Brimonidine: Difference between revisions

{{Short description|Chemical compound}}

| Watchedfields = changed

| verifiedrevid = 459982442

| image = Brimonidine.svg

| width = 195

| alt =

<!-- Clinical data -->

| pronounce = {{IPAc-en|b|r|ɪ|ˈ|m|oʊ|n|ᵻ|d|iː|n}} {{respell|bri|MOH|nid-een}}

| tradename = Alphagan, Mirvaso, Lumify, others

| Drugs.com = {{drugs.com|monograph|brimonidine-tartrate-eent}}

| DailyMedID = Brimonidine

| pregnancy_AU = B3

| pregnancy_AU_comment =

| pregnancy_category=

| routes_of_administration = [[Topical medication|Topical]]

| class =

| ATC_prefix = D11

| ATC_suffix = AX21

| ATC_supplemental = {{ATC|S01|EA05}}, {{ATC|S01|GA07}}

| legal_US = Rx-only

| legal_US_comment = /&nbsp;OTC

<!-- Pharmacokinetic data -->

| metabolism = Primarily [[liver]]

| elimination_half-life = 3 hours (ocular), 12 hours (topical)

<!-- Identifiers -->

| CAS_number_Ref = {{cascite|correct|??}}

<!-- Chemical data -->

| IUPAC_name = 5-Bromo-''N''-(4,5-dihydro-1''H''-imidazol-2-yl) quinoxalin-6-amine

| C=11 | H=10 | Br=1 | N=5

| melting_point = 252

<!-- Definition and medical uses -->

'''Brimonidine''' is an [[Alpha-2 adrenergic receptor|α₂]] agonist [[medication]] used to treat [[glaucoma|open-angle glaucoma]], [[ocular hypertension]], and [[rosacea]].<ref name=AHFS2019Eye>{{cite web |title=Brimonidine Tartrate eent Monograph for Professionals |url=https://www.drugs.com/monograph/brimonidine-tartrate-eent.html |website=Drugs.com |publisher=American Society of Health-System Pharmacists |access-date=17 March 2019 |language=en}}</ref><ref name=AHFS2019Skin>{{cite web |title=Brimonidine Tartrate topical Monograph for Professionals |url=https://www.drugs.com/monograph/brimonidine-tartrate-topical.html |website=Drugs.com |publisher=American Society of Health-System Pharmacists |access-date=17 March 2019 }}</ref> In rosacea it improves the redness.<ref name=AHFS2019Skin/> It is used as [[eye drops]] or applied to the skin.<ref name=AHFS2019Eye/><ref name=AHFS2019Skin/>

<!-- Side effects and mechanism -->

Common side effects when used in the eyes include itchiness, redness, and a dry mouth.<ref name=AHFS2019Eye/> Common side effects when used on the skin include redness, burning, and headaches.<ref name=AHFS2019Skin/> More significant side effects may include [[allergic reactions]] and [[low blood pressure]].<ref name=AHFS2019Skin/><ref name=AHFS2019Eye/> Use in [[pregnancy]] appears to be safe.<ref name=AHFS2019Skin/><ref name=AHFS2019Eye/> When applied to the eye it works by decreasing the amount of [[aqueous humor]] made while increasing the amount that drains from the eye.<ref name=AHFS2019Eye/> When applied to the skin it works by causing blood vessels to contract.<ref name=AHFS2019Skin/>

<!-- Society and culture -->

Brimonidine was patented in 1972 and came into medical use in 1996.<ref name=Fis2006>{{cite book | vauthors = Fischer J, Ganellin CR |title=Analogue-based Drug Discovery |date=2006 |publisher=John Wiley & Sons |isbn=9783527607495 |page=550 |url=https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA550 |language=en}}</ref> It is available as a [[generic medication]].<ref>{{cite web | title=Competitive Generic Therapy Approvals | website=U.S. [[Food and Drug Administration]] (FDA) | date=29 June 2023 | url=https://www.fda.gov/drugs/generic-drugs/competitive-generic-therapy-approvals | access-date=29 June 2023 | archive-date=29 June 2023 | archive-url=https://web.archive.org/web/20230629233651/https://www.fda.gov/drugs/generic-drugs/competitive-generic-therapy-approvals | url-status=live }}</ref><ref name=BNF76>{{cite book|title=British national formulary : BNF 76|date=2018|publisher=Pharmaceutical Press|isbn=9780857113382|pages=1153|edition=76}}</ref> In 2021, it was the 160th most commonly prescribed medication in the United States, with more than 3{{nbsp}}million prescriptions.<ref>{{cite web | title=The Top 300 of 2021 | url=https://clincalc.com/DrugStats/Top300Drugs.aspx | website=ClinCalc | access-date=14 January 2024 | archive-date=15 January 2024 | archive-url=https://web.archive.org/web/20240115223848/https://clincalc.com/DrugStats/Top300Drugs.aspx | url-status=live }}</ref><ref>{{cite web | title = Brimonidine - Drug Usage Statistics | website = ClinCalc | url = https://clincalc.com/DrugStats/Drugs/Brimonidine | access-date = 14 January 2024}}</ref>

