Brimonidine

Pharmacologic Category

Alpha2 Agonist, Ophthalmic; Ophthalmic Agent, Antiglaucoma

Dosing: Adult

Elevated intraocular pressure:

US labeling: Ophthalmic (0.1%, 0.15%, 0.2% solution): Instill 1 drop in affected eye(s) 3 times/day (approximately every 8 hours)

Canadian labeling: Ophthalmic:

Solution 0.15%: Instill 1 drop in affected eye(s) 3 times/day (approximately every 8 hours)

Solution 0.2%: Instill 1 drop in affected eye(s) 2 times/day (approximately every 12 hours)

Ocular redness (OTC): Ophthalmic (0.025% solution): Instill 1 drop in affected eye(s) every 6 to 8 hours up to 4 times daily

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

* See Dosage and Administration in AHFS Essentials for additional information.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied).

Dosing: Pediatric

Glaucoma, ocular hypertension: Children ≥2 years and Adolescents: Ophthalmic solution (0.1%, 0.15%, or 0.2%): Ophthalmic: Instill 1 drop into lower conjunctival sac of affected eye(s) 3 times daily (approximately every 8 hours)

Ocular redness: Children ≥5 years: Ophthalmic solution (0.025%): Ophthalmic: Instill 1 drop info affected eye(s) every 6 to 8 hours as needed up to 4 times daily

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Renal Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling

Use: Labeled Indications

Elevated intraocular pressure: Reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension

Ocular redness (OTC only): Relief of redness of the eye due to minor eye irritations

* See Uses in AHFS Essentials for additional information.

Administration: Ophthalmic

Remove contact lenses prior to administration; wait 15 minutes before reinserting if using products containing benzalkonium chloride. Separate administration of other ophthalmic agents by at least 5 minutes. Do not touch tip of container to any surface, the eyelids, or the surrounding area.

Administration: Pediatric

Ophthalmic: Wash hands prior to use. Instill into conjunctival sac avoiding contact of bottle tip with skin or eye. Apply gentle pressure to lacrimal sac during and immediately following instillation (1 minute) or instruct patient to gently close eyelid after administration, to decrease systemic absorption of ophthalmic drops (Urtti 1993; Zimmerman 1984). Administer other topical ophthalmic medications at least 5 minutes apart; generic formulation contains benzalkonium chloride which may be absorbed by soft contact lenses; wait at least 10 to 15 minutes after administration to insert soft contact lenses.

Storage/Stability

Store at 15°C to 25°C (59°F to 77°F).

Medication Patient Education with HCAHPS Considerations

What is this drug used for?

• It is used to lower high eye pressure.

• It is used to treat glaucoma.

• Some products are used to treat eye redness.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Burning

• Stinging

• Blurred vision

• Foreign body sensation in eye

• Headache

• Loss of strength and energy

• Fatigue

• Dry mouth

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Vision changes

• Eye pain

• Severe eye irritation

• Eyelid swelling

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Medication Safety Issues

​Sound-alike/look-alike issues:

Contraindications

Hypersensitivity to brimonidine or any component of the formulation; neonates and infants <2 years; concomitant MAO inhibitor therapy

Warnings/Precautions

Concerns related to adverse effects:

• Bacterial keratitis: Inadvertent contamination of multiple-dose ophthalmic solutions has caused bacterial keratitis.

• CNS depression: May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).

Disease-related concerns:

• Cardiovascular disease: Use with caution in patients with severe cardiovascular disease or coronary insufficiency.

• Cerebrovascular insufficiency: Use with caution in patients with cerebral insufficiency.

• Hepatic impairment: Use with caution in patients with hepatic impairment (has not been studied).

• Orthostatic hypotension: Use with caution in patients with orthostatic hypotension.

• Raynaud phenomenon: Use with caution in patients with Raynaud phenomenon.

• Renal impairment: Use with caution in patients with renal impairment (has not been studied).

• Thromboangiitis obliterans: Use with caution in patients with thromboangiitis obliterans.

Special populations:

• Contact lens wearers: Some formulations may contain benzalkonium chloride which may be adsorbed by soft contact lenses; remove contacts prior to administration and wait 15 minutes before reinserting.

• Pediatric: Systemic absorption has been reported; children are at higher risk of systemic adverse events (Levy, 2004). Use is contraindicated in children <2 years of age.

Other warnings/precautions:

• Self-medication (OTC use): Discontinue use and contact health care provider if eye pain or changes in vision occur; redness or irritation of the eye continues, or condition worsens or persists for >3 days. Do not use if solution changes color or becomes cloudy.

* See Cautions in AHFS Essentials for additional information.

Geriatric Considerations

Evaluate the patient's or caregiver's ability to safely administer the correct dose of ophthalmic medication.

