Brimonidine

[Guide]

Brimonidine is an α2 adrenergic agonist. According to Wikipedia, "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. In 2013, the FDA approved topical application of brimonidine 0.33% (Mirvaso) for facial erythema or rosacea.

[Guide]

Clinical Review: Brimonidine Gel for Treatment of Facial Erythema in Rosacea Patients -

See more at: http://www.hcplive.com/medical-news/clinical-review-brimonidine-gel-for-treatment-of-facial-erythema-in-rosacea-patients#sthash.CjRg7DeR.dpuf

However, you should be aware that many have reported rebound effect using this gel for rosacea. For more info click here.

[Guide]

There are a number of papers warning about allergic contact dermatitis to topical brimonidine (Mirvaso): 

Case Report: Allergic Contact Dermatitis to Topical Brimonidine Demonstrated With Patch Testing: Insights on Evaluation of Brimonidine Sensitization.

Allergic contact dermatitis caused by Mirvaso®, brimonidine tartrate gel 0.33%, a new topical treatment for rosaceal erythema.

[Allergic contact dermatitis to Mirvaso® (brimonidine tartrate)].

Allergic contact dermatitis to topical brimonidine.

Sensitization to and allergic contact dermatitis caused by Mirvaso(®) (brimonidine tartrate) for treatment of rosacea - 2 cases.

[Guide]

One paper discusses two cases, "a 70+ year-old man having Mohs micrographic surgery for a squamous cell carcinoma and a 90+ year-old man undergoing electrodessication and curettage of a large actinic keratosis adjacent to a seborrheic keratosis. Patients were treated with 10 g of brimonidine 0.33% gel applied under occlusion for hemostasis. Both patients experienced deterioration of mental status, respiratory depression, and somnolence. Results from cardiac testing, laboratory work-up, and imaging were negative for cardiac or neurologic etiology. Both patients improved in less than 24 hours...According to Epocrates, although no serious reactions have been reported with Rhofade, bradycardia and hypotension are listed for Mirvaso. In my experience, flushing and rebound occur with Mirvaso, so I only prescribe it rarely...Based on the current literature, I wholeheartedly concur with Shagalov et al. who 'urge against the use of topical brimonidine as a hemostatic agent until its use is further investigated.' "

 Published in Dermatology
Expert Opinion / Commentary · August 22, 2017
Dr. Warren Heymann on Avoiding Brimonidine and Oxymetazoline as Hemostatic Agents
Warren R Heymann MD
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"Topical brimonidine, 0.33%, gel can result in systemic central nervous system toxic effects when used as a hemostatic agent. At present, it is not possible to define a quantity with which brimonidine can be used safely, nor can a safe wound size be defined. We, therefore, urge against the use of topical brimonidine as a hemostatic agent until its safety is further investigated."

JAMA Dermatol. 2017:153:575-7.
Association of central nervous system depression with topical brimonidine when used for hemostasis: A serious adverse event.
Shagalov DR, Taylor D, Schleichert R, Weiss J, Weiss E.
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"The top 3 reported adverse events related to BT are erythema worse than baseline (4%), flushing (3%), and burning (2%). At least 1% of patients had an adverse reaction to the medication."

J AM ACAD DERMATOL, FEBRUARY 2014, Case Letters, To the Editor
Rebound Erythema and Burning Sensation from a New Topical Brimonidine Tartrate Gel 0.33%
Ethan T. Routt, BA, Jacob O. Levitt, MD
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