Brimonidine
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| Pronunciation | /brɪˈmoʊnɪdiːn/ bri-MOH-nid-een |
| Trade names | Alphagan, Mirvaso, Lumify |
| AHFS/Drugs.com | Consumer Drug Information |
| MedlinePlus | a601232 |
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| Routes of administration | topical (ophthalmic solution, gel) |
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| Pharmacokinetic data | |
| Metabolism | Primarily liver |
| Elimination half-life | 3 hours (ocular), 12 hours (topical) |
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100.149.042  |
| Chemical and physical data | |
| Formula | C11H10BrN5 |
| Molar mass | 292.135 g/mol |
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| Melting point | 252 °C (486 °F) |
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Brimonidine is a drug, used as eye drops under the brand names Alphagan and Alphagan-P to treat open-angle glaucoma or ocular hypertension, as a gel, Mirvaso, for facial skin redness in rosacea, and in tartrate formulation, beginning in July 2018, as an ophthalmic vasoconstrictor, sold by Bausch and Lomb under the brand name Lumify, also as eye drops, in 0.025% solution.
It acts via decreasing synthesis of aqueous humor, and increasing the amount that drains from the eye through uveoscleral outflow; brimonidine treats reddened skin (erythema) by causing narrowing of blood vessels (vasoconstriction).
Clinical uses
Brimonidine is indicated for the lowering of intraocular pressure in patients with open-angle glaucoma or ocular hypertension. It is also the active ingredient of Combigan along with timolol maleate.
A Cochrane Systematic Review compared the effect of brimonidine and timolol in slowing the progression of open angle glaucoma in adult participants.[1]
In 2013, the FDA approved topical application of brimonidine 0.33% gel (Mirvaso) for persistent facial redness of rosacea.
OTC eye drops ("Lumify")
In July 2018, Bausch and Lomb began to market OTC eye drops, using brimonidine's tartrate formulation in a concentration of 0.025%, as an ophthalmic vasoconstrictor under the brand name Lumify. Intended to relieve redness in the sclerae of the eyes for periods of up to eight hours at a time through its vasoconstrictive effects, Lumify was marketed as an alternative to "Visine," the brand of tetrahydrozoline hydrochloride solution most commonly used for that purpose.
Mechanism of action
Brimonidine is an α2 adrenergic agonist.
α2 agonists, through the activation of a G protein-coupled receptor, inhibit the activity of adenylate cyclase. This reduces cAMP and hence aqueous humour production by the ciliary body.
Peripheral α2 agonist activity results in vasoconstriction of blood vessels (as opposed to central α2 agonist activity that decreases sympathetic tone, as can be seen by the medication clonidine). This vasoconstriction may explain the acute reduction in aqueous humor flow. The increased uveoscleral outflow from prolonged use may be explained by increased prostaglandin release due to α adrenergic stimulation. This may lead to relaxed ciliary muscle and increased uveoscleral outflow.[2]
References
- ↑ Sena DF, Lindsley K (2017). "Neuroprotection for treatment of glaucoma in adults". Cochrane Database Syst Rev. 1: CD006539. doi:10.1002/14651858.CD006539.pub4. PMC 5370094. PMID 28122126.
- ↑ Toris, C.; Camras, C.; Yablonski, M. (1999). "Acute versus chronic effects of brimonidine on aqueous humor dynamics in ocular hypertensive patients". American Journal of Ophthalmology. 128 (1): 8–14. doi:10.1016/s0002-9394(99)00076-8. PMID 10482088.
- Mosby's Drug Guide for Nurses (7th edition; Skidmore) 2007.