What is it used for?

• Raised pressure in the eye (ocular hypertension).
• Open angle glaucoma.

How does it work?

• Ganfort eye drops contain two active ingredients, bimatoprost and timolol maleate. These are both medicines that decrease raised pressure within the eye. They work in different ways to produce a combined effect greater than either medicine produces on its own.
• The pressure within the eyeball is naturally maintained by a continuous flow of liquid called aqueous humour through the eyeball. Aqueous humour is produced by a part of the eye called the ciliary body. It drains out of the eyeball through channels called the trabecular meshwork. If the outflow of aqueous humour is blocked, the aqueous humour builds up inside the eye, increasing the pressure within the eyeball. This pressure needs to be reduced, as otherwise it can damage the optic nerve and impair vision as a result.
• Bimatoprost reduces the pressure in the eye by mimicking the action of a naturally-occuring prostaglandin. Prostaglandins are a group of natural body chemicals found in many places in the body. In the eye, they increase the drainage of the aqueous humour out of the eyeball. Bimatoprost is a synthetic compound related to one of the natural prostaglandins. It works by increasing the drainage of aqueous humour out of the eyeball. This decreases the pressure within the eye.
• Timolol is a type of medicine called a beta-blocker. These medicines block beta-receptors in various parts of the body. Blocking the beta receptors in the eye reduces the amount of aqueous humour that is produced. Timolol therefore reduces the inflow of aqueous humour into the eyeball and so decreases the pressure within the eye in a different way.
• The combination of these two medicines is used to lower the pressure in the eye when a beta-blocker or a prostaglandin analogue eye drop does not lower the pressure enough on its own.

How do I use it?

• Ganfort eye drops are available in multi-dose bottles or preservative-free single-dose containers.
• If you wear contact lenses, you should remove them before putting in these eye drops. You should wait at least 15 minutes after using the drops before putting your contact lenses back in.
• Wash your hands before using the eye drops.
• One drop should be put into the affected eye(s) once a day, at the same time each day - either in the morning or the evening. The medicine is most effective if the drops are applied in the evening. Click here for instructions on how to put in the eye drops.
• Immediately after administering the eye drops, close the eye and press on the tear duct (at the corner of the eye closest to your nose) for about two minutes. This is to minimise the amount of medicine that may be absorbed into the bloodstream, which will increase the local effect in the eye and minimise any adverse effects elsewhere in the body.
• If any of the eye drops run onto your cheek you should wipe this away.
• When using these eye drops you should take care to not touch the dropper tip to any surface, or to your eye.
• If you miss a dose just apply your next dose as usual. Don't use the drops twice in one day to make up for a missed dose.
• Each preservative-free single-use vial contains enough solution to put one drop in both eyes. However, only treat both eyes if you have been told to do so by your doctor. If there is any medicine remaining in the single-use container after you have used it this should be thrown away and not kept for future use.

Warning!

• This medicine is not to be taken by mouth.
• These eye drops may cause your vision to blur temporarily after you have put them in your eye. Do not drive or operate machinery until this has worn off. You should also take into account that this medicine can sometimes cause other visual disturbances, eg double vision, and dizziness or fatigue, all of which may affect your ability to drive or operate machinary.
• Ganfort eye drops are sterile until opened. The multi-dose bottles contain a preservative that helps keep the eye drops sterile. This preservative, benzalkonium chloride, can be absorbed by contact lenses and cause eye irritation so you should not put your contact lenses back in for at least 15 minutes after using the eye drops. Any medicine remaining in the bottle four weeks after the first opening should be carefully disposed of, as after this time it is likely to be contaminated with germs. You may find it helpful to write the date of first opening on the packet. Dispose of carefully, preferably by returning to your pharmacy. Ganfort single-dose containers do not contain a preservative and are for single use only. They should be disposed of after use, even if there is some solution remaining.
• Bimatoprost can cause your eye colour to gradually change, by increasing the amount of brown pigment in your iris. This is not associated with any symptoms and is not harmful. It predominately happens in people with green-brown, yellow-brown or blue/grey-brown eyes. If these eye drops are only used in one eye, this may cause your eyes to permanently become different colours. The drops may also cause eyelash growth and darkening of the eyelid skin of the treated eye(s). Ask your doctor, eye specialist or pharmacist for more information.
• While using this medicine you should have regular eye examinations.
• If you go into hospital or to the dentist to have an operation you should tell the person treating you that you are using these eye drops. This is because your blood pressure may fall too low if you are given certain types of anaesthetics in combination with beta-blockers.

