Brimonidine

What is Brimonidine?

• Brimonidine (Alphagan P) is an alpha adrenergic agonist used for lowering intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension (pressure in the eyes that is higher than normal but not high enough to cause vision loss).

Brimonidine

Brimonidine structure

What are the uses of this medicine?

• Brimonidine (Alphagan P) is used for lowering intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension.
• The IOP lowering efficacy of brimonidine tartrate ophthalmic solution diminishes over time in some patients.

How does this medicine work?

• The tartrate salt form of brimonidine, an imidazole derivative and a selective alpha-2 adrenergic receptor agonist.
• Upon ocular administration, brimonidine tartrate acts on the blood vessels causing them to constrict which leads to a decrease in the production of aqueous humor.
• Brimonidine tartrate also enhances the outflow of aqueous humor.
• This drug is used in the treatment of glaucoma to reduce intraocular pressure.

Who Should Not Use this medicine ?

This medicine cannot be used:

• In neonates and infants (under the age of 2 years)
• In patients who have exhibited a hypersensitivity reaction to any component of this medication in the past.

What drug interactions can this medicine cause?

• Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Be sure to mention any of the following:

• antidepressants such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil)
• barbiturates such as phenobarbital and secobarbital (Seconal)
• digoxin (Lanoxin)
• medications for anxiety, high blood pressure, mental illness, pain, or seizures
• sedatives
• sleeping pills
• tranquilizers
• monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl), or tranylcypromine (Parnate)

Is this medicine FDA approved?

• Brimonidine was patented in 1972 and came into medical use in 1996.

How should this medicine be used?

Recommended dosage:

• The recommended dose is one drop of brimonidine tartrate ophthalmic solution 0.2% in the affected eye(s) three times daily, approximately 8 hours apart.
• Brimonidine tartrate ophthalmic solution may be used concomitantly with other topical ophthalmic drug products to lower intraocular pressure.

Administration:

• Ophthalmic brimonidine comes as a solution (liquid) to instill in the eyes.
• It is usually instilled in the affected eye(s) three times a day.
• Use brimonidine eye drops at around the same times every day, and try to space your 3 daily doses about 8 hours apart.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As Solution containing 2 mg/mL brimonidine tartrate.

This medicine is available in fallowing brand namesː

• Alphagan P

What side effects can this medication cause?

The most common side effects of this medicine include:

• oral dryness
• ocular hyperemia
• burning and stinging
• headache
• blurring
• foreign body sensation
• fatigue/drowsiness
• conjunctival follicles
• ocular allergic reactions
• ocular pruritus

What special precautions should I follow?

• Brimonidine tartrate ophthalmic solution may potentiate syndromes associated with vascular insufficiency. Brimonidine tartrate ophthalmic solution should be used with caution in patients with depression, cerebral or coronary insufficiency, Raynaud’s phenomenon, orthostatic hypotension, or thromboangiitis obliterans.
• Caution should be exercised in treating patients with severe cardiovascular disease.
• There have been reports of bacterial keratitis associated with the use of multiple-dose containers of topical ophthalmic products.
• The preservative in brimonidine tartrate ophthalmic solution, benzalkonium chloride, may be absorbed by soft contact lenses. Patients wearing soft contact lenses should be instructed to wait at least 15 minutes after instilling brimonidine tartrate ophthalmic solution to insert soft contact lenses.
• Instruct patients that ocular solutions, if handled improperly or if the tip of the dispensing container contacts the eye or surrounding structures, can become contaminated by common bacteria known to cause ocular infections.
• Always replace the cap after using. If solution changes color or becomes cloudy, do not use. Do not use the product after the expiration date marked on the bottle.
• Advise patients that if more than one topical ophthalmic drug is being used, the drugs should be administered at least five minutes apart.
• Brimonidine tartrate ophthalmic solution may cause fatigue and/or drowsiness in some patients. Caution patients who engage in hazardous activities of the potential for a decrease in mental alertness.

What to do in case of emergency/overdose?

Symptoms of overdosage may include:

• hypotension

Management of overdosage:

• Treatment of an oral overdose includes supportive and symptomatic therapy; a patent airway should be maintained.

Can this medicine be used in pregnancy?

• Pregnancy Category B.
• There are no adequate and well-controlled studies in pregnant women.
• Brimonidine tartrate ophthalmic solution should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the fetus.

Can this medicine be used in children?

• Brimonidine tartrate ophthalmic solution is contraindicated in children under the age of 2 years.
• The safety and effectiveness of brimonidine tartrate have not been studied in children below the age of 2 years.

What are the active and inactive ingredients in this medicine?

Active Ingredient:

• BRIMONIDINE TARTRATE

Inactive Ingredients:

• BENZALKONIUM CHLORIDE
• CITRIC ACID MONOHYDRATE
• HYDROCHLORIC ACID
• WATER
• SODIUM CHLORIDE
• SODIUM CITRATE, UNSPECIFIED FORM
• SODIUM HYDROXIDE
• POLYVINYL ALCOHOL, UNSPECIFIED

Who manufactures and distributes this medicine?

Distributed by:

• Bausch & Lomb Americas Inc.
• Bridgewater, NJ USA

• Alphagan P marks owned by Allergan, Inc.

What should I know about storage and disposal of this medication?

* Store at 15o-25oC (59o-77oF).

• Dailymed label info on Brimonidine
• FDA Brimonidine

Brimonidine Resources
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