Brimonidine tartrate ocular
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Eye drop solution containing brimonidine tartrate.
Drugs List
Therapeutic Indications
Uses
Elevated IOP in ocular hypertension - adjunctive therapy
Elevated IOP in ocular hypertension - alternative to beta-blockers
Elevated IOP in open-angle glaucoma - adjunctive therapy
Elevated IOP in open-angle glaucoma - alternative to beta-blockers
Dosage
Adults
Instil one drop in the affected eye(s) twice daily approximately 12 hours apart.
Elderly
Instil one drop in the affected eye(s) twice daily approximately 12 hours apart.
Children
Brimonidine tartrate eye drops are contraindicated in infants under 2 years.
Safety and efficacy have not been established in children aged 2-12 years. Systemic side effects, including increased risk of drowsiness, have been reported in this age group, particularly in the 2-7 year age group and those weighing less than 20kg. No dose recommendations are given by the manufacturer.
Contraindications
Children under 2 years
Breastfeeding
Precautions and Warnings
Children aged 2 to 18 years
Soft contact lenses
Cerebrovascular insufficiency
Depression
Hepatic impairment
Postural hypotension
Pregnancy
Raynaud's syndrome
Renal impairment
Severe cardiovascular disorder
Thromboangiitis obliterans
Advise patient blurred vision may affect ability to drive/operate machinery
Advise patient drowsiness may affect ability to drive or operate machinery
Contains benzalkonium chloride
In combined therapy, administer eye products at least five minutes apart
To reduce systemic absorption compress lacrimal sac during administration
Discontinue if allergic reaction occurs
Advise patient to avoid touching the eye/other surfaces with container tip
Discolours soft contact lenses
If soft contact lenses worn,insert them 15 minutes after using eye drops
Pregnancy and Lactation
Pregnancy
Caution is advised in pregnancy.
In animal studies, no teratogenic effects were seen, however pre-implantation loss and postnatal growth reduction were seen in rabbits when brimonidine tartrate was present at plasma levels higher than those achieved during human treatment.
The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Lactation
This medication is contraindicated in breastfeeding.
It is not known if brimonidine is excreted in human milk; it is known to be excreted in the milk of lactating rats.
Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Counselling
Advise patient to remove soft contact lenses before instillation of the eye drops and re-insert them after 15 minutes.
Advise patient that brimonidine tartrate is known to discolour soft contact lenses.
Advise patient to leave an interval of at least 5 minutes before instilling another ophthalmic medication.
Advise patient to avoid contact of the container with eye or other surfaces as contamination may occur.
Advise patient to compress the lacrimal sac during administration and for one minute afterwards, to reduce systemic absorption.
Advise patient that eye drops may cause fatigue/drowsiness and may also cause blurred/abnormal vision after instillation - avoid driving or operating machinery until these symptoms have cleared.
Side Effects
Abnormal vision
Allergic reaction
Arrhythmias
Asthenia
Blepharitis
Blepharoconjunctivitis
Blurred vision
Bradycardia
Burning sensation
Conjunctival blanching
Conjunctival discharge
Conjunctival follicles
Conjunctival oedema
Conjunctivitis
Corneal erosion
Corneal staining
Depression
Dizziness
Drowsiness
Dry eyes
Dry mouth
Dyspnoea
Eyelid hyperaemia
Eyelid oedema
Fatigue
Gastro-intestinal symptoms
Headache
Hypertension
Hypotension
Insomnia
Iritis
Miosis
Nasal dryness
Ocular hyperaemia
Ocular irritation
Ocular pain
Palpitations
Photophobia
Pruritus
Sensation of foreign body in eye
Stinging
Syncope
Tachycardia
Taste disturbances
Tearing
Upper respiratory symptoms
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: January 2013
Reference Sources
British National Formulary, 64th Edition (2012) Pharmaceutical Press, London.
BNF for Children (2012-2013) Pharmaceutical Press, London.
Martindale: The Complete Drug Reference, 36th edition (2009) ed. Sweetman, S. Pharmaceutical Press, London.
Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.
Summary of Product Characteristics: Alphagan eye drops. Allergan Ltd. September 2010.
Summary of Product Characteristics: Brymont eye drops. Blumont Pharma Ltd. Revised August 2012.
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.