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Drug Profile

The information on this site is intended to supplement and enhance, not replace, the advice of a physician who is familiar with your medical history. Decisions about your health should always be made ONLY after detailed conversation with your doctor.

Generic drug name: brimonidine (bri MOE ni deen)
Brand name(s): ALPHAGAN
GENERIC: not available FAMILY: Drugs for Glaucoma
Find the drug label by searching at DailyMed.

Pregnancy and Breast-feeding Warnings [top]

Pregnancy Warning

Brimonidine crosses the placenta, exposing the fetus to the drug. Use during pregnancy only for clear medical reasons. Tell your doctor if you are pregnant or thinking of becoming pregnant before you take this drug.

Breast-feeding Warning

Brimonidine was excreted in animal milk. Since it is likely that this drug, like many others, is excreted in human milk, you should consult with your doctor if you are planning to nurse.

Facts About This Drug [top]

Brimonidine (ALPHAGAN) is a drug that helps lower the pressure inside the eye to treat glaucoma. It works by decreasing the production of fluid in the eye and by increasing the flow of fluids out of the eye.

Clinical studies have shown that when used twice daily, brimonidine is not as effective at lowering eye pressure as timolol (TIMOPTIC), a beta-blocker eye drop,[1],[2] or latanoprost (XALATAN).[3]

When used three times daily, brimonidine was found to be as effective as dorzolamide...

Brimonidine (ALPHAGAN) is a drug that helps lower the pressure inside the eye to treat glaucoma. It works by decreasing the production of fluid in the eye and by increasing the flow of fluids out of the eye.

Clinical studies have shown that when used twice daily, brimonidine is not as effective at lowering eye pressure as timolol (TIMOPTIC), a beta-blocker eye drop,[1],[2] or latanoprost (XALATAN).[3]

When used three times daily, brimonidine was found to be as effective as dorzolamide (TRUSOPT).[4]

However, dorzolamide is considered therapeutically inferior to timolol.[5] Studies on patients who need to use a second drug in addition to timolol to control their eye pressure have found that brimonidine provides more benefit than dorzolamide[6] and latanoprost when used as a combination agent.[7]

Unlike timolol, brimonidine does not worsen lung disorders such as asthma nor does it cause a decrease in heart rate like timolol. Brimonidine does cause a lowering of blood pressure during recovery from exercise and at four hours after use.[1],[8]

A major drawback to brimonidine use is its tendency to cause allergic reactions, such as inflammation of the lining of the eye and eyelids, in almost 12% of users.[1]

In a clinical trial of this drug, 7% of patients had to discontinue use of brimonidine due to allergic complications.[2]

Brimonidine also commonly causes stinging, dry mouth, blurring, headache, and drowsiness.[2]

There is limited data available on the use and safety of brimonidine in children.  No studies on pediatric patients under the age of 2 have been conducted, however, one infant given the drug after approval reacted to treatment with brimonidine with severe lethargy and stupor, requiring discontinuation of the drug.[9]  Allergan, the manufacturer of brimonidine does not recommend it for use in these patients.

Due to its therapeutic inferiority to other available antiglaucoma drugs, and its adverse effect profile, brimonidine should be used only when other treatment options have been exhausted or when a secondary drug is needed in addition to current therapy.

In 2012, the British Journal of Ophthalmology published an article in which five new cases of anterior uveitis associated with brimonidine use were reported. Uveitis is inflammation (swelling and irritation) in the uvea (an inner layer of the eye that includes the iris). Anterior uveitis occurs when the front part of the eye becomes inflamed. The iris of the eye is usually affected. In the cases reported, symptoms of inflammation resolved when brimonidine therapy was stopped.[10]

Before You Use This Drug [top]

Do not use this drug if you have or have had:

  • allergy to this drug or other ingredients in its formulation

Tell your doctor if you have or have had:

  • allergy to drugs
  • pregnancy or are breast-feeding
  • decreased blood circulation to the brain
  • heart disease
  • kidney disease
  • liver disease
  • inflammation of the blood vessels
  • low blood pressure
  • mental depression
  • Raynaud’s disease

Tell your doctor about any other drugs you take, including aspirin, herbs, vitamins, and other nonprescription products.

When You Use This Drug [top]

  • Until you know how you react to this drug, do not drive or perform other activities requiring alertness. This drug may cause drowsiness.
  • This drug may cause your eyes to be more sensitive to bright lights. You may need to wear sunglasses and avoid intense lights.
  • Call your doctor immediately if you become faint or have a fainting episode.
  • Have regular visits with your doctor to check your eye pressure.

How to Use This Drug [top]

  • Follow directions for applying eye drops.
  • Prevent the container from becoming contaminated. Avoid letting the tip of the container touch your eye, hands, or any other object.
  • Recap the container immediately to prevent contamination and to prevent crystals from forming on the tip of the container.[11]
  • Contact lenses should be removed prior to administration of this drug. Preservative in the drug product may be absorbed by the contacts; wait at least 15 minutes after putting in eye drops before inserting contacts.
  • Wait at least 10 minutes between application of two different eye-drop drugs. If you miss a dose, take it as soon as you remember, but skip it if it is almost time for the next dose. Do not take double doses.
  • Do not share your medication with others.
  • Take the drug at the same time(s) each day.
  • Store at room temperature with lid on tightly. Do not store in the bathroom. Do not expose to heat, moisture, or strong light. Keep out of reach of children.

Interactions with Other Drugs [top]

The following drugs, biologics (e.g., vaccines, therapeutic antibodies), or foods are listed in Evaluations of Drug Interactions 2003 as causing “highly clinically significant” or “clinically significant” interactions when used together with any of the drugs in this section. In some sections with multiple drugs, the interaction may have been reported for one but not all drugs in this section, but we include the interaction because the drugs in this section are similar to one another. We have also included potentially serious interactions listed in the drug’s FDA-approved professional package insert or in published medical journal articles. There may be other drugs, especially those in the families of drugs listed below, that also will react with this drug to cause severe adverse effects. Make sure to tell your doctor and pharmacist the drugs you are taking and tell them if you are taking any of these interacting drugs:

ELDEPRYL, furazolidone, isocarboxazid, MARPLAN, MATULANE, moclobemide, NARDIL, pargyline, PARNATE, phenelzine, procarbazine, selegiline, tranylcypromine.

Adverse Effects [top]

In addition to the allergic reactions mentioned above, brimonidine can be absorbed into the blood through the eye. Therefore, use of this drug may have systemic adverse effects.

Call your doctor immediately if you experience:

  • blood pressure increase
  • bloody eye
  • blurred vision or other change in vision
  • corneal erosion
  • dizziness
  • eye pain or ache
  • fainting
  • feeling of something in eye
  • headache
  • itching
  • mental depression
  • muscle pain
  • nausea or vomiting
  • oozing in eye
  • redness of eye or inner lining of eyelid
  • runny or stuffy nose
  • sneezing
  • redness, swelling, and/or itching of eyelid
  • tearing

Call your doctor if these symptoms continue:

  • anxiety
  • burning, stinging, or tearing of eye
  • crusting on eyelid or corner of eye
  • discoloration of white part of eye
  • drowsiness or tiredness
  • dryness of eye
  • increased sensitivity of eye to light
  • muscle weakness
  • paleness of eye or inner lining of eyelid
  • pounding heartbeat
  • change in sense of taste
  • trouble sleeping

Periodic Tests[top]

Ask your doctor if this test should be done periodically while you are taking this drug:

  • eye pressure exams

last reviewed January 31, 2021