Warnings: Additional Pediatric Considerations

May cause CNS depression, particularly in young children; not recommended for use in infants or children <2 years. The most common adverse effects reported in a study of pediatric glaucoma patients were somnolence and decreased alertness (50% to 83% in children 2 to 6 years of age); these effects resulted in a 16% discontinuation of treatment rate; children >7 years (>20 kg) had a much lower rate of somnolence (25%); apnea, bradycardia, hypotension, hypothermia, hypotonia, and somnolence have been reported in infants receiving brimonidine.

Pregnancy Risk Factor

B

Pregnancy Considerations

Teratogenic effects were not observed in animal reproduction studies.

Breast-Feeding Considerations

It is not known if brimonidine is excreted in breast milk. Due to the potential for serious adverse reactions in the nursing infant, the manufacturer recommends a decision be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of treatment to the mother.

Briggs' Drugs in Pregnancy & Lactation

• Brimonidine Ophthalmic

Adverse Reactions

Actual frequency of adverse reactions may be formulation dependent; percentages reported with Alphagan P:

>10%:

Central nervous system: Drowsiness (children 25% to 83%; adults 1% to 4%)

Ophthalmic: Allergic conjunctivitis, conjunctival hyperemia, eye pruritus

1% to 10% (unless otherwise noted 1% to 4%):

Cardiovascular: Hypertension (5% to 9%), hypotension

Central nervous system: Dizziness, fatigue, foreign body sensation of eye, headache, impaired consciousness (children), insomnia

Dermatologic: Erythema of eyelid, skin rash

Endocrine & metabolic: Hypercholesterolemia

Gastrointestinal: Xerostomia (5% to 9%), dyspepsia

Hypersensitivity: Local ocular hypersensitivity reaction (5% to 9%), hypersensitivity reaction

Infection: Infection

Neuromuscular & skeletal: Weakness

Ophthalmic: Burning sensation of eyes (5% to 9%), follicular conjunctivitis (5% to 9%), visual disturbance (5% to 9%), blepharitis, blepharoconjunctivitis, blurred vision, cataract, conjunctival edema, conjunctival hemorrhage, conjunctivitis, decreased visual acuity, dry eye syndrome, epiphora, eye discharge, eye irritation, eyelid disease, eyelid edema, eye pain, keratitis, photophobia, stinging of eyes, superficial punctate keratitis, visual field defect, vitreous detachment, vitreous opacity, watery eyes

Respiratory: Bronchitis, cough, dyspnea, flu-like symptoms, pharyngitis, rhinitis, sinus infection, sinusitis

<1%, postmarketing, and/or case reports: Anterior uveitis, apnea (infants), bradycardia, corneal erosion, depression, dermatological reaction (erythema, eyelid pruritus, vasodilation), dry nose, dysgeusia, hordeolum, hypothermia (infants), hypotonia (infants), iritis, keratoconjunctivitis sicca, miosis, nausea, tachycardia

* See Cautions in AHFS Essentials for additional information.

Allergy and Idiosyncratic Reactions

• Brimonidine Allergy

Metabolism/Transport Effects

None known.

Drug Interactions Open Interactions

Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Risk C: Monitor therapy

Alizapride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Azelastine (Nasal): May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Beta-Blockers: Alpha2-Agonists may enhance the AV-blocking effect of Beta-Blockers. Sinus node dysfunction may also be enhanced. Beta-Blockers may enhance the rebound hypertensive effect of Alpha2-Agonists. This effect can occur when the Alpha2-Agonist is abruptly withdrawn. Management: Closely monitor heart rate during treatment with a beta blocker and clonidine. Withdraw beta blockers several days before clonidine withdrawal when possible, and monitor blood pressure closely. Recommendations for other alpha2-agonists are unavailable. Exceptions: Levobunolol; Metipranolol. Risk D: Consider therapy modification

Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Risk D: Consider therapy modification

Brexanolone: CNS Depressants may enhance the CNS depressant effect of Brexanolone. Risk C: Monitor therapy

Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Bromopride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Bromperidol: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Buprenorphine: CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Risk D: Consider therapy modification

Cannabidiol: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Cannabis: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Risk D: Consider therapy modification

Chlorphenesin Carbamate: May enhance the adverse/toxic effect of CNS Depressants. Risk C: Monitor therapy

CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Risk C: Monitor therapy

Dimethindene (Topical): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Doxylamine: May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended. Risk C: Monitor therapy

Dronabinol: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Droperidol: May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs. Risk D: Consider therapy modification

Esketamine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression (eg, sedation, respiratory depression). Use non-CNS depressant alternatives when available. Risk D: Consider therapy modification

