Brimonidine (Ophthalmic)

Overview

Brimonidine is administered as eye drops in the treatment of open-angle glaucoma and hypertension of the eye.

Brimonidine is an alpha-adrenergic agonist, which stimulates alpha-2 receptors in the eye. This lowers adenylate cyclase activity and lowers the intracellular cAMP levels. In doing so this medicine serves to lower the pressure in the eye and relieve pressure being placed on the optic nerve.

Open-angle glaucoma is a condition that will gradually steal the vision of the patient. Usually symptoms go unnoticed until late on in the development of the disease. This is the most common form of glaucoma and affects over four million Americans. If left untreated the condition will eventually lead to loss of sight due to optic nerve damage. Brimonidine lowers the pressure in the eye and prevents the damage to the optic nerve from occurring.

Ocular hypertension is a condition in which the eye holds too much fluid and intraocular pressure becomes too great. If untreated this condition can cause glaucoma and eventually lead to loss of sight. Brimonidine will lower the pressure in the eye and prevent this condition from developing and causing sight loss.

This medication is available only with a doctor's prescription and is administered by the patient in the form of eye drops. It is usually administered thrice daily with an 8 hour gap between doses.

Condition treated

• Open-angle glaucoma
• Ocular hypertension

Type of medicine

• Alpha-adrenergic agonist

Side Effects

In addition to the required effects of lowering the pressure in the eye, Brimonidine can also have some serious side effects and can impact on other health conditions. Some of these side effects may require you to seek medical attention while others will not necessitate any medical interaction.

The following side effects may indicate serious complications and should be reported to your doctor immediately once you recognize them occurring:

Occurring commonly

• Blurry vision or decrease in vision
• Burning, dryness or itchiness of eyes
• Discharge from the eye or excessive tearing
• Disturbed color perception or changed vision
• Double vision
• Halos seen around lights
• Headaches
• Itching on the eye
• Night blindness or decreased night vision
• Overbright appearance of lights and increased sensitivity to light
• Reddening of the eye or inner lining of the eyelid
• Swelling of the upper or lower eyelids
• Tearing of the eye
• Tunnel vision

Occurring less commonly

• Ache or pain experienced in the eye
• Blindness
• Blood visible in the eye
• Blurry vision or other change in vision
• Change in color perception
• Confusion or disorientation
• Decreased vision quality
• Difficult or labored breathing
• Difficulty seeing in low levels of light
• Dizziness, feeling of faintness or lightheadedness, particularly when rising suddenly from lying or sitting
• positions
• Drainage of liquid from the eye
• Fainting or faintness
• Fast or irregular heartbeat
• Feeling of something in the eye or irritation of the eye
• Gradual blurring or decrease in quality of vision
• Increased blood pressure
• Increased sensitivity to the light
• Mental depression
• Muscle pains
• Nausea, sickness or vomiting
• Oozing from the eye
• Redness, swelling or irritation of the upper or lower eye or eyelids
• Runny nose or nasal blockage
• Seeing flashes or sparks of light that aren't there
• Seeing floating dark spots or material before eyes that aren't there
• Seeing floating spots before the eyes
• Seeing a barrier appearing across part of vision
• Shortness of breath
• Skin rashes with lesions
• Sneezing
• Sweating when cold
• Swelling of the eyeball
• Tightness in the chest area
• Unusual tiredness
• Unusual weakness
• Watering from the eyes
• Wheezing or labored breathing

Frequency of occurrence unknown

• Bluish tinge to the lips or skin
• Chest pain or discomfort
• Confusion or disorientation
• Irregular heartbeat or pulse
• Feeling of warmth or heat on skin
• Flushing around the face and neck
• Irregular or shallow breathing
• Low core body temperature
• Muscle aching or weakness
• Pounding hearbeat
• Shivering when warm
• slow or irregular heartbeat
• Weak pulse
• Weight gain

The following side effects may occur but would not usually need medical attention. You can report the occurrence of these side effects to your healthcare professional when you have your next check up and they may be able to advise you on ways to alleviate them. In some cases the side effects may disappear as the body gets used to the medicine. If the following side effects become bothersome you can seek advice on how to alleviate them.

Occurring commonly

• Burning of the eye
• Stinging of the eye
• Tearing of the eye
• Unusual or unexplained drowsiness or tiredness
• Dryness of the mouth

Occurring less commonly

• Acid stomach our sourness of stomach
• Anxiousness
• Bad aftertaste
• Belching or burping
• Body aching or feeling of pain
• Changes in perceived taste
• Chills
• Congestion
• Cough
• Coughing up of mucus
• Crusting around the eyelid or in the corner of eye
• Diarrhea
• Difficulty taking breath
• Discoloration of white of the eye
• Dryness of the eye
• Dryness of the throat
• Feverishness
• General feeling of illness
• Hoarseness
• Indigestion
• Joint pains
• Lack of strength
• Large amounts of cholesterol in the blood
• Lid disorder
• Loss of hunger
• Muscle aching and feeling of pain in muscles
• Pain or tenderness around eye and cheekbone
• Paleness of the eye or of the inner lining of the eyelid
• Passing of gas
• Pounding heart
• Rash with or without raised lesions
• Shivering when warm
• Sleepiness or unusual tiredness
• Sleeplessness or inability to sleep
• Sneezing
• Sore throat
• Stomach discomfort, feeling of fullness, or pain
• Tender or swollen glands
• Troubled sleep
• Troubled swallowing
• Troubled breathing or labored breathing
• Unable to sleep
• Voice tone changes or loss on control of voice

Frequency of occurrence unknown

• Constricted pupils in treated eye
• Redness of the skin
• Sensitivity to light increased
• Throbbing pains
• Unusual feeling of sluggishness or drowsiness
• Unusually weak body
• Unusually warm feeling skin

Other side effects may occur that are not listed here. If you experience other side effects then you should inform your doctor when you next have a check up or sooner if you are concerned.

