What is Brinsupri?

Brinsupri: A Carbonic Anhydrase Inhibitor for Glaucoma Treatment

Brinsupri is a brand name for brinzolamide, a carbonic anhydrase inhibitor used as an ophthalmic medication to reduce intraocular pressure (IOP) in patients with open-angle glaucoma and ocular hypertension. 1

Mechanism of Action

• Brinzolamide works as a highly specific, non-competitive, reversible inhibitor of carbonic anhydrase II (CA-II) in the eye 1
• By inhibiting CA-II, it suppresses the formation of aqueous humor, thereby decreasing intraocular pressure 1
• This mechanism makes it effective for treating elevated IOP in glaucoma patients 2

Clinical Use

• Formulated as a 1% ophthalmic suspension for topical application 1
• Can be used as:
  • First-line monotherapy for open-angle glaucoma or ocular hypertension 2
  • Adjunctive therapy with beta-blockers when additional IOP reduction is needed 2
  • Part of combination therapy with prostaglandin analogs 1
• Typically administered twice or three times daily, with similar efficacy between dosing schedules 2

Efficacy

• Clinical studies show brinzolamide reduces IOP by approximately 15-20% from baseline 1
• As monotherapy, it demonstrates IOP-lowering efficacy equivalent to dorzolamide 2% but less than timolol 0.5% 2
• When used as adjunctive therapy with beta-blockers, it provides additional IOP reduction 2

Available Formulations

• As standalone brinzolamide 1% ophthalmic suspension 2
• In fixed-combination formulations:
  • Brinzolamide/brimonidine (combining a carbonic anhydrase inhibitor with an α2-adrenergic receptor agonist) 3
  • Brinzolamide/timolol (combining a carbonic anhydrase inhibitor with a beta-blocker) 4

Safety Profile

• Generally well-tolerated with mostly mild, transient, and localized adverse effects 1
• Most common adverse events include:
  • Blurred vision (3-8% of patients) 1
  • Ocular discomfort (1.8-5.9% of patients) 1
  • Eye pain (0.7-4.0% of patients) 1
  • Abnormal taste sensation 2
• Unlike oral carbonic anhydrase inhibitors, topical brinzolamide does not typically cause significant systemic side effects or acid-base disturbances 2

Special Considerations

• May have a secondary beneficial effect on ocular blood flow in some patients 1
• Preferred over some other carbonic anhydrase inhibitors (like dorzolamide) due to less ocular discomfort 2
• Provides a non-beta-blocker option for patients with contraindications to beta-blockers such as asthma, COPD, or certain cardiac conditions 3

Clinical Positioning

• Good second-line option for glaucoma management 2
• Particularly useful for patients who:
  • Are unresponsive to beta-blockers 2
  • Have contraindications to beta-blocker therapy 2
  • Need additional IOP reduction beyond monotherapy 2