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# Brimonidine
## Overview
Brimonidine is an alpha-2 adrenergic agonist used primarily for ophthalmic conditions.
## Primary Indications
* **Glaucoma and Ocular Hypertension:** Reduces intraocular pressure (IOP).
## Adult Dosing
* **Glaucoma and Ocular Hypertension:** 1 drop in the affected eye(s) 2-3 times daily. Maximum frequency is 3 times daily.
## Pediatric Dosing
* **Glaucoma and Ocular Hypertension:** Safety and efficacy not established in pediatric patients.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution.
* **Renal Impairment:** Use with caution.
## Contraindications
* Hypersensitivity to brimonidine or any component of the formulation.
* Neonates and children under 2 years of age (due to risk of somnolence).
## Adverse Effects
* **Common:** Ocular hyperemia, foreign body sensation, eye pruritus, allergic conjunctivitis, dry eye, tearing.
* **Serious:** Somnolence (especially in children), bradycardia, hypotension, CNS depression.
## Key Drug Interactions
* **CNS Depressants (e.g., alcohol, barbiturates, opioids, sedatives, anesthetics):** May cause additive CNS depression.
* **Antihypertensives (including beta-blockers):** May potentiate hypotensive effect.
* **Tricyclic Antidepressants and Monoamine Oxidase Inhibitors (MAOIs):** May interfere with the hypotensive effect of brimonidine.
## Monitoring
* Intraocular pressure (IOP).
* Signs of systemic absorption (e.g., somnolence, bradycardia, hypotension).
## Clinical Pearls
* Brimonidine is a potent alpha-2 adrenergic agonist; systemic absorption can lead to significant adverse effects, particularly in children.
* Consider the preservative in the formulation (e.g., benzalkonium chloride) which can cause dry eye or ocular surface toxicity with prolonged use. Preservative-free formulations may be preferred in some patients.
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*Disclaimer: This information is intended for clinical pharmacy use and does not replace current prescribing information. Always verify with the most recent product monograph or trusted clinical resources.*
