Drug Action
Brimonidine, an alpha2-adrenoceptor agonist, is used to reduce erythema in rosacea by cutaneous vasoconstriction.
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Drug reference
Brimonidine, an alpha2-adrenoceptor agonist, is used to reduce erythema in rosacea by cutaneous vasoconstriction.
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Facial erythema in rosacea ▶TO THE SKIN ▶Adult: Apply once daily until erythema subsides, apply thinly, divide dose over forehead, chin, nose, and cheeks, max. 1 g of gel per day DOSE EQUIVALENCE AND CONVERSION ▶1 g of gel contains 5 mg of brimonidine tartrate (equivalent to 3.3 mg of brimonidine).
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Cerebral insufficiency. coronary insufficiency. depression. postural hypotension. Raynaud’s syndrome. severe cardiovascular disease. thromboangiitis obliterans
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Scottish Medicines Consortium (SMC) decisions The Scottish Medicines Consortium has advised (January 2015) that brimonidine (Mirvaso ®) is accepted for restricted use within NHS Scotland for the symptomatic treatment of moderate to severe persistent facial erythema associated with rosacea. All Wales Medicines Strategy Group (AWMSG) decisions The All Wales Medicines Strategy Group has advised (September 2015) that brimonidine (Mirvaso ®) is accepted for restricted use within NHS Wales for the symptomatic treatment of moderate to severe persistent facial erythema associated with rosacea.
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MHRA/CHM ADVICE: BRIMONIDINE GEL (MIRVASO ®): RISK OF SYSTEMIC CARDIOVASCULAR EFFECTS (JUNE 2017) Systemic cardiovascular effects including bradycardia, hypotension, and dizziness have been reported after application of brimonidine gel. To minimise the possibility of systemic absorption, it is important to avoid application to irritated or damaged skin, including after laser therapy. MHRA/CHM ADVICE: BRIMONIDINE GEL (MIRVASO ®): RISK OF EXACERBATION OF ROSACEA (NOVEMBER 2016) Symptom exacerbation has been reported very commonly in patients treated with brimonidine gel. Treatment should be initiated with a small amount of gel (less than the maximum dose) for at least 1 week, then increased gradually, based on tolerability and response. Patients should be counselled on the importance of not exceeding the maximum daily dose, and advised to stop treatment and seek medical advice if symptoms worsen during treatment.
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→Appendix 1: brimonidine
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▶Common or very common Dizziness. dry mouth. flushing. headache. skin reactions ▶Uncommon Angioedema. eyelid oedema. feeling hot. nasal congestion. paraesthesia. peripheral coldness ▶Rare or very rare Bradycardia. hypotension
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Manufacturer advises avoid—limited information available.
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Manufacturer advises avoid—no information available.
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Manufacturer advises caution (no information available).
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Manufacturer advises use with caution.
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Avoid contact with eyes, mouth, and mucous membranes; avoid use on irritated or damaged skin or open wounds; apply other topical preparations (including cosmetics) only after brimonidine gel has dried on skin.
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There can be variation in the licensing of different medicines containing the same drug. Gel CAUTIONARY AND ADVISORY LABELS 28 EXCIPIENTS: May contain Hydroxybenzoates (parabens), propylene glycol ▶Mirvaso (Galderma (UK) Ltd) Brimonidine (as Brimonidine tartrate) 3 mg per 1 gram Mirvaso 3mg/g gel | 30 gram P £33.69 DT = £33.69 Scalp and hair conditions Scalp and hair conditions Overview Dandruff is considered to be a mild form of seborrhoeic dermatitis. Shampoos containing antimicrobial agents such as pyrithione zinc (which are widely available) and selenium p. 1341 may have beneficial effects. Shampoos containing tar extracts may be useful and they are also used in psoriasis. Ketoconazole shampoo p. 1298 should be considered for more persistent or severe dandruff or for seborrhoeic dermatitis of the scalp. Corticosteroid gels and lotions can also be used. Shampoos containing coal tar with salicylic acid p. 1320 may also be useful. A cream or an ointment containing coal tar with salicylic acid is very helpful in Psoriasis p. 1304 that affects the scalp. Patients who do not respond to these treatments may need to be referred to exclude the possibility of other skin conditions. Cradle cap in infants may be treated with coconut oil or olive oil applications followed by shampooing. Hirsutism Hirsutism may result from hormonal disorders or as a side- effect of drugs such as minoxidil below, corticosteroids, anabolic steroids, androgens, danazol p. 783, and progestogens. Weight loss can reduce hirsutism in obese women. Women should be advised about local methods of hair removal, and in the mildest cases this may be all that is required. Eflornithine p. 1342 an antiprotozoal drug, inhibits the enzyme ornithine decarboxylase in hair follicles. Topical eflornithine can be used as an adjunct to laser therapy for facial hirsutism in women. Co-cyprindiol p. 1335 may be effective for moderately severe hirsutism. Metformin hydrochloride p. 730 is an alternative in women with polycystic ovary syndrome [unlicensed indication]. Systemic treatment is required for 6–12 months before benefit is seen. Androgenetic alopecia Finasteride p. 831 is licensed for the treatment of androgenetic alopecia in men. Continuous use for 3–6 months is required before benefit is seen, and effects are reversed 6–12 months after treatment is discontinued. Topical application of minoxidil may stimulate limited hair growth in a small proportion of adults but only for as long as it is used. Other drugs used for Scalp and hair conditions Coal tar, p. 1319. Coal tar with salicylic acid and precipitated sulfur, p. 1320 ANTISEPTICS AND DISINFECTANTS › UNDECENOATES
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Patients should be advised on administration of gel. Driving and skilled tasks Drowsiness may affect performance of skilled tasks (e.g. driving).
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Apply once daily until erythema subsides, apply
First-line fragment. Read the complete Indications and Dose section above.
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