was no statistically significant difference in mean diurnal IOP at 12 weeks between the treatment groups (18.1 mmHg vs 18.1 mmHg in the brinzolamide and timolol groups, respectively). The mean reductions in diurnal IOP were 3.4 mmHg and 3.2 mmHg for the brinzolamide and timolol groups, respectively. Overall, the efficacy of brinzolamide 1%, as concomitant therapy, was comparable to concomitant therapy with timolol 0.5%. There was a higher incidence of local adverse effects (conjunctival hyperaemia, burning or foreign body sensation) with brinzolamide than with timolol; however, the differences were not statistically significant.
A second, open-label 12-week study was conducted in 82 patients with open-angle glaucoma or ocular hypertension. A total of 79 patients were evaluable for the intent-to-treat analysis. Patients, requiring additional IOP-lowering from a baseline of travoprost eye drops, received brinzolamide 1% concomitantly. The primary efficacy endpoint was the mean reduction in IOP at 12 weeks.
There was a mean reduction of 3.9 mmHg after 4 weeks and 4.2 mmHg after 12 weeks. Overall, 43 patients (60.6%) had an IOP below 18 mmHg at the conclusion of the study.
Additional studies have been published concerning IOP control (Tsukamoto et al. J. Ocular Pharmacol. Ther. 21: 170-173, 2005, Tsukamoto et al. J. Ocular Pharmacol. Ther. 21: 395-399, 2005). These studies suggest that brinzolamide might be added to dual therapy (latanoprost plus beta-blocker) or substituted for dorzolamide in triple therapy.
When used twice daily, adjunctively to timolol maleate 0.5% for 3 months, brinzolamide 1.0% provided an additional intraocular pressure lowering effect. This was equivalent to dorzolamide 2% dosed twice daily adjunctively to timolol maleate 0.5% (see Table 5). No additional clinically or statistically significant benefit was evident following administration of brinzolamide 1.0% three times daily.
During this study, up to 89.3% (at peak) receiving brinzolamide 1.0% in combination with timolol maleate 0.5% achieved an intraocular pressure reduction ≥ 5 mmHg or had their intraocular pressure reduced to ≤ 21 mmHg. These results were equivalent to those seen with dorzolamide eye drops 2.0% in combination with timolol maleate 0.5% (85.4%).

5.2 Pharmacokinetic Properties

Following topical ocular administration, brinzolamide is absorbed into the systemic circulation. Due to its high affinity for carbonic anhydrase II (CA-II), brinzolamide distributes extensively into the red blood cells (RBCs) and exhibits a long half-life in whole blood (approximately 111 days). In humans, the metabolite N-desethyl brinzolamide is formed, which also binds to CA and accumulates in RBCs. This metabolite binds mainly to CA-I in the presence of brinzolamide. In plasma, both parent brinzolamide and N-desethyl brinzolamide concentrations are low and generally below assay quantitation limits (< 10 nanogram/mL). Binding to plasma proteins is not extensive (approximately 60%). Brinzolamide is eliminated predominantly in the urine as unchanged drug. N-desethyl brinzolamide is also found in the urine along with lower concentrations of the N-desmethoxypropyl and O-desmethyl metabolites.
An oral pharmacokinetic study was conducted in which healthy volunteers received 1 mg capsules of brinzolamide twice daily for up to 32 weeks. This regimen provided a higher systemic exposure rate than topical ocular administration of brinzolamide dosed in both eyes three times daily, and simulated systemic drug and metabolite concentrations similar to those achieved with long-term topical dosing. RBC CA activity was measured to assess the degree of systemic CA inhibition.
Brinzolamide saturation of RBC CA-II was achieved within 4 weeks (RBC concentrations of approximately 20 microM). N-desethyl brinzolamide accumulated in RBCs to steady-state within 20-28 weeks reaching concentrations ranging from 6-30 microM. The inhibition of total RBC CA activity at steady state was approximately 70-75%, which is below that expected to adversely affect renal function or respiration in healthy subjects.
An oral pharmacokinetic study was conducted in which subjects with mild to moderate renal impairment (creatinine clearance of 30-60 mL/minute) received 1 mg capsules of brinzolamide twice daily for up to 54 weeks. By week 4 of treatment, parent drug RBC concentrations ranged from approximately 20 to 40 microM and showed little subsequent change. At steady state, parent drug and N-desethyl metabolite RBC concentrations ranged from 22.0 to 46.1 and 17.1 to 88.6 microM, respectively. Metabolite RBC concentrations, but not those of parent drug, showed a significant (p < 0.05) increase with decreasing creatinine clearance. Total RBC CA activity, but not CA-II activity, showed a significant decrease as creatinine clearance decreased. In spite of the greater inhibition of total CA activity in subjects showing the highest degree of renal impairment, all subjects showed < 90% total CA inhibition at steady state. This is below the 99% or greater inhibition associated with systemic adverse effects.
In a topical ocular study, patients with open-angle glaucoma or ocular hypertension received brinzolamide 1.0% either two or three times daily for up to 18 months. Steady-state concentrations of brinzolamide were reached for most subjects within 6-9 months, while steady state for the N-desmethyl metabolite was reached within 12 to 18 months. At steady state, brinzolamide RBC concentrations were similar to those found in the oral study, but levels of the N-desmethyl metabolite were lower. Carbonic anhydrase activity was approximately 40-70% of per-dose levels, indicating a degree of inhibition that was substantially lower than that observed orally and unlikely to elicit systemic side effects.

