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Brimonidine (ophthalmic): Pediatric drug information

Brimonidine (ophthalmic): Pediatric drug information
2025© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Brimonidine (ophthalmic): Drug information" and "Brimonidine (ophthalmic): Patient drug information"

For abbreviations, symbols, and age group definitions show table
Brand Names: US
  • Alphagan P;
  • Lumify [OTC]
Brand Names: Canada
  • Alphagan;
  • Alphagan P;
  • APO-Brimonidine [DSC];
  • Brimonidine P;
  • JAMP-Brimonidine;
  • MED-Brimonidine;
  • PMS-Brimonidine [DSC];
  • RIVA-Brimonidine;
  • SANDOZ Brimonidine
Therapeutic Category
  • Alpha-Adrenergic Agonist, Ophthalmic;
  • Glaucoma, Treatment Agent
Dosing: Pediatric
Glaucoma, ocular hypertension

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

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: Kidney Impairment: Pediatric

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

Dosing: Liver Impairment: Pediatric

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

Dosing: Adult

(For additional information see "Brimonidine (ophthalmic): Drug information")

Elevated intraocular pressure

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).

Miosis

Miosis (following laser refractive surgery) (off-label use): Ophthalmic: 0.15%, 0.2% solution: Instill 1 drop in each eye 30 to 60 minutes before scotopic condition (Ref).

Ocular redness

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.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied); use with caution.

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied); use with caution.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. 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, miosis, nausea, tachycardia

Contraindications

Hypersensitivity to brimonidine or any component of the formulation; neonates and infants <2 years of age.

Canadian labeling: Additional contraindications (not in the US labeling): Concomitant monoamine oxidase inhibitor therapy.

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

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).

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.

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.

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: 0.1% (5 mL, 10 mL, 15 mL); 0.15% (5 mL, 10 mL, 15 mL); 0.2% (5 mL, 10 mL, 15 mL)

Generic Equivalent Available: US

Yes

Pricing: US

Solution (Alphagan P Ophthalmic)

0.1% (per mL): $46.64

0.15% (per mL): $49.74

Solution (Brimonidine Tartrate Ophthalmic)

0.1% (per mL): $30.41 - $44.31

0.15% (per mL): $38.33

0.2% (per mL): $0.84 - $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.

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) [contains benzalkonium chloride]

Alphagan P: 0.15% (5 mL, 10 mL)

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

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 (Ref). 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.

Administration: Adult

Ophthalmic: For topical ophthalmic use only. 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.

Storage/Stability

Store at 15°C to 25°C (59°F to 77°F).

Use

Prescription products: Reduction of IOP in patients with open-angle glaucoma or ocular hypertension (Ophthalmic 0.1%, 0.15%, and 0.2% solution: FDA approved in ages ≥2 years and adults)

OTC products: Relief of redness of the eye due to minor eye irritations (Ophthalmic 0.025% solution: FDA approved in ages ≥5 years and adults)

Medication Safety Issues
Sound-alike/look-alike issues:

Brimonidine may be confused with bromocriptine

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program

Acrivastine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Alcohol (Ethyl): CNS Depressants may increase CNS depressant effects of Alcohol (Ethyl). Risk C: Monitor

Alizapride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Amisulpride (Oral): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Articaine: May increase CNS depressant effects of CNS Depressants. Management: Consider reducing the dose of articaine if possible when used in patients who are also receiving CNS depressants. Monitor for excessive CNS depressant effects with any combined use. Risk D: Consider Therapy Modification

Azelastine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Benperidol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Beta-Blockers: May increase rebound hypertensive effects of Alpha2-Agonists. This effect can occur when the Alpha2-Agonist is abruptly withdrawn. Alpha2-Agonists may increase AV-blocking effects of Beta-Blockers. Sinus node dysfunction may also be enhanced. 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. Risk D: Consider Therapy Modification

Blonanserin: CNS Depressants may increase CNS depressant effects 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 increase CNS depressant effects of Brexanolone. Risk C: Monitor

Brimonidine (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Bromopride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Bromperidol: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Buclizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Buprenorphine: CNS Depressants may increase CNS depressant effects 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

BusPIRone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Cannabinoid-Containing Products: CNS Depressants may increase CNS depressant effects of Cannabinoid-Containing Products. Risk C: Monitor

Cetirizine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk D: Consider Therapy Modification

Chloral Hydrate/Chloral Betaine: CNS Depressants may increase CNS depressant effects of Chloral Hydrate/Chloral Betaine. Management: Consider alternatives to the use of chloral hydrate or chloral betaine and additional CNS depressants. If combined, consider a dose reduction of either agent and monitor closely for enhanced CNS depressive effects. Risk D: Consider Therapy Modification

