Adult: For the reduction of elevated IOP: As monotherapy or as an adjunct to other IOP-lowering medications: As 0.1% or 0.15% solution: Instil 1 drop into the affected eye(s) tid, approx 8 hours apart. As 0.2% solution: Instil 1 drop into the affected eye(s) bid, approx 12 hours apart.
Topical/Cutaneous Persistent facial erythema associated with rosacea
Adult: As 0.33% gel: Apply a pea-size amount once daily as a thin layer to each of the 5 areas of the face (forehead, chin, nose, and each cheek). Max: 1 g per day.
What are the brands available for Brimonidine in Malaysia?
Alphagan P
Contraindications
Children <2 years. Concomitant MAOI therapy.
Special Precautions
Patient with orthostatic hypotension; severe, unstable or uncontrolled CV disease; coronary or cerebrovascular insufficiency, Raynaud's phenomenon, thromboangiitis obliterans, depression; Sjogren's syndrome, scleroderma (topical). Renal and hepatic impairment. Pregnancy and lactation.
Adverse Reactions
Significant: Ophthalmic: Bacterial keratitis (when using multiple-dose containers); CNS depression. Topical: Recurrent and worsening erythema (at or outside the affected areas); intermittent flushing (new onset or increased frequency); hypersensitivity reactions (e.g. allergic contact dermatitis, angioedema, throat tightening, tongue swelling, urticaria); pallor, systemic effects (e.g. bradycardia, hypotension, dizziness). Eye disorders: Eye pain, irritation and tearing, foreign body sensation, burning and stinging, blurred vision, blepharitis, follicular conjunctivitis, photophobia, dry eye, corneal erosion and staining; ocular hypersensitivity reactions (e.g. allergic conjunctivitis, conjunctival hyperaemia, ocular pruritus). Gastrointestinal disorders: Abnormal taste, dry mouth, gastrointestinal symptoms. General disorders and administration site conditions: Fatigue, asthenia. Nervous system disorders: Headache, drowsiness. Respiratory, thoracic and mediastinal disorders: Colds, cough, rhinitis, nasal dryness. Skin and subcutaneous tissue disorders: Pruritus, rosacea, skin burning sensation (topical).
Ophthalmic: This drug may cause drowsiness, CNS depression, or transient blurring of vision, if affected, do not drive or operate machinery. Remove contact lenses prior to administration and reinsert them after 15 minutes. Topical: Avoid contact with the eyes, mouth, and mucous membranes. Avoid use on open wounds, irritated or damaged skin (including after laser therapy).
Monitoring Parameters
Ophthalmic: Monitor IOP (routinely) and blood pressure. Assess for signs and symptoms of orthostatic hypotension.
Drug Interactions
Increased serum concentration and enhanced adverse effects with MAOIs. Diminished therapeutic effect with TCAs. Additive CNS depressant effects with barbiturates, opiates, sedatives, or anaesthetics. Increased risk of hypotension and other CV effects with antihypertensives and/or cardiac glycosides.
Food Interaction
Additive CNS depressant effect with alcohol.
Action
Description: Mechanism of Action: Brimonidine is a relatively selective α2-adrenergic agonist. It is believed to reduce aqueous humour formation and increase uveoscleral outflow, thereby lowering intraocular pressure (IOP). When applied topically, brimonidine may reduce erythema by direct cutaneous vasoconstriction. Pharmacokinetics: Absorption: Time to peak plasma concentration: 0.5-4 hours (ophthalmic); after 15 days (topical). Metabolism: Extensively metabolised in the liver. Excretion: Via urine. Elimination half-life: Approx 3 hours (ophthalmic).
Chemical Structure
Brimonidine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 2435, Brimonidine. https://pubchem.ncbi.nlm.nih.gov/compound/Brimonidine. Accessed May 29, 2025.
S01EA05 - brimonidine ; Belongs to the class of sympathomimetics used in the treatment of glaucoma. D11AX21 - brimonidine ; Belongs to the class of other dermatologicals.
References
AbbVie Limited. Alphagan 0.2% Eye Drops data sheet 04 May 2023. Medsafe. http://www.medsafe.govt.nz. Accessed 11/04/2025.Alphagan P Ophthalmic Solution 0.1% (AbbVie Sdn Bhd). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 11/04/2025.Alphagan P Ophthalmic Solution 0.15% (AbbVie Sdn Bhd). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 11/04/2025.Alphagan P Solution/Drops (Allergan, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 11/04/2025.Brayfield A, Cadart C (eds). Brimonidine Tartrate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/04/2025.Brimonidine (Ophthalmic). UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 11/04/2025.Brimonidine (Topical). UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 11/04/2025.Brimonidine Tartrate (EENT). UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 11/04/2025.Brimonidine Tartrate (Topical). UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 11/04/2025.Brimonidine Tartrate 2 mg/mL Eye Drops, Solution (Generics [UK] Limited t/a Mylan). MHRA. https://products.mhra.gov.uk. Accessed 11/04/2025.Healthcare Logistics. Mirvaso 3.3 mg/g Gel data sheet 26 March 2019. Medsafe. http://www.medsafe.govt.nz. Accessed 11/04/2025.Joint Formulary Committee. Brimonidine Tartrate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/04/2025.Mirvaso 3 mg/g Gel (Galderma [U.K.] Limited). MHRA. https://products.mhra.gov.uk. Accessed 11/04/2025.Mirvaso Gel (Galderma Laboratories, L.P.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 11/04/2025.
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