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Brimonidine structure.png
Systematic (IUPAC) name
5-Bromo-N-(4,5-dihydro-1H-imidazol-2-yl) quinoxalin-6-amine
Clinical data
Trade names Alphagan, Mirvaso
AHFS/ Consumer Drug Information
MedlinePlus a601232
  • US: B (No risk in non-human studies)
Routes of
Ocular (eye drops), topical (gel)
Legal status
Legal status
Pharmacokinetic data
Metabolism Primarily liver
Biological half-life 3 hours ocular 12 hours topical
CAS Number 59803-98-4 YesY
ATC code D11AX21 (WHO) S01EA05 (WHO)
PubChem CID 2435
DrugBank DB00484 YesY
ChemSpider 2341 YesY
KEGG D07540 YesY
Chemical data
Formula C11H10BrN5
Molar mass 292.135 g/mol

Brimonidine (bri-MOE-ni-deen) is a drug used as eye drops under the brand names Alphagan and Alphagan-P to treat open-angle glaucoma or ocular hypertension, and as a gel, Mirvaso, for facial skin redness in rosacea.

It acts via decreasing synthesis of aqueous humor, and increasing the amount that drains from the eye through uveoscleral outflow; brimonidine treats reddened skin (erythema) by causing narrowing of blood vessels (vasoconstriction).

Clinical uses[edit]

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 Combigan along with timolol maleate.

A Cochrane Systematic Review compared the effect of brimonidine and timolol in slowing the progression of open angle glaucoma in adult participants.[1]

In 2013, the FDA approved topical application of brimonidine 0.33% (Mirvaso) for facial redness or rosacea.

Mechanism of action[edit]

Brimonidine is an α2 adrenergic agonist.

Alpha 2 agonists, through the activation of a G protein-coupled receptor, inhibit the activity of adenylate cyclase. This reduces cAMP and hence aqueous humour production by the ciliary body.

Peripheral alpha 2 agonist activity results in vasoconstriction of blood vessels (as opposed to central alpha 2 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 alpha adrenergic stimulation. This may lead to relaxed ciliary muscle and increased uveoscleral outflow.[2]


  1. ^ Sena DF, Lindsley K (2013). "Neuroprotection for treatment of glaucoma in adults". Cochrane Database Syst Rev 2: CD006539. doi:10.1002/14651858.CD006539.pub3. PMC 3478138. PMID 20166085. 
  2. ^ Toris, C.; Camras, C.; Yablonski, M. (1999). "Acute versus chronic effects of brimonidine on aqueous humor dynamics in ocular hypertensive patients". American journal of ophthalmology 128 (1): 8–14. doi:10.1016/s0002-9394(99)00076-8. PMID 10482088. 
  • Mosby's Drug Guide for Nurses (7th edition; Skidmore) 2007.

External links[edit]