Chlormethiazole: May increase CNS depressant effects 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 increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

CNS Depressants: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

Dantrolene: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Daridorexant: May increase CNS depressant effects of CNS Depressants. Management: Dose reduction of daridorexant and/or any other CNS depressant may be necessary. Use of daridorexant with alcohol is not recommended, and the use of daridorexant with any other drug to treat insomnia is not recommended. Risk D: Consider Therapy Modification

DexmedeTOMIDine: CNS Depressants may increase CNS depressant effects of DexmedeTOMIDine. Management: Monitor for increased CNS depression during coadministration of dexmedetomidine and CNS depressants, and consider dose reductions of either agent to avoid excessive CNS depression. Risk D: Consider Therapy Modification

Difelikefalin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Difenoxin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Digoxin: Brimonidine (Ophthalmic) may increase bradycardic effects of Digoxin. Risk C: Monitor

Dihydralazine: CNS Depressants may increase hypotensive effects of Dihydralazine. Risk C: Monitor

Dimethindene (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Dothiepin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Doxylamine: CNS Depressants may increase CNS depressant effects of Doxylamine. Risk C: Monitor

DroPERidol: May increase CNS depressant effects of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Risk D: Consider Therapy Modification

Emedastine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk C: Monitor

Entacapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Esketamine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Flunarizine: CNS Depressants may increase CNS depressant effects of Flunarizine. Risk X: Avoid

Flunitrazepam: CNS Depressants may increase CNS depressant effects 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 increase CNS depressant effects of CNS Depressants. Management: Consider a decrease in the CNS depressant dose, as appropriate, when used together with hydroxyzine. Increase monitoring of signs/symptoms of CNS depression in any patient receiving hydroxyzine together with another CNS depressant. Risk D: Consider Therapy Modification

Ixabepilone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Kava Kava: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Ketotifen (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Kratom: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Lemborexant: May increase CNS depressant effects 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

Levocetirizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lisuride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lofepramine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lofexidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Loxapine: CNS Depressants may increase CNS depressant effects of Loxapine. Management: Consider reducing the dose of CNS depressants administered concomitantly with loxapine due to an increased risk of respiratory depression, sedation, hypotension, and syncope. Risk D: Consider Therapy Modification

Magnesium Sulfate: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Melitracen [INT]: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Mequitazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Metergoline: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Methotrimeprazine: CNS Depressants may increase CNS depressant effects of Methotrimeprazine. Methotrimeprazine may increase CNS depressant effects of CNS Depressants. 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

Methoxyflurane: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Metoclopramide: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

MetyroSINE: CNS Depressants may increase sedative effects of MetyroSINE. Risk C: Monitor

Minocycline (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Mirtazapine: May decrease antihypertensive effects 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 increase adverse/toxic effects of Brimonidine (Ophthalmic). Monoamine Oxidase Inhibitors may increase serum concentration of Brimonidine (Ophthalmic). Risk C: Monitor

Moxonidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Nabilone: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Nalfurafine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Noscapine: CNS Depressants may increase adverse/toxic effects of Noscapine. Risk X: Avoid

Olopatadine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Opicapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Opioid Agonists: CNS Depressants may increase CNS depressant effects 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

Opipramol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Orphenadrine: CNS Depressants may increase CNS depressant effects of Orphenadrine. Risk X: Avoid

Oxomemazine: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Oxybate Salt Products: CNS Depressants may increase CNS depressant effects 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. Interrupt oxybate salt treatment during short-term opioid use Risk D: Consider Therapy Modification

OxyCODONE: CNS Depressants may increase CNS depressant effects 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

Paliperidone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Paraldehyde: CNS Depressants may increase CNS depressant effects of Paraldehyde. Risk X: Avoid

Perampanel: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Periciazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Pipamperone: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

Piribedil: CNS Depressants may increase CNS depressant effects of Piribedil. Risk C: Monitor

Pizotifen: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Pramipexole: CNS Depressants may increase sedative effects of Pramipexole. Risk C: Monitor

Procarbazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Rilmenidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Ropeginterferon Alfa-2b: CNS Depressants may increase adverse/toxic effects of Ropeginterferon Alfa-2b. Specifically, the risk of neuropsychiatric adverse effects may be increased. Management: Avoid coadministration of ropeginterferon alfa-2b and other CNS depressants. If this combination cannot be avoided, monitor patients for neuropsychiatric adverse effects (eg, depression, suicidal ideation, aggression, mania). Risk D: Consider Therapy Modification

ROPINIRole: CNS Depressants may increase sedative effects of ROPINIRole. Risk C: Monitor