5.3 Preclinical Safety Data

Genotoxicity.

Genotoxicity studies with brinzolamide did not demonstrate any mutagenic potential in one in vitro (Ames assay) or chromosomal damage in an in vivo assay (micronucleus formation). Brinzolamide did induce forward mutations in the mouse lymphoma assay in vitro, with, but not without metabolic activation. Brinzolamide was negative in a sister chromatid exchange assay in mice.

Carcinogenicity.

A two year bioassay, in which rats were dosed by oral gavage at doses up to 8 mg/kg/day brinzolamide revealed no evidence of a carcinogenic effect. A similar study conducted in mice (0, 1, 3 and 10 mg/kg/day brinzolamide dosed by oral gavage) also showed that brinzolamide was non-carcinogenic. The mouse study did, however, reveal a statistically significant increase in urinary bladder tumours in female mice given 10 mg/kg/day orally for 24 months. Dose-related proliferative changes in the urinary bladder were observed in female mice at all dose levels and among males at 10 mg/kg/day. The elevated bladder tumour incidence was due to the increased incidence of a tumour considered to be unique to mice.

6 Pharmaceutical Particulars

6.1 List of Excipients

Mannitol, carbomer 974P, sodium chloride, tyloxapol, disodium edetate, sodium hydroxide and/or hydrochloric acid (for pH adjustment), purified water and benzalkonium chloride.

6.2 Incompatibilities

Incompatibilities were either not assessed or not identified as part of the registration of this medicine.

6.3 Shelf Life

Discard container 4 weeks after opening.
In Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

Store below 25°C.

6.5 Nature and Contents of Container

BrinzoQuin Eye Drops 1.0% is available in LDPE bottle dispenser. Pack sizes: 1 x 5 mL and 1 x 10 mL.
Not all pack sizes may be marketed.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of in accordance with local requirements.

6.7 Physicochemical Properties

Brinzolamide is presented as white to off-white crystals or powder.
Brinzolamide is very slightly soluble in water at neutral pH.

Chemical structure.


Molecular weight: 383.51.
Empirical formula: C12H21N3O5S3.
Chemical name: (R)-4-(ethylamino)-3,4-dihydro- 2-(3-methoxypropyl)- 2H-thieno[3,2-e]-1,2-thiazine- 6-sulfonamide-1,1-dioxide.

CAS number.

138890-62-7.

7 Medicine Schedule (Poisons Standard)

Prescription Only Medicine (Schedule 4).

Summary Table of Changes