Cozopt SUD 2%+0.5% Ophthalmic Solution

✔️ Pharmacology / Mode of Action

Cozopt SUD combines two medicines that lower intraocular pressure through complementary mechanisms.

Dorzolamide inhibits carbonic anhydrase in the ciliary processes of the eye. This reduces the formation of bicarbonate ions and subsequently decreases the production of aqueous humour.

Timolol is a non-selective beta-adrenergic receptor blocker. It reduces aqueous humour production in the eye, thereby lowering intraocular pressure.

The combined effect of dorzolamide and timolol provides greater reduction in intraocular pressure than either medicine used alone.

✔️ Cozopt is contraindicated in patients with:

• Hypersensitivity to dorzolamide, timolol, sulfonamides, or any component of the formulation
• Bronchial asthma or a history of bronchial asthma
• Severe chronic obstructive pulmonary disease
• Sinus bradycardia
• Second- or third-degree atrioventricular block
• Overt cardiac failure
• Cardiogenic shock
• Severe renal impairment (CrCl <30 mL/min)
• Hyperchloremic acidosis

✔️ How Cozopt Works

Cozopt lowers intraocular pressure by reducing the production of aqueous humour.

• Dorzolamide reduces aqueous humour production by inhibiting carbonic anhydrase.
• Timolol reduces aqueous humour production through beta-adrenergic blockade.

Together, these effects lower intraocular pressure and help protect the optic nerve from pressure-related damage.

✔️ Interaction

Systemic absorption of timolol and dorzolamide may result in clinically relevant interactions.

Cozopt may have additive effects with:

• Oral calcium-channel blockers
• Other beta-blockers
• Catecholamine-depleting medicines
• Antiarrhythmic medicines, including amiodarone
• Digitalis glycosides
• Parasympathomimetic medicines
• Certain narcotic medicines
• Monoamine oxidase inhibitors (MAOIs)
• Oral carbonic anhydrase inhibitors

Concomitant use with other beta-blockers or systemic carbonic anhydrase inhibitors may increase systemic effects and should be undertaken only under medical supervision.

CYP2D6 inhibitors, including some quinidine and SSRI medicines, may increase systemic beta-blockade from timolol.

Patients should inform their doctor about all prescription medicines, over-the-counter medicines, and supplements they are using.

✔️ Dosage & Administration

Adults

For ocular hypertension or open-angle glaucoma:

Instill 1 drop into the affected eye(s) twice daily, or use exactly as prescribed by the ophthalmologist.

Children

Safety and efficacy in children younger than 2 years have not been established, and use is generally contraindicated.

For children 2 years and older, dosing should be determined by an ophthalmologist.

Renal Impairment

Cozopt should generally not be used in patients with severe renal impairment (CrCl <30 mL/min).

How to Use

1. Wash your hands before using the eye drops.
2. Check that the container is intact and that the seal has not been broken before first use.
3. If instructed for this formulation, gently shake the container before use.
4. Remove contact lenses before instilling the drops.
5. Tilt your head back and gently pull down the lower eyelid.
6. Hold the vial/dropper close to the eye without touching the eye, eyelid, eyelashes, or any other surface.
7. Instill one drop into the lower eyelid pocket.
8. Close the eye gently after application.
9. Apply gentle pressure to the corner of the eye near the nose for approximately 1 minute to reduce systemic absorption.
10. Wipe away any excess solution.

If more than one ophthalmic medicine is prescribed, allow an interval of at least 5–10 minutes between different eye drops, unless otherwise directed.

Remove contact lenses before application and wait at least 15 minutes before reinserting them.

✔️ Cozopt should be used cautiously in patients with:

• Mild to moderate renal impairment
• Liver impairment
• Cardiac disease
• Hypotension
• Prinzmetal's angina
• Myasthenia gravis
• Peripheral or central circulatory disorders
• A history of renal stones
• Previous intraocular surgery
• Pre-existing chronic corneal defects

Timolol may:

• Cause or worsen bronchospasm in susceptible patients
• Slow the heart rate and reduce blood pressure
• Mask certain symptoms of hypoglycaemia
• Mask some clinical signs of hyperthyroidism
• Worsen certain peripheral circulatory disorders
• Affect patients with myasthenia gravis

Treatment should generally not be stopped abruptly, particularly in patients with coronary heart disease. If cardiac failure develops, treatment should be medically reassessed and discontinued when appropriate.

Patients should not drive or operate machinery if blurred vision or other visual disturbances occur.

✔️ Pregnancy & Lactation

Pregnancy

Cozopt should be used during pregnancy only when clearly necessary and after careful assessment by a healthcare professional.

Lactation

Dorzolamide and timolol may be excreted into breast milk. Use during breastfeeding is generally not recommended unless specifically advised by a healthcare professional.

✔️ Missed Dose

If a dose is missed, administer it as soon as remembered.

If it is nearly time for the next scheduled dose, skip the missed dose and continue with the regular dosing schedule.

Do not use a double dose to compensate for a missed dose.

✔️ Side Effects

Common Eye-related Effects

• Burning or stinging
• Eye discomfort or irritation
• Blurred vision
• Dry eyes
• Eye redness
• Excessive tearing
• Photophobia
• Superficial punctate keratitis
• Ocular allergic reactions
• Bitter or unusual taste

Other Reported Effects

• Headache
• Fatigue
• Nausea
• Dizziness
• Paresthesia
• Depression
• Reduced exercise tolerance

Timolol-related Systemic Effects

Because timolol may be absorbed systemically, it can rarely cause:

• Bradycardia
• Arrhythmia
• Syncope
• Hypotension
• Shortness of breath
• Bronchospasm
• Chest pain
• Oedema
• Raynaud's phenomenon

Serious reactions such as cardiac failure, severe bronchospasm, Stevens-Johnson syndrome, or toxic epidermal necrolysis are rare but require immediate medical attention.

✔️ Storage:

• Store according to the manufacturer's instructions.
• Keep away from excessive heat, light, and moisture.
• Keep the container properly closed when not in use.
• Keep out of reach of children.
• Do not use the medicine if the container is damaged or the seal is broken before first use.