HydrOXYzine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Kava Kava: May enhance the adverse/toxic effect of CNS Depressants. Risk C: Monitor therapy

Lemborexant: May enhance the CNS depressant effect of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Risk D: Consider therapy modification

Lisuride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Lofexidine: May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs. Risk C: Monitor therapy

Magnesium Sulfate: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Methotrimeprazine: May enhance the CNS depressant effect of CNS Depressants. CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Management: Reduce the usual dose of CNS depressants by 50% if starting methotrimeprazine until the dose of methotrimeprazine is stable. Monitor patient closely for evidence of CNS depression. Risk D: Consider therapy modification

Metoclopramide: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

MetyroSINE: CNS Depressants may enhance the sedative effect of MetyroSINE. Risk C: Monitor therapy

Mianserin: May diminish the therapeutic effect of Alpha2-Agonists (Ophthalmic). Risk X: Avoid combination

Minocycline (Systemic): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Mirtazapine: May diminish the antihypertensive effect of Alpha2-Agonists. Management: Consider avoiding concurrent use. If the combination cannot be avoided, monitor for decreased effects of alpha2-agonists if mirtazapine is initiated/dose increased, or increased effects if mirtazapine is discontinued/dose decreased. Risk D: Consider therapy modification

Monoamine Oxidase Inhibitors: May enhance the adverse/toxic effect of Brimonidine (Ophthalmic). Monoamine Oxidase Inhibitors may increase the serum concentration of Brimonidine (Ophthalmic). Risk C: Monitor therapy

Nabilone: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Opioid Agonists: CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider therapy modification

Orphenadrine: CNS Depressants may enhance the CNS depressant effect of Orphenadrine. Risk X: Avoid combination

Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Oxybate Salt Products: CNS Depressants may enhance the CNS depressant effect of Oxybate Salt Products. Management: Consider alternatives to this combination when possible. If combined, dose reduction or discontinuation of one or more CNS depressants (including the oxybate salt product) should be considered. Interupt oxybate salt treatment during short-term opioid use. Risk D: Consider therapy modification

OxyCODONE: CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider therapy modification

Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Risk X: Avoid combination

Perampanel: May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. Risk D: Consider therapy modification

Piribedil: CNS Depressants may enhance the CNS depressant effect of Piribedil. Risk C: Monitor therapy

Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Risk C: Monitor therapy

ROPINIRole: CNS Depressants may enhance the sedative effect of ROPINIRole. Risk C: Monitor therapy

Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Risk C: Monitor therapy

Rufinamide: May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. Risk C: Monitor therapy

Serotonin/Norepinephrine Reuptake Inhibitors: May diminish the antihypertensive effect of Alpha2-Agonists. Risk C: Monitor therapy

Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Risk D: Consider therapy modification

Tetrahydrocannabinol: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Tetrahydrocannabinol and Cannabidiol: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Risk X: Avoid combination

Tricyclic Antidepressants: May diminish the therapeutic effect of Alpha2-Agonists (Ophthalmic). Risk C: Monitor therapy

Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider therapy modification

Monitoring Parameters

IOP routinely (first month of therapy may not reflect long-term level of IOP reduction)

Advanced Practitioners Physical Assessment/Monitoring

Obtain intraocular pressure routinely. Obtain orthostatic blood pressure measurements. Assess other medications patient is taking; discontinuation or dosage adjustments may be needed. Educate patient on proper administration technique.

Nursing Physical Assessment/Monitoring

Check ordered tests and report abnormalities. Monitor blood pressure and assess for signs of orthostatic hypotension. Instruct patient on proper administration technique.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Ophthalmic, as tartrate:

Alphagan P: 0.1% (5 mL, 10 mL, 15 mL); 0.15% (5 mL, 10 mL, 15 mL)

Lumify: 0.025% (2.5 mL, 7.5 mL) [contains benzalkonium chloride]

Generic: 0.15% (5 mL, 10 mL, 15 mL); 0.2% (5 mL, 10 mL, 15 mL)

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Ophthalmic, as tartrate:

Alphagan: 0.2% (5 mL, 10 mL)

Alphagan P: 0.15% (3 mL, 5 mL, 10 mL, 15 mL) [contains carboxymethylcellulose sodium]

Generic: 0.15% (5 mL, 10 mL); 0.2% (5 mL, 10 mL)

Anatomic Therapeutic Chemical (ATC) Classification

• S01EA05

Generic Available (US)

Yes

Pricing: US

Solution (Alphagan P Ophthalmic)

0.1% (per mL): $40.29

0.15% (per mL): $42.97

Solution (Brimonidine Tartrate Ophthalmic)

0.15% (per mL): $35.03

0.2% (per mL): $1.50 - $6.52

Solution (Lumify Ophthalmic)

