Brimonidine

Brimonidine is a prescription and over-the-counter medicine used to treat the symptoms of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension and ocular redness caused by minor eye irritations.

• Brimonidine is available under the following different brand names: Alphagan P, Qoliana, Lumify

Adult and pediatric dosage

Ophthalmic solution (Rx)

• 0.1% (Alphagan P)
• 0.15% (Alphagan P, Qoliana, generic)

Ophthalmic solution (OTC)

• 0.025% (Lumify)

Elevated Intraocular Pressure

Adult dosage

• Alphagan P, Qoliana: 1 drop in affected eye(s) every 8 hours

Pediatric dosage

• Children below 2 years: Contraindicated
• Children above 2 years: Alphagan P, Qoliana: 1 drop in affected eye(s) every 8 hours

Ocular Redness

Adult dosage

• Lumify: Instill 1 drop in affected eye(s) every 6-8 hours

Pediatric dosage

• Children below 5 years (Lumify): Safety and efficacy not established
• Children above 5 years (Lumify): Instill 1 drop in affected eye(s) every 6-8 hours

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of Brimonidine include:

• mild itching, redness, burning, or other irritation of the eyes,
• dry mouth,
• blurred vision,
• drowsiness, and
• tiredness.

Serious side effects of Brimonidine include:

• eye pain,
• increased watering of the eye,
• vision changes, and
• severe swelling, redness, burning, or discomfort in or around the eye.

Rare side effects of Brimonidine include:

• none 

This is not a complete list of side effects and other serious side effects or health problems that may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Brimonidine has severe interactions with the following drugs:
  • isocarboxazid
  • linezolid
  • phenelzine
  • procarbazine
  • rasagiline
  • selegiline
  • selegiline transdermal
  • tranylcypromine
• Brimonidine has serious interactions with no other drugs.
• Brimonidine has moderate interactions with the following drugs:
  • amifostine
  • candesartan
  • digoxin
  • eprosartan
  • esketamine intranasal
  • irbesartan
  • lasmiditan
  • losartan
  • lurasidone
  • nitroglycerin rectal
  • olmesartan
  • sacubitril/valsartan
  • stiripentol
  • telmisartan
  • valsartan
• Brimonidine has minor interactions with at least 177 other drugs. 

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• Hypersensitivity to product or components
• Children below 2 years (0.1-0.15% ophthalmic solution)

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Brimonidine?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Brimonidine?”

Cautions

• Remove contact lenses before instilling eye drops; wait 15 min before reinserting contact lenses
• If more than 1 ophthalmic product is being administered, wait 5 minutes between instilling eye drops
• May potentiate syndromes associated with vascular insufficiency; caution with depression, cerebral or coronary insufficiency, Raynaud phenomenon, orthostatic hypotension, or thromboangiitis obliterans
• Although brimonidine ophthalmic had minimal effect on the blood pressure of patients in clinical studies, caution with severe cardiovascular disease
• Bacterial keratitis associated with the use of multiple-dose containers of topical ophthalmic products; instruct patients on how to avoid contamination
• Drug interaction overview
  • Because brimonidine ophthalmic may reduce blood pressure, caution in using drugs such as antihypertensives and/or cardiac glycosides with advised
  • Although specific drug interaction studies have not been conducted with brimonidine ophthalmic, the possibility of an additive or potentiating effect with CNS depressants (alcohol, barbiturates, opiates, sedatives, or anesthetics) should be considered
  • Tricyclic antidepressants (TCAs) have been reported to blunt the hypotensive effect of systemic clonidine; unknown whether the concurrent use of TCAs with brimonidine ophthalmic can interfere with IOP lowering effect
  • MAOIs may theoretically interfere with the metabolism of brimonidine and potentially result in increased systemic effects (e.g., hypotension); advise caution to patients taking MAO inhibitors

Pregnancy and Lactation

• May be acceptable during pregnancy.
• Lactation
  • It is not known whether this drug is excreted in milk. A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.