Brimonidine
ALPHAGAN
What it isTopical alpha-2 agonist that reduces aqueous production or constricts cutaneous vessels; glaucoma and rosacea.
Why this oneIt lowers intraocular pressure without beta blockade and its facial gel directly blanches persistent rosacea erythema.
What limits itSomnolence and apnea can occur in small children; ocular allergy and rebound facial redness can end treatment.
FDA-approved for
- glaucoma (1996)
- rosacea (2013)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Reduction of elevated IOP in open-angle glaucoma or ocular hypertension | adults & children ≥2 y | 1 drop affected eye(s) TID (~8 h apart) | 1 drop TID | 1 drop TID |
Renal Undefined
Hepatic Undefined
Instructions
- Instill 1 drop in affected eye(s) three times daily, ~8 hours apart
- May be used with other topical ophthalmic IOP-lowering products; instill different products ≥5 minutes apart
- Do not touch dispenser tip to eye (contamination/bacterial keratitis risk)
Contraindications
- Neonates and infants (younger than 2 years)
Cautions
- May potentiate vascular insufficiency — caution in depression, cerebral or coronary insufficiency, Raynaud's phenomenon, orthostatic hypotension, thromboangiitis obliterans
- Caution in severe cardiovascular disease
- Contaminated multi-dose containers have caused bacterial keratitis
- Pediatric ≥2 y: somnolence and decreased alertness common (less frequent ≥7 y/>20 kg)
Adverse reactions
- Allergic conjunctivitis
- Conjunctival hyperemia
- Eye pruritus
- Burning sensation
- Conjunctival folliculosis
- Hypertension
- Ocular allergic reaction
- Oral dryness
- Visual disturbance
Pregnancy No adequate human studies; crosses placenta in animals; use only if benefit justifies fetal risk
Lactation Unknown if in human milk (present in rat milk); not recommended during lactation — risk of CNS depression and apnea in nursing infants
NO BOXED WARNINGS
Principal riskSomnolence, marked in small children
Cost, est. cash$200–$1,000/month
Generic entry2003
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
Mechanism of action: Brimonidine ballicule
Open Brimonidine in the interactive console ↗
Memory aids: mascots and interaction avatars
orange plus signs → alpha-2 agonist