==Medical uses ==

Brimonidine is indicated for the lowering of [[intraocular pressure]] in patients with open-angle glaucoma or ocular hypertension. It is also the active ingredient of [[brimonidine/timolol]] along with [[timolol]] maleate.

A 2017 [[Cochrane Collaboration|Cochrane]] review found insufficient evidence to determine if brimonidine slows optic nerve damage.<ref name="Sena">{{cite journal | vauthors = Sena DF, Lindsley K | title = Neuroprotection for treatment of glaucoma in adults | journal = The Cochrane Database of Systematic Reviews | volume = 1 | pages = CD006539 | date = January 2017 | issue = 1 | pmid = 28122126 | pmc = 5370094 | doi = 10.1002/14651858.CD006539.pub4 }}</ref>

In 2013, the FDA approved topical application of brimonidine 0.33% gel for persistent facial redness of rosacea.

==Mechanism of action==

Brimonidine is an [[alpha-2 adrenergic receptor|α₂]] [[adrenergic agonist]].<ref name=AHFS2019Eye/>

α₂ agonists, through the activation of a [[G protein-coupled receptor]], inhibit the activity of [[adenylate cyclase]]. This reduces [[Cyclic adenosine monophosphate|cAMP]] and hence aqueous humour production by the [[ciliary body]].

Peripheral α₂ agonist activity results in vasoconstriction of blood vessels (as opposed to central α₂ agonist activity that decreases sympathetic tone, as can be seen by the medication [[clonidine]]). This vasoconstriction may explain the acute reduction in aqueous humor flow. The increased uveoscleral outflow from prolonged use may be explained by increased prostaglandin release due to α adrenergic stimulation. This may lead to relaxed ciliary muscle and increased uveoscleral outflow.<ref>{{cite journal | vauthors = Toris CB, Camras CB, Yablonski ME | title = Acute versus chronic effects of brimonidine on aqueous humor dynamics in ocular hypertensive patients | journal = American Journal of Ophthalmology | volume = 128 | issue = 1 | pages = 8–14 | date = July 1999 | pmid = 10482088 | doi = 10.1016/s0002-9394(99)00076-8 }}</ref>

==Society and culture==

===Names===

It is sold under the brand names Alphagan, Alphagan-P, Mirvaso, Lumify, Brymont, and others.

===Over the counter===

In July 2018, [[Bausch and Lomb]] began to market [[over the counter]] (OTC) eye drops, using brimonidine's tartrate formulation in a concentration of 0.025%, as an ophthalmic vasoconstrictor under the brand name Lumify. Intended to relieve redness in the [[sclera]]e of the eyes for periods of up to eight hours at a time through its vasoconstrictive effects, Lumify was marketed as an alternative to [[Visine]], the brand of [[Tetryzoline|tetrahydrozoline hydrochloride]] solution most commonly used for that purpose.{{citation needed|date=April 2020}}

== References ==

{{Reflist}}

== Further reading ==

* {{cite journal |vauthors=Oh DJ, Chen JL, Vajaranant TS, Dikopf MS |title=Brimonidine tartrate for the treatment of glaucoma |journal=Expert Opin Pharmacother |volume=20 |issue=1 |pages=115–122 |date=January 2019 |pmid=30407890 |doi=10.1080/14656566.2018.1544241 |s2cid=53240954 }}

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{{Adrenergic agonists}}

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[[Category:Drugs developed by AbbVie]]

[[Category:Alpha-2 adrenergic receptor agonists]]

[[Category:Bromoarenes]]

[[Category:Ophthalmology drugs]]

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