brimonidine, topical

REMS

Topical management of persistent (nontransient) facial erythema due to rosacea.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Lactation: Discontinue breastfeeding or drug.

Use Cautiously in:

Depression;
Cerebral/coronary insufficiency;
Reynaud's phenomenon;
Severe/unstable/uncontrolled cardiovascular disease;
Orthostatic hypotension;
Thromboangiitis obliterans;
scleroderma;
Sjögren's syndrome;
Vascular insufficiency (may potentiate)
OB: Use only if potential benefit justifies potential fetal risk
Pedi: Safe and effective use in children has not been established; inadvertent ingestion has caused serious adverse effects.

Adv. Reactions/Side Effects ⬆ ⬇

CV: bradycardia, hypotension

Derm: flushing, contact dermatitis, erythema, pallor, skin burning sensation

EENT: nasopharyngitis

Neuro: dizziness, headache

Misc: HYPERSENSITIVITY REACTIONS(INCLUDING ANGIOEDEMA, ANAPHYLAXIS, AND URTICARIA)

Interactions ⬆ ⬇

Drug-drug:

Due to possible ↓ in BP, use cautiously with antihypertensives, beta-adrenergic blockers, digoxin.
May ↑ risk of sedation with alcohol, anti-anxiety agents, barbiturates and opioidssedative/hypnotics.
Concurrent use with MAO inhibitors may ↑ risk of systemic side effects, including hypotension, undertake concurrent use with caution.

Availability ⬆ ⬇

Topical gel: 0.33%

Route/Dosage ⬆ ⬇

(Adults >18 yr): Apply pea-sized amount to each of five areas on the face (forehead, chin, nose and each cheek) once daily.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Acts as a selective alpha-2 adrenergic agonist, causes direct vasoconstriction.

Therapeutic effects:

Decreased erythema in rosacea.

Classifications ⬆ ⬇

Therapeutic Classification: cosmetic agents

Pharmacologic Classification: alpha adrenergic agonists

Pharmacokinetics ⬆ ⬇

Absorption: Some absorption follows topical use.

Distribution: Unknown.

Metabolism/Excretion: Extensively metabolized by the liver; drug and metabolites are excreted in urine.

Half-Life: Unknown.

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

(decreased erythema)

ROUTE	ONSET	PEAK	DURATION
top	within 3 hr	3–6 hr	at least 12 hr

Patient/Family Teaching ⬆ ⬇

Instruct patient in correct application of brimonidine. Caution patient not to use more gel than prescribed. Advise patient to read Patient Information Leaflet prior to therapy and with each Rx refill in case of changes.
Inform patient that erythema or flushing may occur; usually diminishes 30 min to several hrs after application; resolves after discontinuation.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Advise female patients to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