Rotigotine: CNS Depressants may increase sedative effects of Rotigotine. Risk C: Monitor

Serotonin/Norepinephrine Reuptake Inhibitor: May decrease therapeutic effects of Alpha2-Agonists. Risk C: Monitor

Suvorexant: CNS Depressants may increase CNS depressant effects 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

Thalidomide: CNS Depressants may increase CNS depressant effects of Thalidomide. Risk X: Avoid

TiZANidine: Alpha2-Agonists may increase hypotensive effects of TiZANidine. Risk X: Avoid

Tricyclic Antidepressants: May decrease therapeutic effects of Alpha2-Agonists (Ophthalmic). Risk C: Monitor

Trimeprazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Valerian: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Zolpidem: CNS Depressants may increase CNS depressant effects 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

Zuranolone: May increase CNS depressant effects of CNS Depressants. Management: Consider alternatives to the use of zuranolone with other CNS depressants or alcohol. If combined, consider a zuranolone dose reduction and monitor patients closely for increased CNS depressant effects. Risk D: Consider Therapy Modification

Pregnancy Considerations

Teratogenic effects were not observed in animal reproduction studies.

Monitoring Parameters

Monitor IOP when using for glaucoma or ocular hypertension; vision changes, CNS alertness

Mechanism of Action

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

Pharmacokinetics (Adult Data Unless Noted)

Protein binding: ~29%.

Metabolism: Hepatic (extensive).

Half-life elimination: ~3 hours.

Time to peak, plasma: 1 to 4 hours.

Excretion: Urine (74%).

