Alpha-2 adrenergic agonist

Brimonidine tartrate

Brand names: Alphagan, Mirvaso (dermal — rosacea)

Adult dose

Dose: Eye: 1 drop BD–TDS; Rosacea (dermal): apply 1g daily

Route: Ophthalmic / Topical

Frequency: BD–TDS (eye) / OD (skin)

Clinical pearls

NICE NG81 glaucoma / OHT; RCOphth
BAD rosacea: dermal 0.5% gel for persistent erythema (Mirvaso)
Punctal occlusion reduces systemic absorption

Contraindications

Concurrent or recent MAOI / TCA
Children <2
Severe cardiovascular disease (relative)
Hypersensitivity

Side effects

Ocular: hyperaemia, allergy, dry mouth, drowsiness; Systemic: hypotension, fatigue (especially infants)
Rosacea: rebound flushing, contact dermatitis

Interactions

MAOIs / TCAs
CNS depressants
Beta-blockers / antihypertensives

Monitoring

IOP
BP
Symptoms

Reference: BNF; NICE NG81; RCOphth; BAD rosacea; SmPC; https://bnf.nice.org.uk/drugs/brimonidine-tartrate/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways