Brimonidine tartrate ophthalmic solution for elevated eye pressure in glaucoma

Brimonidine tartrate ophthalmic solution 0.15% is a topical eye medication used to lower elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension. It works by decreasing fluid production in the eye and enhancing fluid drainage, helping to prevent damage from high eye pressure.

This medication is approved for reducing elevated intraocular pressure in adults with open-angle glaucoma or ocular hypertension.

Brimonidine tartrate

Brimonidine is an alpha-2 adrenergic receptor agonist that lowers intraocular pressure by two main actions: reducing the production of aqueous humor (the fluid inside the eye) and increasing its outflow through the uveoscleral pathway. Peak effect occurs about two hours after administration.

• Adults: Instill one drop of 0.15% solution into the affected eye(s) three times daily, approximately 8 hours apart.
• If multiple ophthalmic products are used, space instillations at least 5 minutes apart.

• Neonates and infants younger than 2 years old due to serious adverse reactions reported (e.g., apnea, coma, hypotension).
• History of hypersensitivity to brimonidine or any components.

Potentiation of vascular insufficiency

Use with caution in patients with depression, cerebral or coronary insufficiency, Raynaud's phenomenon, orthostatic hypotension, or thromboangiitis obliterans, as brimonidine may worsen vascular insufficiency syndromes.

Severe cardiovascular disease

Although minimal blood pressure effects were observed in clinical trials, caution is advised when treating patients with severe cardiovascular disease.

Risk of bacterial keratitis

Contamination of the multi-dose container can lead to serious eye infections. Avoid touching the tip of the bottle to the eye or surrounding areas to reduce contamination risk.

Common adverse reactions (5% to 20%)

• Allergic conjunctivitis
• Conjunctival hyperemia (redness)
• Eye itching (pruritus)

Adverse reactions occurring in 5% to 9%

• Burning sensation
• Conjunctival folliculosis
• Hypertension
• Ocular allergic reaction
• Oral dryness
• Visual disturbance

Less common adverse reactions (1% to 4%)

• Blurred vision
• Dizziness
• Fatigue
• Headache
• Insomnia
• Eye irritation and pain
• Photophobia
• Somnolence
• Others including cough, rash, tearing, and conjunctivitis

Rare (less than 1%)

• Corneal erosion
• Hordeolum (stye)
• Nasal dryness
• Taste perversion

Postmarketing reports include

• Bradycardia, depression, hypersensitivity reactions, iritis
• Keratoconjunctivitis sicca, miosis, nausea, skin reactions, syncope, tachycardia
• In infants: apnea, coma, hypotension, respiratory depression, somnolence

• Antihypertensives and cardiac glycosides: May enhance blood pressure-lowering effects; use with caution.
• CNS depressants (e.g., alcohol, sedatives, opioids): Potential additive sedative effects.
• Tricyclic antidepressants: May reduce brimonidine’s eye pressure lowering effect; caution advised.
• Monoamine oxidase inhibitors (MAOIs): May increase systemic side effects like hypotension; caution advised.

Pregnancy

No adequate well-controlled studies in pregnant women. Animal data show limited placental transfer and fetal exposure. Use only if potential benefit justifies risk.

Lactation

Brimonidine is excreted into milk in animal studies and crosses the blood-brain barrier. Not recommended during breastfeeding due to risk of serious adverse reactions (e.g., CNS depression, apnea) in nursing infants.

Limited adult overdose data; hypotension has been reported. In infants and children, overdose may cause severe CNS and cardiovascular effects including apnea and coma. Treatment is supportive with maintenance of airway.