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((Short description|Chemical compound))
<span class="plainlinks"></span>((More citations needed|date=October 2017))
((Drugbox
| verifiedrevid = 459982553
| image = Brinzolamide.svg

<!--Clinical data-->
| pronounce = brin ZOH la mide
| tradename = Azopt
| Drugs.com = ((drugs.com|monograph|brinzolamide))
| MedlinePlus = a601233
| licence_EU = yes
| DailyMedID = Brinzolamide
| licence_US = Brinzolamide
| pregnancy_AU = B3
| pregnancy_AU_comment = <ref name="Drugs.com pregnancy">((cite web | title=Brinzolamide ophthalmic (Azopt) Use During Pregnancy | website=Drugs.com | date=16 May 2019 | url=https://www.drugs.com/pregnancy/brinzolamide-ophthalmic.html | access-date=17 August 2020))</ref>
| pregnancy_category =  
| routes_of_administration = [[Ophthalmic drug administration|Ophthalmic]]
| ATC_prefix = S01
| ATC_suffix = EC04
| ATC_supplemental =  

| legal_AU = S4
| legal_UK = <!-- GSL / P / POM / CD -->
| legal_US = Rx-only
| legal_EU = Rx-only
| legal_status =  

<!--Pharmacokinetic data-->
| bioavailability = Absorbed systemically, but below detectable levels (less than 10 ng/mL)
| protein_bound = ~60%
| metabolism =  
| elimination_half-life = 111 days
| excretion = Kidney (60%)

<!--Identifiers-->
| IUPHAR_ligand = 6797
| CAS_number_Ref = ((cascite|correct|??))
| CAS_number = 138890-62-7
| PubChem = 68844
| DrugBank_Ref = ((drugbankcite|correct|drugbank))
| DrugBank = DB01194
| ChemSpiderID_Ref = ((chemspidercite|correct|chemspider))
| ChemSpiderID = 62077
| UNII_Ref = ((fdacite|correct|FDA))
| UNII = 9451Z89515
| KEGG_Ref = ((keggcite|correct|kegg))
| KEGG = D00652
| ChEBI_Ref = ((ebicite|correct|EBI))
| ChEBI = 3176
| ChEMBL_Ref = ((ebicite|correct|EBI))
| ChEMBL = 220491

<!--Chemical data-->
| IUPAC_name = (5''R'')-5-ethylamino-3-(3-methoxypropyl)-<br />2,2-dioxo-2λ<sup>6</sup>,9-dithia-<br />3-azabicyclo[4.3.0]nona-7,10-diene-<br />8-sulfonamide
| C=12 | H=21 | N=3 | O=5 | S=3
| smiles = O=S(=O)(c1sc2c(c1)[C@@H](NCC)CN(CCCOC)S2(=O)=O)N
| StdInChI_Ref = ((stdinchicite|correct|chemspider))
| StdInChI = 1S/C12H21N3O5S3/c1-3-14-10-8-15(5-4-6-20-2)23(18,19)12-9(10)7-11(21-12)22(13,16)17/h7,10,14H,3-6,8H2,1-2H3,(H2,13,16,17)/t10-/m0/s1
| StdInChIKey_Ref = ((stdinchicite|correct|chemspider))
| StdInChIKey = HCRKCZRJWPKOAR-JTQLQIEISA-N
))

'''Brinzolamide''' (trade name '''Azopt''') is a [[carbonic anhydrase inhibitor]] used to lower intraocular pressure in patients with open-angle [[glaucoma]] or ocular hypertension.

Brinzolamide was approved as a [[generic medication]] in the United States in November 2020.<ref>((cite web | title=First Generic Drug Approvals | website=U.S. [[Food and Drug Administration]] (FDA) | url=https://www.fda.gov/drugs/drug-and-biologic-approval-and-ind-activity-reports/first-generic-drug-approvals | access-date=13 February 2021))</ref>

== Chemistry ==
Brinzolamide is a [[carbonic anhydrase inhibitor]] (specifically, carbonic anhydrase II). Carbonic anhydrase is found primarily in [[erythrocytes]] (but also in other tissues including the eye). It exists as a number of isoenzymes, the most active of which is carbonic anhydrase II (CA-II).

== Indications ==
Use for the treatment of open-angle glaucoma and raised intraocular pressure due to either excess aqueous humor production or inadequate drainage of the humor via the [[trabecular meshwork]].

== Pharmacodynamics ==
Inhibition of carbonic anhydrase in the ciliary processes of the eye decreases aqueous humor secretion and thus lowers the intraocular pressure in the anterior chamber, presumably by reducing the rate of formation of bicarbonate ions with subsequent reduction in sodium and fluid transport; this may alleviate the effects of open-angle glaucoma.

== Pharmacokinetics ==

=== Absorption ===
The recommended frequency for topical application is two times per day. Following ocular instillation, the suspension is systemically absorbed to some degree; however the plasma concentrations are low and generally below the limits of detection (less than 10&nbsp;ng/mL) due to extensive binding by tissues and erythrocytes. Oral administration is less-favored due to variable absorption from the stomach mucosa and an increased side-effect profile versus ophthalmic administration.

=== Distribution ===
The compound is fairly well protein-bound (60%), but adheres extensively to the carbonic anhydrase-containing erythrocytes. Due to the abundance of readily-bound erythrocytes and minimal known metabolism, Brinzolamide's whole blood half-life is very long (111 days).

