Alpha-2 adrenergic agonist Pregnancy: SPC §4.6: safety of use during human pregnancy has not been established; should only be used during pregnancy if the potential benefit to the mother outweighs the potential risk to the foetus. It is not known if brimonidine is excreted in human milk — should not be used by women nursing infants.

Brimonidine tartrate

Brand names: Alphagan, Mirvaso (dermal — rosacea)

Brimonidine tartrate is a selective alpha-2 adrenergic agonist eye drop used to lower intraocular pressure in open-angle glaucoma and ocular hypertension, either alone or adjunctively when other agents are insufficient.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One drop into the affected eye(s)

Route: Topical ocular (brimonidine tartrate 0.2% w/v eye drops)

Frequency: Twice daily, approximately 12 hours apart

SPC §4.2 'Adults including the elderly': one drop into the affected eye(s) twice daily, approximately 12 hours apart. No dosage adjustment is required in elderly patients. To reduce possible systemic absorption, compress the lachrymal sac at the medial canthus (punctal occlusion) for one minute immediately after instillation of each drop. If more than one topical ophthalmic drug is administered, instil 5 to 15 minutes apart. Paediatric: contraindicated in neonates and infants (less than 2 years of age); should not be used in children aged below 12 years; no clinical studies performed in adolescents 12–17 years; safety and efficacy not established in children. Children 2 years and above, especially 2–7 years and/or weighing ≤20 kg, should be treated with caution and closely monitored due to the high incidence and severity of somnolence (§4.4). Contains benzalkonium chloride 0.05 mg/ml — remove soft contact lenses before instillation and do not reinsert until at least 15 minutes after use. The US (openFDA) record retrieved for this id was LUMIFY Redness Reliever Eye Drops (an OTC ocular-redness product of different strength and indication) — not used for this dose.

Dose adjustments

Renal

SPC §4.2/§4.4: has not been studied in patients with renal or hepatic impairment; caution should be exercised when treating such patients. No numeric dose adjustment is stated.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Neonates and infants
Patients receiving monoamine oxidase (MAO) inhibitor therapy
Patients on antidepressants which affect noradrenergic transmission (e.g. tricyclic antidepressants and mianserin)

Side effects

Oral dryness (very common; 22–25% with ocular hyperaemia and burning/stinging)
Ocular irritation including allergic reactions — hyperaemia, burning, stinging, pruritus, foreign body sensation, conjunctival follicles (very common; ocular allergic reactions in 12.7% of trial subjects)
Headache and drowsiness (very common)
Fatigue (very common); asthenia (common)
Dizziness and abnormal taste (common)
Blurred vision, allergic blepharitis/blepharoconjunctivitis, allergic conjunctivitis (very common)

Interactions

MAO inhibitors and antidepressants affecting noradrenergic transmission (e.g. tricyclic antidepressants, mianserin) — contraindicated (§4.3/§4.5)
CNS depressants (alcohol, barbiturates, opiates, sedatives or anaesthetics) — possibility of an additive or potentiating effect should be considered
Medicines that can affect the metabolism and uptake of circulating amines (e.g. chlorpromazine, methylphenidate, reserpine) — caution advised
Antihypertensives and/or cardiac glycosides — caution advised, as clinically insignificant decreases in blood pressure have been reported after application
Caution when initiating (or changing the dose of) a concomitant systemic agent that may interact with alpha-adrenergic agonists or interfere with their activity

Clinical monograph

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.

Reference: NICE NG81; RCOphth; BAD rosacea; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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