Brimonidine is an alpha-2 receptor agonist that causes vasoconstriction when applied topically to the skin.  It is used as a topical treatment of persistent erythema of Rosaceae in adults. It is also used to treat open-angle glaucoma and ocular hypertension.

Brimonidine Dose in Adults

Use in the treatment of Rosacea:

• Apply a pea-size amount once a day as a thin layer across the entire face covering the central forehead, each cheek, nose, and chin.

Use in the treatment of open-angle glaucoma:

• Instill one drop in the affected eye three times a day.

Brimonidine Dose in Childrens

Not recommended. It is contraindicated in neonates and infants.

Pregnancy Risk Factor B

• Negative fetal outcomes in animal reproduction studies have not been documented.

Breastfeeding:

• It is unknown if the drug can be absorbed into breastmilk.
• Manufacturers recommend that you stop breastfeeding or discontinue using the drug.

Brimonidine Dose in Renal Disease:

• Adjustments in the dose have not been recommended by the manufacturer in patients with renal impairment.

Brimonidine Dose in Liver Disease:

• Adjustments in the dose have not been recommended by the manufacturer in patients with liver disease.

Common Side Effects of Brimonidine Innclude:

• Cardiovascular:
  • Flushing
• Central Nervous System:
  • Burning Sensation Of Skin
  • Localized Warm Feeling
  • Paresthesia
• Dermatologic:
  • Erythema
  • Acne Vulgaris
  • Allergic Contact Dermatitis
  • Contact Dermatitis
  • Dermatitis
  • Skin Pain
• Ophthalmic:
  • Blurred vision
• Respiratory:
  • Nasal congestion

Contraindication to Brimonidine include:

• Allergy reactions to brimonidine and any component of the formulation
• Infants and neonates.

Warnings and Precautions

• Erythema
  • The gel formulation can begin to lose its effectiveness within hours.
  • Recurrent or worsening erythema may occur in patients who are not receiving therapy. This may resolve with discontinuation of therapy.
• Flushing
  • Flushing may begin again or occur at a higher frequency 30 minutes to several hours following the application. This may resolve on discontinuation.
• Hypersensitivity
  • It is possible for allergic reactions to occur, including angioedema and throat tightening. Tongue swelling may also occur. This may necessitate discontinuation of therapy.
• Pallor:
  • In some areas, excessive whitening or pallor can occur that are not treated.
• Systemic effects
  • Systemic effects such as bradycardia and hypotension (including orthostatic hypotension) can occur, especially when the dose is high and for non-approved indications.
• Cardiovascular disease
  • Patients suffering from unstable or uncontrolled heart disease should be cautious.
  • It can lower blood pressure and increase the risk of vascular insufficiency.
  • Patients with cerebral, heart, or sclerosis should not use it.
• Depression
  • Patients suffering from depression should be cautious.
• Sjogren syndrome:
  • Patients suffering from sjogren's syndrome should be cautious.

Monitoring Parameters:

None required.

How to administer Brimonidine?

• It should be applied topically as a thin layer evenly across the entire face avoiding the lips and eyes.
• The hands should be washed immediately after applying. It should not be applied to open wounds and broken skin.

Eye drops:

• Instill the drops three times a day in the affected eye. Avoid touching the distal end.

Mechanism of action of Brimonidine:

• It acts as a selective alpha-2 receptor antagonist and causes vasoconstriction when it is applied topically.

It isMetabolizedBy the liver and the time it takes to get therepeak plasma concentrationIt is observed for 15 days. It isexcretedPrimarily in the urine

International brands of Brimonidine:

• Mirvaso
• Onreltea

Brimonidine brands in Pakistan: