General

Pronunciation:
bri-moe-ni-deen

Trade Name(s)

• Mirvaso
• Onreltea 

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)

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

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)

* 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.

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.