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

Brimonidine belongs to the class of medications called selective alpha-2 adrenergic agonists. It is used to treat the redness of the skin that is caused by a condition called rosacea.

This medication works by narrowing the blood vessels in the skin to reduce the redness caused by rosacea. Brimonidine topical gel often begins to work within 30 minutes of applying it to the affected skin. The maximum effect is frequently seen approximately 3 hours after application.

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 taking this medication, speak to your doctor. Do not stop taking 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 take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Each gram of white to light yellow opaque aqueous gel contains 5 mg of brimonidine tartrate equivalent to 3.3 mg of brimonidine free base. Nonmedicinal ingredients: carbomer, glycerol, methylparahydroxybenzoate, phenoxyethanol, propylene glycol, purified water, titanium dioxide and sodium hydroxide.

How should I use this medication?

The recommended dose of brimonidine topical gel is approximately 1 gram of gel applied once daily. Five small pea-size amounts, totalling approximately 1 gram, should be applied evenly to each of the five areas of the face (chin, nose, forehead and each cheek). This is the maximum daily dose. Avoid the eye and lip areas. Do not apply to open wounds or irritated skin.

Wash your hands immediately after applying the gel. Make-up may be used after applying the gel.

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 ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be used exactly as prescribed by your doctor. If you do not notice any improvement within 5 days, contact your doctor. Do not apply this medication more frequently than your doctor recommends.

If you miss a dose, apply it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not apply 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, protect it from light and moisture, and keep it out of the reach of children.

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 this medication if you are allergic to brimonidine or any ingredients of the medication.
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.

  • acne
  • dry mouth
  • dry skin
  • feeling cold in the hands and feet
  • headache
  • itching
  • flushing
  • nasal congestion
  • redness
  • skin burning sensation
  • tingling or burning where the gel is applied
  • warm skin sensation

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:

  • dizziness
  • eyelid swelling
  • headache
  • rash
  • skin discomfort or pain
  • worsening of rosacea

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

  • allergic reaction (e.g., rash, itchiness, redness, swelling, difficulty breathing)
  • severe skin irritation

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.

Cardiovascular effects: The cardiovascular system (heart and blood vessels) may be affected by the use of brimonidine. When brimonidine causes the blood vessels in the skin to narrow, it can also have this effect on other blood vessels in the body. If you have a history of 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.

Raynaud's phenomenon: People with Raynaud's phenomenon experience poor blood circulation to the extremities. Brimonidine may make the symptoms of Raynaud's worse. If you have Raynaud's phenomenon, 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 taking 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: The safety and effectiveness of using this medication have not been established for children. This medication is not recommended for children between 2 and 18 years of age.

What other drugs could interact with this medication?

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

  • alcohol
  • aliskiren
  • alpha agonists (e.g., clonidine, methyldopa)
  • angiotensin converting enzyme inhibitors (ACEIs; captopril, enalapril, ramipril)
  • angiotensin receptor blockers (ARBs; e.g., candesartan, irbesartan, losartan)
  • antihistamines (e.g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
  • antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
  • apomorphine
  • baclofen
  • barbiturates (e.g., butalbital,  phenobarbital)
  • beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
  • benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
  • buspirone
  • carbamazepine
  • calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
  • chloral hydrate
  • digoxin
  • diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
  • efavirenz
  • entacapone
  • flibanserin
  • gabapentin
  • hydralazine
  • lamotrigine
  • lemborexant
  • levetiracetam
  • levodopa
  • mirtazapine
  • monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
  • muscle relaxants (e.g., cyclobenzaprine, methocarbamol, orphenadrine)
  • narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone, tramadol)
  • nitrates (e.g., isosorbide dinitrate, nitroglycerin)
  • phenytoin
  • pregabalin
  • primidone
  • scopolamine
  • tizanidine
  • topiramate
  • trazodone
  • zolpidem
  • zopiclone

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 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.

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