Lowering IOP is the most readily modifiable risk factor to delay the development and progression of
glaucoma (POAG). The fixed combination of
brimonidine tartrate 0.2% and
timolol maleate 0.5% (FCBT) combines a highly selective alpha2-adrenergic agonist (
brimonidine) with a non-selective beta-blocker (
timolol). FCBT reduces aqueous production and enhances uveoscleral outflow. Concomitant
brimonidine and
timolol have additive effects on reducing intraocular pressure (IOP). Multi-center randomized control trials have documented superiority of FCBT twice daily on IOP control compared with monotherapy with the individual components, and equal efficacy compared with concomitant
therapy. IOP reduction with FCBT versus fixed combination
dorzolamide 2% and
timolol 0.5% (
FCDT) was similar in a small study. Other studies (n > 293) evaluating concomitant
brimonidine and
timolol have shown that it is not inferior to
FCDT. However, concomitant
brimonidine and
timolol administered twice daily was significantly less efficacious in IOP reduction than fixed combination
latanoprost 0.005% and
timolol 0.5% (FCLT). There are no published studies comparing FCBT with FCLT. The side effect profile for FCBT reflects that of its individual components. FCBT was generally well tolerated, with less ocular side effects than brimondine alone, but more than
timolol alone. Documented systemic effects were few, although this could be confounded by selection bias. FCBT is a safe and effective IOP lowering agent for POAG and
ocular hypertension.