=== Metabolism ===
While definitive sites of metabolism have not been firmly established, there are several metabolites worthy of note. N-Desethylbrinzolamide is an active metabolite of the parent compound, and thus exhibits carbonic anhydrase inhibitory activity (largely carbonic anhydrase-I, when in the presence of Brinzolamide) and also accumulates in the erythrocytes. However, Brinzolamide's other known metabolites (N-Desmethoxypropylbrinzolamide and O-Desmethylbrinzolamide) either have no activity or their activity is currently unknown.

=== Excretion ===
Brinzolamide is excreted primarily unchanged (60%) in the urine, although the renal clearance rate has not been definitively determined. N-Desethylbrinzolamide is also found in the urine along with lower concentrations of the inactive metabolites, N-Desmethoxypropylbrinzolamide and O-Desmethylbrinzolamide; exact levels have not been definitively determined.

== Cautions ==

=== Side effects ===
*Common, but mild: blurred vision; bitter, sour, or unusual taste; itching, pain, watering, or dryness of the eyes; feeling that something is in the eye; headache; runny nose
*Rare, but serious: fast or irregular heartbeat; fainting; skin rash, hives, or itching; severe eye irritation, redness, or swelling; swelling in the face, lips, or throat; wheezing or trouble breathing

=== Precautions ===
*Hypersensitivity to other [[sulfonamide]]s
*Acute [[angle-closure glaucoma]]
*Concomitant administration of oral [[carbonic anhydrase inhibitor]]s
*Moderate-to-severe [[chronic kidney disease]] or liver disease

== Combinations ==

=== With timolol ===
The combination of brinzolamide with [[timolol]] is marketed under the trade name Azarga. This combination may be more effective than either medication alone.<ref name="brinzol">((cite journal | vauthors = Croxtall JD, Scott LJ | title = Brinzolamide/timolol: in open-angle glaucoma and ocular hypertension | journal = Drugs & Aging | volume = 26 | issue = 5 | pages = 437–46 | date = 2009 | pmid = 19552495 | doi = 10.2165/00002512-200926050-00007 ))</ref>

=== With brimonidine ===
The combination of [[Brinzolamide/brimonidine|brinzolamide with brimonidine]] is marketed under the trade name Simbrinza.<ref name="Simbrinza EPAR">((cite web | title=Simbrinza EPAR | website=European Medicines Agency | url=https://www.ema.europa.eu/en/medicines/human/EPAR/simbrinza | access-date=11 June 2020))</ref><ref name="Simbrinza FDA label">((cite web | title=Simbrinza- brinzolamide/brimonidine tartrate suspension/ drops | website=DailyMed | date=9 September 2019 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a49c157e-6310-0011-7b7f-e26fc1820d59 | access-date=11 June 2020))</ref> This combination may be more effective than either medication alone.<ref name="Simbrinza EPAR" /><ref name="Simbrinza FDA label" />

==References==
((Reflist))

== Further reading ==
((refbegin))
* ((cite journal |vauthors=Ermis S, Ozturk F, Inan U | title = Comparing the effects of travoprost and brinzolamide on intraocular pressure after phacoemulsification. | journal = Eye | volume = 19 | issue = 3 | pages = 303–7 | year = 2005 | pmid = 15258611 | doi = 10.1038/sj.eye.6701470| s2cid = 7285009 ))
* ((cite journal |vauthors=Iester M, Altieri M, Michelson G, Vittone P, Traverso C, Calabria G | title = Retinal peripapillary blood flow before and after topical brinzolamide. | journal = Ophthalmologica | volume = 218 | issue = 6 | pages = 390–6 | year = 2004| pmid = 15564757 | doi = 10.1159/000080942| s2cid = 24843128 ))
* ((cite journal |vauthors=Kaup M, Plange N, Niegel M, Remky A, Arend O | title = Effects of brinzolamide on ocular haemodynamics in healthy volunteers. | journal = Br J Ophthalmol | volume = 88 | issue = 2 | pages = 257–62 | year = 2004 | pmid = 14736787 | doi = 10.1136/bjo.2003.021485 | pmc = 1771998))
* ((cite journal |vauthors=March WF, Ochsner KI | title = The long-term safety and efficacy of brinzolamide 1.0% (azopt) in patients with primary open-angle glaucoma or ocular hypertension. | journal = Am J Ophthalmol | volume = 129 | issue = 2 | pages = 136–143 | year = 2000 | pmid = 10682964 | doi = 10.1016/S0002-9394(99)00343-8))
* ((cite journal | vauthors = Sall KN, Greff LJ, Johnson-Pratt LR, DeLucca PT, Polis AB, Kolodny AH, Fletcher CA, Cassel DA, Boyle DR, Skobieranda F | display-authors = 6 | title = Dorzolamide/timolol combination versus concomitant administration of brimonidine and timolol: six-month comparison of efficacy and tolerability | journal = Ophthalmology | volume = 110 | issue = 3 | pages = 615–624 | date = March 2003 | pmid = 12623832 | doi = 10.1016/S0161-6420(02)01900-0 ))
((refend))

== External links ==
* ((cite web | url = https://druginfo.nlm.nih.gov/drugportal/name/brinzolamide | publisher = U.S. National Library of Medicine | work = Drug Information Portal | title = Brinzolamide ))

((Antiglaucoma preparations and miotics))
((Portal bar | Medicine))

[[Category:Drugs developed by Alcon]]
[[Category:Amines]]
[[Category:Carbonic anhydrase inhibitors]]
[[Category:Ethers]]
[[Category:Drugs developed by Novartis]]
[[Category:Ophthalmology drugs]]
[[Category:Sultams]]
[[Category:Sulfones]]
[[Category:Thienothiazines]]

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