bri/mo’ ni/dēn

Brand Names: Alphagan® P

  • Generic Available

Common Dosage Forms:

  • Ophthalmic Solution:
    0.1% brimonidine tartrate with Purite® 0.005% as a preservative.
    0.15% brimonidine tartrate with Purite® 0.005% as a preservative.

FDA Indications/Dosages:

  • For the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension:
    The recommended dose is one drop in the affected eye(s) three times daily, approximately 8 hours apart. The IOP lowering effects may diminish over time in some patients. This loss of effect appears with a variable time of onset in each patient and should be closely monitored.

Monitor:

IOP

Pharmacology/Pharmacokinetics:

Brimonidine is a relatively selective alpha-2- adrenergic agonist which lowers elevated intraocular pressure. Its mechanism of action is due to a reduction of aqueous humor production and increased uveoscleral outflow. Elevated intraocular pressure increases the patient’s risk of optic nerve damage and visual field loss. Peak ocular hypotensive effects are reached in 2 hours post dose. Systemic half-life is approximately 3 hours. Very small amounts are absorbed after topical use in the eye and present minimal cardiovascular and pulmonary effects.

Drug Interactions:

Tricyclic antidepressants may decrease effectiveness of Alphagan. Additive effects may be seen when used with beta-blockers (oral or ophthalmic). Coadministration with MAO INHIBITORS may elevate blood pressure.

Contraindications/Precautions:

Contraindicated in patients using monoamine oxidase inhibitors. Caution should be used in patients with depression, cerebral or coronary insufficiency, Raynaud’s phenomenon, orthostatic hypotension, or thromboangiitis obliterans. Pregnancy Category B.

Adverse Effects:

Allergic conjunctivitis, conjunctival hyperemia, and eye pruritis (10-20%) are the most common adverse effects. Less frequent effects include burning sensation, conjunctival foliculosis, hypertension, dry mouth, and visual disturbances (5-9%).

Patient Consultation:

  • To instill: Lie down or tilt head backward and look up. Holding the dropper above the eye, drop solution inside lower lid, making sure the dropper does not come in contact with the eye or fingers. Then release lid, keeping the eye open for at least 30 seconds, and apply pressure to the inside corner of eye for at least one minute.
  • Wait at least 5 minutes before instilling other ophthalmic preparations.
  • Avoid squinting or closing of eyes tightly after instilling drops.
  • Store in a cool, dry place away from sunlight and children.
  • If a dose is missed instill it as soon as possible. If it is closer to the time of your next dose than the dose you missed, skip the missed dose and return to your dosing schedule.
  • Contact a physician if the above side effects are severe or persistent.