COSOPT (DORZOLAMIDE HCL/TIMOLOL MALEATE)

Ophthalmologist Carolina Valdivia, MD discusses Cosopt (Dorzolamide HCL/Timolol Maleate), a medication used in the treatment of glaucoma and high intraocular pressure.

What is Cosopt?

This is an eye-drop medicine for lowering pressure inside the eye in people with open-angle glaucoma or high intraocular pressure. People with these conditions have pressures in one or both of their eye(s) that are too high for them. High intraocular pressure may damage the optic nerve, which can lead to loss of vision and possible blindness.

There generally are few symptoms that you can feel to tell you whether you have high intraocular pressure. Your doctor needs to examine your eyes to determine this. Cosopt If you are found to have high intraocular pressure, you will need to have your pressure checked and your eyes examined regularly.

Cosopt is a combination of two glaucoma medications: strong>dorzolamide hydrochloride, which is an ophthalmic carbonic-anhydrase-inhibiting drug, and timolol maleate, which is a beta-blocking drug. This medication is used when a beta-blocker eye drop alone is not adequate to control high intraocular pressure. It is convenient because it combines two effective medications into one glaucoma eye drop.

You should exercise care when using these glaucoma eye drops. It is important not to contaminate the dorzolamide - Timolol maleate solution, as this can cause harm to the eye. If you are using more than one medication, administration of the eye drops should be spaced at least ten minutes apart to provide adequate time for absorption.

This drug should be stored at room temperature, away from bright light, and out of the reach of children.

Who should NOT take Cosopt?

These glaucoma eye drops are not recommended, or should be used only under extreme precautions, if you have or have had:

heart failure.
cardiogenic shock.
sinus bradycardia.
atrioventricular block.
bronchial asthma.
chronic obstructive pulmonary disease (COPD).
Overactive thyroid (hyperthyroidism).

Major surgery, including eye surgery, may require discontinuation of these glaucoma eye drops.

What should I tell my doctor before I take the first dose?

Tell your ophthalmologist about all prescription, over-the-counter, and herbal medications you are taking before beginning treatment with these glaucoma eye drops. Additionally, share your complete medical history, especially if you are pregnant or plan to become pregnant. It is important to notify your doctor about previous eye infections, family history of glaucoma, diabetes, kidney, or liver problems.

What is the usual dosage?

The information that I present below is based on the dosage guidelines from the manufacturer. Depending on your condition and medical history, your doctor may prescribe a different regimen. Do not change the dosage or stop taking your medication without your doctor's knowledge.

The usual starting dose is one drop (2% – 0.5%) in the affected eye twice daily.
You should shake the medicine well before use. Prior to administration, wash your hands thoroughly. Remove the cap and position yourself with your head tilted back. Gently pull your lower eye lid with your index finger and administer the drops in each eye without touching the eye or eyelid with the tip of the applicator.
After administration of a drop, blink a few times and remove any excess liquid with a clean tissue. Repeat this process for the other eye and wash your hands. If more than one type of eye drop is being used, the drugs need to be spaced out by at least ten minutes.
Avoid allowing the tip of the applicator to contact your eye, finger, or any other surface in order to avoid contamination of the product. Contamination may lead to serious damage to your eye.
If you use contact lenses, you should be aware that Cosopt contains benzalkonium chloride which may be absorbed by soft contact lenses. You should remove your contact lenses prior to administering the eye drops. Lenses may be reinserted 15 minutes following administration.

What are possible food and drug interactions associated with this medication?

If these glaucoma eye drops are used with certain other drugs, the effects of either could be increased, decreased, or otherwise altered. It is particularly important to check with your doctor before combining Cosopt with any of the following medications.
Oral carbonic anhydrase inhibitors, such as acetazolamide or Diamox
Oral beta-blockers, such as propranolol, Inderal and metoprolol
Calcium antagonists, such as nifedipine or Procardia
Catecholamine-depleting drugs, such as reserpine
Digitalis in combination with calcium antagonists, such as Lanoxin with Procardia
Anti-diabetes drugs, such as insulin and metformin
Quinidine, such as Cardioquin
Calcium channel blockers, such as verapamil and diltiazem
Clonidine, such as Catapres
Injectable epinephrine, such as EpiPen
SSRIs, such as fluoxetine or Prozac

What are the possible side effects?

Any medicine may have unintended or undesirable effects. These are called side effects. Side effects may not occur, but if they do occur, you may need medical attention. If you experience any problems or if they change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking this combination of dorzolamide and timolol maleate. Discontinuing this medication on your own could result in high intraocular pressure, which can lead to optic nerve damage.
According to the manufacturer, the most common side effects you may experience from this dorzolamide and timolol maleate combination are:
Blurred vision.
Bitter taste in the mouth after administration.
Burning/stinging in the eyes.
Tearing or itching in the eyes.
Eye redness.
Other side effects may occur rarely, and some of these may be serious. Tell your doctor right away if you experience:
Shortness of breath.
Visual changes.
An irregular heartbeat and/or a slowing of your heart rate.
Severe skin reactions.
The above is NOT a complete list of all side effects reported with Cosopt. Your doctor can discuss with you a more complete list of side effects.

Can I use these glaucoma eye drops if I am pregnant or breastfeeding?

There are no adequate and well-controlled studies in pregnant women. Cosopt 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 Cosopt 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.

What should I do if I miss a dose?

If you miss a dose, take it as soon as you remember. If it is close to the time of your next dose, skip it and resume your scheduled dose. Do not double your dose.

REFERENCE:
Sweetman SC. Martindale: The Complete Drug Reference, 36th Ed. London: Pharmaceutical Press, 2009.

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My goal in providing information about medications is to give you a starting point for having an informed conversation with your doctor. However, under no circumstances should the information presented here be used as a substitute for an ongoing consultation with your doctor. Since I have not examined you, I only can speak in terms of generalities, whereas your doctor has sufficient clinical details to evaluate your case specifically and prescribe appropriate treatment.

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