How does this medication work? What will it do for me?

Brimonidine belongs to the family of medications known as alpha-2-adrenergic receptor agonists. It is available in eye-drop form and is used to reduce the pressure inside the eye for people with open-angle glaucoma or intraocular hypertension (increased pressure in the eye).

Fluid is constantly being formed and drained out of the eye. When this fluid does not drain out of the eye properly, pressure inside the eye increases. Brimonidine works by reducing the amount of fluid produced by the eye and by increasing the flow of fluid out of the eye. It starts to work within 2 hours after being instilled in the eye.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are being given this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Each 1 mL of clear, pale yellow sterile ophthalmic solution contains brimonidine tartrate 2 mg (0.2%). Nonmedicinal ingredients: benzalkonium chloride, citric acid, hydrochloric acid or sodium hydroxide to adjust pH, polyvinyl alcohol, purified water, sodium chloride, and sodium citrate.

How should I use this medication?

The usual recommended dose for adults is one drop of brimonidine 0.2% solution into the affected eye(s) twice daily, approximately 12 hours apart (e.g., in the morning and at bedtime).

For brimonidine 0.15% ophthalmic drops, the recommended dose for adults is one drop of solution into the affected eye(s) 3 times daily, approximately 8 hours apart.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the one listed here, do not change the way that you are using the medication without consulting your doctor.

Some bottles that contain the eye drops are equipped with a special cap to help you remember how many times to use your drops each day. See the package insert for an illustration of how to properly use these drops.

To use the eye drops:

  1. Wash your hands before using the eye drops.
  2. Remove the cap and place it in a clean location. To avoid possible contamination, keep the tip of the container away from contact with any surface.
  3. Tilt the head back and look towards the ceiling.
  4. With your index finger, gently pull the lower eyelid down and away from the eye to form a pouch.
  5. Apply one drop into the pouch but do not allow the tip of the container to touch the eye or areas around the eye.
  6. Gently apply pressure to the inner corner of the eye (at the bridge of the nose) for about 30 seconds (this is called nasolacrimal occlusion). This prevents the medication from dripping down through the tear duct and entering the bloodstream, which could cause you to experience some side effects.
  7. Repeat with the other eye, if prescribed by your physician.
  8. Wash your hands again to remove any medication.

Do not allow the dropper tip of the bottle to touch the eye or other surrounding structures. This can contaminate the tip with common bacteria known to cause eye infections. Serious damage to the eye may result if you use eye drop solutions that have become contaminated.

If you wear contact lenses, remove them before instilling brimonidine into your eye. You may put your contact lenses back in 15 minutes after using the medication.

It is important to use this medication exactly as prescribed by your doctor. If you miss a dose, instill it as soon as possible and continue on with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue on with your regular dosing schedule. Do not instill a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature and keep it out of the reach of children.

Some brands require you to discard any remaining medication 28 days after opening the container and begin using a new bottle. Check the package insert or with your pharmacist for more information.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not use brimonidine eye drops if you:

  • are allergic to brimonidine or any ingredients of the medication
  • are using monoamine oxidase inhibitors (MAOI; e.g., phenelzine, tranylcypromine)

Do not give this medication to children less than 2 years of age.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • burning, stinging, or irritated eyes upon instillation of eye drops
  • discoloration of white part of the eye
  • drowsiness or tiredness
  • dry eyes
  • dry mouth
  • headache
  • muscle weakness
  • taste changes
  • temporarily blurred vision

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • cold-like symptoms (e.g., sore throat, tiredness, nasal congestion or runny nose)
  • dizziness
  • lightheaded feeling or dizziness when rising from a sitting or lying position
  • red, swollen, or itchy eyelid
  • redness of the eye or inner lining of the eyelid
  • sensitivity of the eye to light
  • signs of an eye infection (e.g., pain, irritation, redness of the eye; increased sensitivity to light)slowed heartbeat
  • vision problems (e.g., decrease acuity)

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • symptoms of an allergic reaction such as difficulty breathing, hives, or itchy skin rash

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Contact lenses: People who wear contact lenses should remove the lenses before using the eye drops and wait at least 15 minutes before reinserting them.

Depression: If you have clinical depression or a history of depression, discuss with your doctor how this medication may affect your medical condition and whether any special monitoring is needed. You may need to visit your doctor more often to ensure that this medication is not making your condition worse.

Drowsiness/reduced alertness: Brimonidine may cause temporary fatigue and drowsiness. Do not drive, operate machinery, or engage in any potentially hazardous activities until you determine how this medication affects you.

Kidney function: The use of brimonidine eye drops by people with kidney disease has not been studied. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: The use of brimonidine eye drops by people with liver disease has not been studied. If you have reduced liver function or liver disease, discuss with your doctor how this medication may affect your medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Orthostatic hypotension: Orthostatic hypotension, also known as postural hypotension, is a drop in blood pressure when getting up from a lying position. This may happen to people using brimonidine eye drops. If you experience this, rise slowly from a lying or sitting position when using brimonidine.

Raynaud's disease: Raynaud's disease is a disorder of the small blood vessels that feed the skin. If you have Raynaud's disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Severe cardiovascular (heart) disease: Although brimonidine typically has little effect on blood pressure and heart rate, it may lower blood pressure and heart rate (pulse) if you have severe heart disease. If you have severe heart disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Thromboangiitis obliterans: Thromboangiitis obliterans is a condition causing inflammation of small- and medium-sized arteries and veins. If you have thromboangiitis obliterans, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while using this medication, contact your doctor immediately.

Breast-feeding: It is not known if brimonidine passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: This medication is not recommended for children, as serious side effects have been reported in people less than 18 years of age. Do not use this medication for children less than 2 years old.

What other drugs could interact with this medication?

There may be an interaction between brimonidine and any of the following:

  • alcohol
  • alpha agonists (e.g., clonidine, methyldopa)
  • alpha blockers (e.g., alfuzosin, doxazosin, tamsulosin)
  • angiotensin converting enzyme inhibitors (ACEIs; e.g., captopril, enalapril, ramipril)
  • angiotensin receptor blockers (ARBs; e.g., candasartan, irbesartan, losartan)
  • antihistamines (e.g,. cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
  • antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
  • aripiprazole
  • azelastine
  • baclofen
  • barbiturates (e.g., butalbital, phenobarbital)
  • beta-blockers (e.g., atenolol, metoprolol, propranolol)
  • buprenorphine
  • benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
  • buspirone
  • calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
  • carbamazepine
  • chloral hydrate
  • diphenoxylate
  • diuretics (e.g., hydrochlorothiazide, furosemide)
  • droperidol
  • efavirenz
  • gabapentin
  • hydralazine
  • lamotrigine
  • levetiracetam
  • mirtazapine
  • monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
  • selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine, fluoxetine, paroxetine, sertraline)
  • muscle relaxants (e.g., cyclobenzaprine, methocarbamol, orphenadrine)
  • narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone)
  • nitrates(e.g., nitroglycerin, isosorbide dinitrate)
  • olopatadine
  • phenytoin
  • pramipexole
  • riociguat
  • ropirinirole
  • scopolamine
  • tapentadol
  • topiramate
  • tramadol
  • tricyclic antidepressants (e.g., amitriptyline, imipramine)
  • zopiclone
  • zolipidem

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.