Use with caution in

• Decreased kidney function.
• Decreased liver function.
• People with mild to moderate chronic obstructive pulmonary disease (COPD).
• Closed angle glaucoma.
• Glaucoma caused by the growth of new blood vessels over the iris (neovascular glaucoma).
• Glaucoma caused by inflammation inside the eye (inflammatory glaucoma).
• Glaucoma present from birth (congenital glaucoma).
• Inflammatory conditions of the eye such as conjunctivitis.
• People with dry eyes or disorders of the cornea.
• People with an artificial lens in the eye (pseudophakia).
• People with no lens in the eye (aphakia).
• People with risk factors for swelling of the back of the eye (cystoid macular oedema), such as a closed or blocked retinal vein or diabetes affecting the eyes (diabetic retinopathy).
• Diabetes. (Timolol can be absorbed into the bloodstream after being applied into the eye and may mask the symptoms of low blood sugar, such as increased heart rate and tremor. For this reason, people with diabetes should carefully monitor their blood sugar while using these eye drops.)
• People with a history of sudden drops in blood sugar levels (hypoglycaemia).
• People with heart disease, such as heart failure or a severe form of angina pectoris, not caused by exertion (Prinzmetal's angina).
• People with slowed conduction of electrical messages between the chambers of the heart (1st degree heart block).
• People with low blood pressure (hypotension).
• People with severe conditions involving poor blood circulation in the arteries of the extremities, eg hands and feet (peripheral arterial disorders such as Raynaud's syndrome or intermittent claudication).
• People with an overactive thyroid gland (this medicine may mask the symptoms of a thyroid storm or thyrotoxicosis).
• People with a history of allergies (beta-blockers may increase sensitivity to allergens and result in more serious allergic reactions; they may also reduce the response to adrenaline used to treat anaphylactic shock).
• Psoriasis.
• Abnormal muscle weakness (myaesthenia gravis).

Not to be used in

• People with asthma or a history of asthma.
• People with severe chronic obstructive pulmonary disease (COPD).
• People with a slow heart rate caused by the pacemaker of the heart (sinus bradycardia).
• People with a serious defect in the heart's electrical message pathways, resulting in decreased function of the heart (sino-atrial block, or 2nd or 3rd degree heart block not controlled with a pacemaker).
• A problem common in the elderly, related to poor control of the working of the heart (sick sinus syndrome).
• Uncontrolled heart failure.
• Failure of the heart to maintain adequate circulation of blood (cardiogenic shock).
• Breastfeeding.
• This medicine is not recommended for children and adolescents under 18 years of age, as the manufacturer has not studied its safety and effectiveness in this age group.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

This medicine should not be used during pregnancy unless considered essential by your doctor, as it may be absorbed into the bloodstream and could be harmful to the unborn baby. Seek further medical advice from your doctor.
Timolol passes into breast milk after being applied into the eye. It is not known if bimatoprost passes into breast milk. The manufacturer states that these eye drops should not be used by women who are breastfeeding. Seek further medical advice from your doctor.

Side effects

• Red eye(s) due to increased blood supply (hyperaemia).
• Growth of eyelashes.
• Eye irritation including stinging, burning and itching.
• Sensation of something in the eye(s).
• Dry eye(s).
• Eye pain.
• Redness, itching or swelling of the eyelid(s).
• Dislike of light (photophobia).
• Corneal erosion.
• Eye discharge.
• Darkening of the eyelid(s) or skin around the eye(s).
• Headache.
• Change in colour of the iris.
• Inflammation of the iris (iritis).
• Inflammation of the eyelid(s) (blepharitis).
• Misdirected eyelashes, sometimes resulting in eye irritation.
• Watery eyes.
• Eye strain.
• Inflammation of the lining of the nose (rhinitis).
• Other side effects reported with the individual components of these eye drops
• Swelling of the area at the back of the eye responsible for seeing fine detail (macular oedema).
• Double vision.
• Drooping of the upper eyelid (ptosis).
• Chest pain.
• Slowed heart rate (bradycardia).
• Low blood pressure (hypotension).
• Dizziness.
• Shortness of breath.
• Difficulty sleeping (insomnia).
• Depression.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist. 

How can this medicine affect other medicines?

If you are using more than one type of eye drop you should administer them at least five minutes apart, to prevent the second drop washing away the first. Use eye gels or ointments last.

Eye drops can be absorbed into the bloodstream from the eye, and once in the bloodstream they have the potential to interact with other medicines. For this reason you should be aware of the following:

• In people with diabetes, timolol can prolong the lowering of blood sugar (hypoglycaemia) caused by insulin or other antidiabetic medicines. People with diabetes should monitor their blood sugar, as timolol can also mask the signs of hypoglycaemia.

The timolol in these eye drops may enhance the effects of the following medicines taken by mouth, which may result in low blood pressure and/or a slowed heart rate:

• beta-blockers, eg atenolol
• calcium-channel blockers, eg nifedipine, verapamil, diltiazem
• digoxin
• medicines for abnormal heart rhythms (antiarrhythmics), eg amiodarone.

If the medicine clonidine is suddenly stopped it can cause an increase in blood pressure. This increase in blood pressure may be worse in people taking beta-blockers, including eye drops such as this one.

Beta-blockers oppose the action of medicines for asthma that open the airways, which is why these eye drops should not be used by people with asthma or other breathing difficulties.

Other beta-blocker eye drops are not recommended for use in combination with Ganfort eye drops.

References:

https://www.medicines.ie/medicines/ganfort-32232/patient-info

https://www.netdoctor.co.uk/medicines/eye-care/a6167/ganfort-eye-drops-bimatoprost-timolol/

https://www.medicines.org.uk/emc/product/204/pil

https://www.drugs.com/uk/ganfort.html

https://www.nps.org.au/medicine-finder/ganfort-0-3-5-eye-drops

https://www.ema.europa.eu/en/documents/product-information/ganfort-epar-product-information_en.pdf

https://www.medsafe.govt.nz/consumers/CMI/g/ganfort.pdf