General

Pronunciation:
bri-moe-ni-deen

Trade Name(s)

• Mirvaso
• Onreltea 

Ther. Class.

cosmetic agents

Pharm. Class.

alpha adrenergic agonists

Indications

Persistent (nontransient) facial erythema due to rosacea.

Action

Acts as a selective alpha-2 adrenergic agonist, causing direct vasoconstriction.

Therapeutic Effect(s):

Decreased erythema.

Pharmacokinetics

Absorption: Some absorption follows topical use.

Distribution: Unknown.

Metabolism and Excretion: Extensively metabolized by the liver; drug and metabolites are excreted in urine.

Half-life: Unknown.

TIME/ACTION PROFILE (↓ erythema)

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity
• Lactation: Lactation.

Use Cautiously in:

• Depression;
• Cerebral/coronary insufficiency;
• Raynaud's phenomenon;
• Severe/unstable/uncontrolled cardiovascular disease;
• Orthostatic hypotension;
• Thromboangiitis obliterans;
• Scleroderma;
• Sjögren's syndrome;
• Vascular insufficiency (may worsen);
• OB:  Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
• Pedi:  Safety and effectiveness not established in children; inadvertent ingestion has caused serious adverse effects.

Adverse Reactions/Side Effects

CV: bradycardia, hypotension

Derm: flushing, burning sensation, contact dermatitis, erythema, pallor

EENT: nasopharyngitis

Neuro: dizziness, headache

Misc: HYPERSENSITIVITY REACTIONS(including angioedema, anaphylaxis, and urticaria)

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

• May ↑ risk of hypotension with  antihypertensives,  beta-adrenergic blockers,  digoxin.
• May ↑ risk of sedation with  alcohol,  antianxiety agents,  barbiturates,  opioids, and  sedative/hypnotics.
•   MAO inhibitors  may ↑ risk of systemic side effects, including hypotension.

Route/Dosage

Topical (Adults): Apply pea-sized amount to each of five areas on the face (forehead, chin, nose and each cheek) once daily.

Availability (generic available)

Topical gel: 0.33%

Assessment

• Assess face for erythema of rosacea periodically during therapy.
• Assess for hypersensitivity reactions (angioedema, throat tightening, tongue swelling, and urticaria). Institute appropriate therapy (epinephrine).  If reaction occurs, discontinue brimonidine.

Implementation

• Topical 

  Apply a pea-size amount to central forehead, chin, nose, and each cheek. Spread smoothly and evenly as a thin layer across entire face, avoiding eyes and lips. Do not apply to irritated skin or open wounds. Wash hands after application.

  • Not for PO, ophthalmic, or intravaginal use.

Patient/Family Teaching

• Explain purpose and side effects of medication to patient. Advise patient to read  Patient Information  before starting therapy. Advise patient in correct application of brimonidine.
• Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
• Advise patient that erythema or flushing may occur; usually diminishes 30 min to several hours after application; resolves after discontinuation.
• Advise patient that hypersensitivity reactions following gel application can occur. Discontinue therapy and seek immediate medical attention if necessary.
• Advise patient to avoid excessive sun exposure, heat, spicy foods, and alcohol, which can worsen rosacea.
• Rep:  Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

Decreased erythema.