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brimonidine, topical

General

Pronunciation:
bri-moe-ni-deen


Trade Name(s)

  • Mirvaso
  • Onreltea Canadian Tradename

Ther. Class.
cosmetic agents

Pharm. Class.
alpha adrenergic agonists

Indications

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

Action

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

Therapeutic Effect(s):

Decreased erythema in rosacea.

Pharmacokinetics

Absorption: Some absorption follows topical use.

Distribution: Unknown.

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

Half-life: Unknown.

TIME/ACTION PROFILE (decreased erythema)

ROUTEONSETPEAKDURATION
topwithin 3 hr3–6 hrat least 12 hr

Contraindication/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.

Adverse Reactions/Side Effects

CNS: dizziness, headache

CV: bradycardia, hypotension

EENT: nasopharyngitis

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

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

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

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 opioids sedative/hypnotics.
  • Concurrent use with MAO inhibitors may ↑ risk of systemic side effects, including hypotension, undertake concurrent use with caution.

Route/Dosage

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

Availability

Topical gel: 0.33%

Assessment

  • Assess face for erythema of rosacea periodically during therapy.

Potential Diagnoses

Implementation

  • Topical: Apply a pea-size amount to central forehead, chin, nose, and each cheek. Spread smoothly and evenly as a thin layer across entire face, avoiding eyes and lips. Do not apply to irritated skin or open wounds. Wash hands after application.
    • Not for oral, ophthalmic, or intravaginal use.

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.

Evaluation/Desired Outcomes

Decreased facial erythema of rosacea.

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Citation

Quiring, Courtney, et al. "Brimonidine, Topical." Davis's Drug Guide, 16th ed., F.A. Davis Company, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/Davis-Drug-Guide/110143/all/brimonidine__topical.
Quiring C, Sanoski CA, Vallerand AH. Brimonidine, topical. Davis's Drug Guide. 16th ed. F.A. Davis Company; 2019. https://im.unboundmedicine.com/medicine/view/Davis-Drug-Guide/110143/all/brimonidine__topical. Accessed March 24, 2019.
Quiring, C., Sanoski, C. A., & Vallerand, A. H. (2019). Brimonidine, topical. In Davis's Drug Guide. Available from https://im.unboundmedicine.com/medicine/view/Davis-Drug-Guide/110143/all/brimonidine__topical
Quiring C, Sanoski CA, Vallerand AH. Brimonidine, Topical [Internet]. In: Davis's Drug Guide. F.A. Davis Company; 2019. [cited 2019 March 24]. Available from: https://im.unboundmedicine.com/medicine/view/Davis-Drug-Guide/110143/all/brimonidine__topical.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - brimonidine, topical ID - 110143 A1 - Quiring,Courtney, AU - Sanoski,Cynthia A, AU - Vallerand,April Hazard, BT - Davis's Drug Guide UR - https://im.unboundmedicine.com/medicine/view/Davis-Drug-Guide/110143/all/brimonidine__topical PB - F.A. Davis Company ET - 16 DB - Medicine Central DP - Unbound Medicine ER -