Dosage

This medication should be used only as directed by your doctor. Never use more medication or take medication more regularly than was prescribed by your doctor. Do not use this treatment for a longer period than prescribed.

If you are prescribed more than one eye drop at a time you should leave a gap between the use of each. After using the first eye drop you should wait at lease 5 minutes to allow for absorption before using the second medicine. This prevents interaction in the eye and prevents one drop from ‘washing out' the first drop.

To use the Brimonidine eye drops follow these steps:

• Ensure your face and hands are thoroughly cleaned to avoid contamination.
• Shake the eye drop container well before use.
• Tip your head back and use the forefinger to pull the skin of the lower eyelid down gently.
• Apply the required dose into the space that is created and then gently close your lower eyelid.
• Press your forefinger into the inner corner of your eye and hold in place for 1-2 minutes.
• Keep your eye closed through this process and do not blink.
• If you miss your eye with the first drop, repeat these steps with a second drop.
• Always avoid touching the applicator to your eye or to any other surface.
• When not in use keep the lid of the drops tightly closed. If germs or dirt are allowed to get into the eye drops then you will be at risk of infection that can cause blindness.

These eye drops will normally appear clear with a greenish-yellowish coloration. If this changes then you should stop using the medication and ask your doctor or pharmacist for a new prescription. Never take this medication if you suspect that it may be outdated or contaminated.

The dose of this medication will be different for each individual. The following dosing information is a guideline only and you should follow the instructions given to your by your doctor. Dosing will depend on a range of factors and may differ from the following:

For glaucoma or ocular hypertension

• Adults and children aged 2+ - One drop issued thrice daily with an 8 hour gap between each dose.
• Use is not recommended in children below the age of 2.

If you miss a dose then you should apply it as soon as possible. If, however, it is close to your next dose being due then you should skip the missed dose and return to your normal schedule. Do not take a double dose of this medication. You should make note of missed doses to notify your doctor at your next appointment. Missed doses may impact the test results.

Interactions

Medications can interact with certain other medications and cause unwanted side effects. You should be sure to inform your doctor of all medications that you are taking before receiving this treatment. This includes medications that are available to purchase over the counter, herbal remedies and vitamin supplements.

This treatment may be used in conjunction with other eye drops. If you are prescribed more than one eye drop then you should wait at least 5 minutes before administering the second.

Medications can also interact with other medical conditions. If you have any other medical conditions then you need to inform your doctor before starting this treatment. This is particularly important if you suffer from any of the following conditions:

• Depression
• History of heart attacks
• Heart disease
• Orthostatic hypertension
• Raynaud disease
• History of strokes
• Thromboangiitis obliterans

Use of Brimonidine could make all of these conditions worse and would not normally be advised.

Warnings

Your eyes or your child's eyes will need to be examined at regular intervals to ensure that the treatment is working properly. If the pressure in your eye is not decreasing then you will need to try other courses of medication. You will also be checked for unwanted side effects that could indicate further complications.

If you experience itching, swelling, irritation or signs of significant discomfort in the eye then you should inform your doctor as soon as possible. These can be signs of an allergy to the treatment and you should stop using the medicine until you have see your doctor. You may need to change medicine.

This medication can cause people to become lightheaded and dizzy. You should leave some time after first using it to assess the affects on you before driving or operating any machinery that could put you or someone else at risk if you lose alertness.

This medication can intensify the effects of alcohol and medicines that make you drowsy. You should limit consumption of alcohol with this medication and you should check all medications that you are using with your doctor.

Brimonidine can make your eyes more sensitive to light and it can become painful to experience exposure to bright sunlight or bright electric lights. If this is a problem you can alleviate this effect by wearing sunglasses.

Before using this medication you should consider the risks in relation to the benefits of doing so. Share all medical information that you have about yourself with your doctor and ensure that you and your doctor consider the following:

Allergies – If you have had any unusual allergic reactions to any medications in the past then it is very important that you inform your health care practitioner of this. You should also inform your doctor if you have any allergies to dyes, preservatives, animals, foods or non-prescription products.

Paediatric – Use in children under the age of 2 is not recommended due to the high toxicity levels of this treatment.

Geriatric – There are no age related limitations on the use of Brimonidine.

Pregnancy – There is a low risk to a fetus when a pregnant woman uses Brimonidine. Discuss the risks with your doctor.

Breastfeeding – There is no sufficient data relating to breastfeeding whilst taking Brimonidine. Discuss the potential risks with your doctor.

Storage

This medication should be stored in a closed container out of direct exposure to light. Store at room temperature and keep away from heat and moisture.

This medicine should be kept out of reach of children at all times.

Medicine that has passed out of date should be disposed of properly right away. Your doctor or pharmacist will be able to instruct you on how to dispose of this medicine.

Summary

Brimonidine is an eye drop used in the treatment of open-angle glaucoma and ocular hypertension. These conditions can lead to blindness if left untreated because the increased intraocular pressure damages the optical nerve.

This medication works to lower the pressure in the eye by blocking alpha receptors.

Patients using this treatment would typically use one drop thrice daily at 8 hour intervals. This treatment can be used in children aged 2+ and in teenagers and adults too.

To administer the treatment the eye must be held open to receive the drop and then held closed for 1-2 minutes. During this period pressure should be applied to the inner corner of the eye. The eye drop will be absorbed during this period.

This medication can cause a wide range of side effects. Consider the risks of use with your doctor before beginning treatment.