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Alphagan | Brimo | Brimonidine | Lumify;
  • (AR) Argentina: Alphagan | Alphagan p | Brimopress | Oftalmotonil;
  • (AT) Austria: Alphagan | Brimogen | Brimonidin Arcana;
  • (AU) Australia: Alphagan | Alphagan p | Enidin;
  • (BD) Bangladesh: Alphagan | Alphaten | Bricoma | Brimodin | Eyelia | Luminor;
  • (BE) Belgium: Alphagan | Brimonidine Mylan;
  • (BF) Burkina Faso: Brimodin;
  • (BG) Bulgaria: Brimogen | Brimonidine tartrate teva | Luxfen | Rimonal;
  • (BR) Brazil: Alphabrin | Alphagan | Alphagan p | Alphagan z | Alphagan-p | Glaub | Glaub md | Tartarato de brimonidina;
  • (CH) Switzerland: Alphagan | Brimonidin Mepha | Brimonidin Teva;
  • (CI) Côte d'Ivoire: Bglau;
  • (CL) Chile: Agglad ofteno | Alphagan | Alphagan p | Brimof | Brimokem | Brimonidina tartrato | Brimopress;
  • (CN) China: Alphagan | Brimocon;
  • (CO) Colombia: Agglad ofteno | Alphagan | Alphagan p | Alphagan-p | Brimodelt | Brimoftal | Brimoftal p | Brimoftal z | Brimonidina tartrato | Glaucodina | Pressoftalm soft | Tartrato de brimonidina;
  • (CZ) Czech Republic: Alphagan | Brimonidin olikla | Brimonidine Polpharma | Glabrin | Luxfen;
  • (DE) Germany: Alphagan | Brimo Ophtal | Brimo vision | Brimogen | Brimonidin 1 a pharma | Brimonidin AL | Brimonidin axunio | Brimonidin bluefish | Brimonidin Dura | Brimonidin micro labs | Brimonidin ratiopharm | Brimonidin Stada | Brimonidin stulln | Brimonidintartrat AbZ;
  • (DO) Dominican Republic: Agglad ofteno | Alphagan | Alphagan p | Bridomol | Brimogot | Brimoni;
  • (EC) Ecuador: Agglad | Agglad ofteno | Alphagan | Alphagan p | Brimof | Citol brim;
  • (EE) Estonia: Alphagan | Alphagen;
  • (EG) Egypt: Alfabrimo | Alphagan | Alphagan p | Alphanova | Brimillergy | Brimocoma | Brimonidine | Brimonocond | Brimosalm | Pharmapress;
  • (ES) Spain: Alfadina | Alphagan | Brimonidina cinfa | Brimonidina Colirteva | Brimonidina kern pharma | Brimonidina Mylan | Brimonidina vir | Lumobry;
  • (ET) Ethiopia: Bglau;
  • (FI) Finland: Alphagan | Brimonidin Sandoz | Brimonidine Teva | Glaudin;
  • (FR) France: Alphagan | Brimonidine biogaran | Brimonidine Chauvin | Brimonidine EG | Brimonidine Mylan | Brimonidine Ratiopharm | Brimonidine sandoz | Brimonidine Teva | Lumobry;
  • (GB) United Kingdom: Alphagan | Brimonidine | Brimonidine Teva | Brymont;
  • (GR) Greece: Alphagan | Benil | Brimodine | Brimogan | Brimontal | Brinidin | Corneax | Glaucoval | Pharmexin;
  • (HK) Hong Kong: Alphagan | Brimogan;
  • (HR) Croatia: Alphagan | Bimanox | Brimot | Luxfen;
  • (HU) Hungary: Alphagan | Brimogen;
  • (IE) Ireland: Alphagan;
  • (IL) Israel: Alphagan | Alphagan p;
  • (IN) India: Albrim | Alphagan | Alphagan-p | Alphagan-z | Apbidin P | Arobrim | Bidin ls | Brimed | Brimo | Brimochek | Brimodin | Brimodin-p | Brimonid | Brimonix | Brimopress | Brimosoft | Brimosun ls | Brimosun p | Cibrim z | Glaucom | Globrim | Iobrim | Kaibrim | Rimoflo soft | Rimonid;
  • (IT) Italy: Alphagan | Brimoftal | Brimonidina Bausch & Lomb | Brimonidina EG | Brimonidina Mylan | Brimonidina Ratiopharm | Brimonidina San | Brimonidina Tub | Brimostill | Brimoton | Glaubrim;
  • (JO) Jordan: Alphagan | Alphagan p | Brado | Brimo | Lumify;
  • (JP) Japan: Aiphagan | Brimonidine tartrate ts;
  • (KE) Kenya: Alphagan purite;
  • (KR) Korea, Republic of: Alphagam p ophthalmic solution 0.15% | Alphagan | Alphagan-p | Alphamon p | Bridin T | Bridine t | Brimonin | Monigan | Optigreen;
  • (KW) Kuwait: Alphagan | Alphagan p;
  • (LB) Lebanon: Alphagan p | Bglau | Brimo | Brimogan | Brimonidine biogaran | Lumify;
  • (LT) Lithuania: Alphagan | Brimonal | Brimonidine | Luxfen | Rivotra;
  • (LU) Luxembourg: Alphagan;
  • (LV) Latvia: Alphagan | Briglafre | Brimonidine tartrate elvim | Luxfen;
  • (MA) Morocco: Alphagan | Ibrimo;
  • (MX) Mexico: Agglad | Agglad ofteno | Alphagan | Alphagan-p | Brimonidina 3m | Briop | Nor tenz;
  • (MY) Malaysia: Alphagan | Alphagan p | Brimonidine | Iobrim;
  • (NG) Nigeria: Alphaten | Brimogan | Druphagan;
  • (NL) Netherlands: Alphagan | Brimonidin bluefish | Brimonidinetartraat Mylan | Brimonidinetartraat PCH | Brimonidinetartraat Sandoz | Lumobry;
  • (NO) Norway: Alphagan | Brimonidin aurora | Brimoratio | Brymont;
  • (NZ) New Zealand: Alphagan | Alphagan p | Arrow brimonidine | Brimonidine aft;
  • (PE) Peru: Agglad ofteno | Alphagan | Alphagan p | Brimodual | Citol brim | Nor tenz;
  • (PH) Philippines: Alcon Brimonidine | Alphagan | Alphagan p | Brimochek;
