Brimonidine

Alpha-2 adrenergic agonist, Glaucoma medication, Ocular hypotensive agent

Brimonidine

Alphagan P (ophthalmic glaucoma), Mirvaso (topical rosacea)

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Titration strategies

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Summary

Classes

Alpha-2 adrenergic agonist, Glaucoma medication, Ocular hypotensive agent

Pharmacy

Starting dose

Ophthalmic 1 drop in affected eye(s) TID; topical Mirvaso 0.33% gel applied to face daily

Preparations

0.1%, 0.15%, 0.2% ophthalmic solutions; 0.33% topical gel; combinations with timolol (Combigan) and brinzolamide (Simbrinza)

US FDA Max

TID per eye

Pharmacology

Routes

Topical ophthalmic, topical skin

Onset

IOP lowering at 1 hour; max at 2-3 hours

Duration

8-12 hours

Half-life

~3 hours

Bioavailability

Topical; clinically meaningful systemic absorption can produce systemic α2 effects (somnolence, hypotension), especially in children

Pregnancy

Limited data.^{[citation needed]}

Legal status

Rx-only in US

Purported mechanism

Brimonidine is a selective α2 adrenergic receptor agonist; in the ciliary body it reduces aqueous humor production and increases uveoscleral outflow, lowering intraocular pressure by ~20-25%.▲0▼ Systemic absorption with α2-mediated CNS depression (somnolence, fatigue) limits dosing in children and can be clinically significant in adults using bilateral ophthalmic therapy. Allergic conjunctivitis (delayed-onset, after months of use) is a recognized class effect. The topical rosacea formulation exploits cutaneous α-mediated vasoconstriction for transient erythema reduction.