0.025% (per mL): $3.77

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Mechanism of Action

A relatively selective alpha-2 adrenergic agonist; causes reduction of aqueous humor formation and increased uveoscleral outflow

Pharmacodynamics/Kinetics

Metabolism: Hepatic (extensive)

Half-life elimination: ~3 hours

Time to peak, plasma: 1 to 4 hours

Excretion: Urine (74%)

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

No significant effects or complications reported

Effects on Bleeding

No information available to require special precautions

Pharmacotherapy Pearls

The use of Purite as a preservative in Alphagan P has led to a reduced incidence of certain adverse effects associated with products using benzalkonium chloride as a preservative. The 0.1% and 0.15% solutions are comparable to the 0.2% solution in lowering intraocular pressure.

Index Terms

Alphagan; Brimonidine Tartrate

FDA Approval Date

March 16, 2001

References

Alphagan (brimonidine tartrate) [prescribing information]. Irvine, CA: Allergan, Inc; September 2013.

Alphagan (brimonidine tartrate) [product monograph]. Markham, Ontario, Canada: Allergan Inc; August 2015.

Alphagan P (brimonidine tartrate) [product monograph]. Markham, Ontario, Canada: Allergan Inc; August 2015.

Berlin RJ, Lee UT, Samples JR, et al, “Ophthalmic Drops Causing Coma in an Infant,” J Pediatr, 2001, 138(3):441-3.[PubMed 11241061]

Brimonidine P (brimonidine tartrate) ophthalmic solution 0.15% [product monograph]. Vaughan, Ontario, Canada: AA Pharma Inc; July 2019.

Brimonidine Tartrate Ophthalmic Solution 0.2% [prescribing information]. Bridgewater, NJ: Valeant Pharmaceuticals; July 2016.

Byles DB, Frith P, and Salmon JF, “Anterior Uveitis as a Side Effect of Topical Brimonidine,” Am J Ophthalmol, 2000, 130(3):287-91.[PubMed 11020406]

Carlsen JO, Zabriskie NA, Kwon YH, et al, “Apparent Central Nervous System Depression in Infants After the Use of Topical Brimonidine,” Am J Ophthalmol, 1999, 128(2):255-6.[PubMed 10458196 ]

Enyedi LB and Freedman SF, “Safety and Efficacy of Brimonidine in Children With Glaucoma,” J AAPOS, 2001, 5(5):281-4.[PubMed 11641636]

Levy Y and Zadok D, “Systemic Side Effects of Ophthalmic Drops,” Clin Pediatr (Phila), 2004, 43(1):99-101.

Lumify (brimonidine tartrate) [prescribing information]. Bridgewater, NJ: Bausch + Lomb; received March 2020.

Urtti A, Salminen L. Minimizing systemic absorption of topically administered ophthalmic drugs. Surv Ophthalmol. 1993;37(6):435-456.[PubMed 8100087 ]

Zimmerman TJ, Kooner KS, Kandarakis AS, Ziegler LP. Improving the therapeutic index of topically applied ocular drugs. Arch Ophthalmol. 1984;102(4):551-553.[PubMed 6704011 ]

Brand Names: International

Agglad Ofteno (CL, CO, PE, VE); Alfabrimo (EG); Alfadina (ES); Alfagan P (UA); Alphabrin (BR); Alphabrin P (BR); Alphagan (AR, AT, AU, BE, BH, BR, CH, CL, CN, CZ, DE, DK, EC, ES, FI, FR, GB, GR, HR, IE, IN, IS, IT, JO, JP, KW, LU, MT, MX, NL, NO, NZ, PL, PT, SE, TR, TW, VN, ZA); Alphagan - P (EG); Alphagan P (AE, AR, AU, BB, BR, CL, CN, CO, HK, IL, KR, KW, LB, MY, NZ, PH, SA, SG, TH, TW, VE); Alphagan-P (LK, VN); Alphamon P (KR); Alphanova (EG); Bglau (PT); Bridin-T (KR); Briglau (HU, NL); Brimicon (CN); Brimo (AE, BH, QA, TW); Brimo Ophtal (DE); Brimochek (LK, PH, SG); Brimocom (IN); Brimodin (BD); Brimogan (MT, SY); Brimonal (LV, RO); Brimontal (TR); Brimopress (AR, CL, CR, DO, GT, HN, LK, NI, PA, PY, SV, UY); Brimorand (SE); Brimoratio (NO); Brimot (HR); Briop (CO, MX); Brymont (MT); Citol Brim (PY); Enidin (AU); Enidin P (AU); Glaudin (DK, SE); Iobrim (IN); Locular (BD); Luxfen (BG, CZ, LT, UA); Nor-Tenz (MX); Rocular (BD)

Last Updated 10/14/20