Brimonidine tartrate

How it works

By stimulating ocular alpha-2 adrenoceptors it both reduces aqueous humour production and increases uveoscleral outflow, lowering intraocular pressure.

Prescribing in practice

• Brimonidine is contraindicated in neonates and young infants and used with great caution in older children because it crosses the blood-brain barrier and can cause apnoea, bradycardia, hypotonia and profound somnolence.
• Allergic (follicular) conjunctivitis is a common cause of treatment discontinuation and may appear after months of use.
• Avoid with monoamine oxidase inhibitors and use cautiously with tricyclic antidepressants, CNS depressants and antihypertensive agents.

Monitoring

Monitor intraocular pressure for therapeutic response and review for ocular allergy and systemic effects such as drowsiness, dry mouth or lowered blood pressure.

Counselling the patient

• Instil as prescribed and press gently on the inner corner of the eye afterwards to reduce side effects.
• It can cause tiredness and a dry mouth; be cautious driving or operating machinery.
• Report a persistently red, itchy or watery eye, which may be an allergic reaction.

Evidence & guidelines

Established clinical use and NICE glaucoma guidance support brimonidine as an effective intraocular-pressure-lowering option, particularly as add-on therapy or where prostaglandins or beta-blockers are unsuitable.