  • (PK) Pakistan: Alphagan | Alzagan | Brimo | Brimo T | Brimod | Brimodine | Brimotar | Brimson | Onidin;
  • (PL) Poland: Alphagan | Biprolast | Briglau free | Briglau Pph | Brimogen | Brimoteva | Brymont | Lumobry | Luxfen | Oculobrim;
  • (PR) Puerto Rico: Alphagan | Alphagan p | Lumify;
  • (PT) Portugal: Alphagan | Bglau | Brimonidina bluepharma;
  • (PY) Paraguay: Brimof | Brimopress | Citol brim | Oftalmol b | Oftalmotonil;
  • (QA) Qatar: Alphagan P | Brimo | Brimochek | Brimolix;
  • (RO) Romania: Brimonal | Brimonidina rompharm;
  • (RU) Russian Federation: Alfabrim | Alphagan p | Bimanox | Brim aniglau eco | Brimonidine | Luxfen;
  • (SA) Saudi Arabia: Alphagan | Alphagan p | Brimo | Brimodin;
  • (SE) Sweden: Alphagan | Brimonidin 2care4 | Brimonidin bluefish | Brimonidin hexal | Brimoratio | Brymont | Glaudin;
  • (SG) Singapore: Alphagan | Alphagan p;
  • (SI) Slovenia: Bimanox | Brimonidin medops;
  • (SK) Slovakia: Alphagan | Brimonal | Brimonidin olikla | Luxfen;
  • (SR) Suriname: Apo brimonidine | Asbrim | Brimonidinetartraat Mylan | Locular;
  • (TH) Thailand: Alphagan | Alphagan p;
  • (TN) Tunisia: Alphacol free | Alphagan;
  • (TR) Turkey: Alphagan | Biriglo | Bremon | Brimogut | Brimolix | Gloger | Rimonal;
  • (TW) Taiwan: Almidine | Alphagan | Alphagan p;
  • (UA) Ukraine: Alfa brion | Alphagan p | Bglau | Bimanox | Briglau eco | Brimoftal | Brimogen | Brimonal | Brimonidin farmax | Brirosa | Luxfen;
  • (UG) Uganda: Alphanova | Brimo;
  • (UY) Uruguay: Agglad ofteno | Alphagan | Brimopress | Oftamotonil;
  • (VE) Venezuela, Bolivarian Republic of: Agglad ofteno | Alphagan | Alphagan p | Brimolag | Brimopress;
  • (ZA) South Africa: Alphagan | Alphagan purite | Brimoct
  1. Alphagan (brimonidine tartrate) [prescribing information]. Irvine, CA: Allergan Inc; June 2024.
  2. Alphagan (brimonidine tartrate) [product monograph]. St-Laurent, Quebec, Canada: AbbVie Corp; September 2022.
  3. Alphagan P (brimonidine tartrate) [prescribing information]. North Chicago, IL: AbbVie Inc; March 2025.
  4. Berlin RJ, Lee UT, Samples JR, et al. Ophthalmic Drops Causing Coma in an Infant. J Pediatr. 2001;138(3):441-443. [PubMed 11241061]
  5. Brimonidine P (brimonidine tartrate) ophthalmic solution 0.15% [product monograph]. Vaughan, Ontario, Canada: AA Pharma Inc; July 2019.
  6. Brimonidine Tartrate Ophthalmic Solution 0.2% [prescribing information]. Boca Raton, FL: Florida Pharmaceutical Products LLC; November 2021.
  7. Brimonidine tartrate ophthalmic solution [prescribing information]. Somerset, NJ: Somerset Therapeutics LLC; March 2025.
  8. Byles DB, Frith P, Salmon JF. Anterior Uveitis as a Side Effect of Topical Brimonidine. Am J Ophthalmol. 2000;130(3):287-291. [PubMed 11020406]
  9. 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):255-256. [PubMed 10458196]
  10. Edwards JD, Burka JM, Bower KS, Stutzman RD, Sediq DA, Rabin JC. Effect of brimonidine tartrate 0.15% on night-vision difficulty and contrast testing after refractive surgery. J Cataract Refract Surg. 2008;34(9):1538-1541. doi:10.1016/j.jcrs.2008.05.029 [PubMed 18721716]
  11. Enyedi LB, Freedman SF. Safety and efficacy of brimonidine in children with glaucoma. J AAPOS. 2001;5(5):281-284. [PubMed 11641636]
  12. Lee JH, You YS, Choe CM, Lee ES. Efficacy of brimonidine tartrate 0.2% ophthalmic solution in reducing halos after laser in situ keratomileusis. J Cataract Refract Surg. 2008;34(6):963-967. doi:10.1016/j.jcrs.2008.01.028 [PubMed 18499002]
  13. Levy Y, Zadok D. Systemic side effects of ophthalmic drops. Clin Pediatr (Phila). 2004;43(1):99-101. [PubMed 14968900]
  14. Lumify (brimonidine tartrate) [prescribing information]. Bridgewater, NJ: Bausch + Lomb; received May 2023.
  15. McDonald JE 2nd, El-Moatassem Kotb AM, Decker BB. Effect of brimonidine tartrate ophthalmic solution 0.2% on pupil size in normal eyes under different luminance conditions. J Cataract Refract Surg. 2001;27(4):560-564. doi:10.1016/s0886-3350(01)00769-6 [PubMed 11311624]
  16. Thordsen JE, Bower KS, Warren BB, Stutzman R. Miotic effect of brimonidine tartrate 0.15% ophthalmic solution in normal eyes. J Cataract Refract Surg. 2004;30(8):1702-1706. doi:10.1016/j.jcrs.2003.12.037 [PubMed 15313293]
  17. Urtti A, Salminen L. Minimizing systemic absorption of topically administered ophthalmic drugs. Surv Ophthalmol. 1993;37(6):435-456. [PubMed 8100087]
  18. 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]
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