brimonidine
Brimonidine (Mirvaso) is a topical gel used to treat adults with facial redness from rosacea that doesn't go away. It's only available with a prescription and belongs to a class of medications called alpha-2 agonist. The gel is applied directly to the face once per day. Side effects are rare but can include skin flushing and a burning sensation. Some people might also experience rebound erythema, where their facial redness worsens after starting the medication.
What is Brimonidine (Mirvaso)?
What is Brimonidine (Mirvaso) used for?
Facial redness caused by rosacea in adults
How Brimonidine (Mirvaso) works
Brimonidine (Mirvaso) is an alpha-2 agonist. It works by narrowing blood vessels near the skin's surface, reducing facial redness.
Drug Facts
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What are the side effects of Brimonidine (Mirvaso)?
Common Side Effects
- Redness (4%)
- Flushing (3%)
- Burning sensation (2%)
Other Side Effects
- Skin warmth
- Acne
- Skin pain
- Blurry vision
- Stuffy nose
- Tingling sensation
- Skin irritation
Serious Side Effects
- Worsening heart problems: low heart rate, dizziness, feeling faint
- Serious allergic reaction: rash, trouble breathing, swelling of the mouth and throat, hives
Source:Â DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Blurred or loss of vision
burning, dry, or itching eyes
discharge or excessive tearing
disturbed color perception
double vision
halos around lights
headache
itching of the eye
night blindness
overbright appearance of lights
redness of the eye or inner lining of the eyelid
swelling of the eyelid
tearing of the eye
tunnel vision
Less common
Ache or pain in the eye
blindness
bloody eye
blurred vision or other change in vision
change in color vision
confusion
decreased vision
difficult or labored breathing
difficulty seeing at night
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
drainage from the eye
fainting
fast heartbeat
feeling of something in the eye
gradual blurring or loss of vision
increased blood pressure
increased sensitivity of the eye to light
mental depression
oozing in the eye
redness, swelling, or itching of the eye or eyelid
runny or stuffy nose
seeing flashes or sparks of light
seeing floating dark spots or material before eyes
seeing floating spots before the eyes or a veil or curtain appearing across part of vision
skin rash
sweating
swelling of the eye
tightness in the chest
unusual tiredness or weakness
vomiting
watery eyes
Incidence not known
Bluish lips or skin
chest pain or discomfort
confusion
fast, pounding, or irregular heartbeat or pulse
feeling of warmth or heat
flushing or redness of the skin, especially on the face and neck
irregular, fast, slow, or shallow breathing
low body temperature
muscle aches or weakness
shivering
slow or irregular heartbeat
weak or feeble pulse
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Burning, stinging, or tearing of the eye
drowsiness or tiredness
dryness of the mouth
Less common
bad, unusual, or unpleasant (after) taste
belching
body aches or pain
change in taste
chills
congestion
cough producing mucus
crusting on the eyelid or on the corner of the eye
difficulty breathing
discoloration of the white part of the eye
dryness of the eye
dryness or soreness of the throat
general feeling of discomfort or illness
hoarseness
indigestion
joint pain
lack or loss of strength
large amounts of cholesterol in the blood
lid disorder
loss of appetite
muscle aches and pains
pain or tenderness around the eyes and cheekbones
paleness of the eye or inner lining of the eyelid
passing of gas
pounding heartbeat
rash
shivering
sleepiness or unusual drowsiness
stomach discomfort, fullness, upset, or pain
tender, swollen glands in the neck
trouble with sleeping
trouble with swallowing
troubled breathing
unable to sleep
voice changes
Incidence not known
Constricted, pinpoint, or small pupils (black part of the eye)
redness of the skin
sensitivity to light
throbbing pain
unusual drowsiness, dullness, or feeling of sluggishness
unusual weak feeling
unusually warm skin
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Brimonidine (Mirvaso)
Pros
Starts working quickly to improve skin
Only needs to be applied once daily
Generally well tolerated with few side effects
Cons
Might lead to rebound erythema, making redness worse than before
Might cause problems in blood circulation
Not known whether it's safe for children
Pharmacist tips for Brimonidine (Mirvaso)
Don't apply brimonidine (Mirvaso) on irritated skin or open wounds. Additionally, avoid contact with the eyes, mouth, and lips.
Brimonidine (Mirvaso) can cause worsening redness or flushing on your face, neck, and chest. Generally, these side effects might appear 30 minutes to several hours after using the medication. Tell your healthcare professional if the redness doesn't go away.
Some people have noticed that their skin looks unusually pale or white around the area where they apply brimonidine (Mirvaso). Let your prescriber know if it becomes bothersome.
If you experience dizziness or feel like you want to pass out after using this medication, get medical help right away because brimonidine (Mirvaso) could lower your heart rate or blood pressure.
Be sure to inform your care team about all your medications before and during treatment with brimonidine (Mirvaso). This medication can interact with other treatments, such as blood pressure medications or monoamine oxidase inhibitors (MAOIs).
Store brimonidine (Mirvaso) at room temperature and keep it out of reach of children, as it can cause serious side effects (e.g. breathing problems or confusion) if ingested by a child.
How to use brimonidine (Mirvaso)
Make sure you review the instructions for use before using brimonidine (Mirvaso).
Wash your hands well with soap and water before and after you apply the gel to the affected areas.
If you're using the pump, you'll need to prime it by pressing down on the pump a few times until the medication comes out. If you're using the tube, you don't need to prime it.
Apply a pea-sized amount on your forehead, chin, nose, and each cheek. Spread the gel smoothly in a thin layer. Then close the tube tightly or secure the cap on the pump to prevent a child from opening it.
Frequently asked questions about Brimonidine (Mirvaso)
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What are the risks and warnings for Brimonidine (Mirvaso)?
Brimonidine (Mirvaso) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Worsening blood flow problems
Risk factors: Conditions that cause poor blood flow to brain or heart | Depression | Sjogren's syndrome
Brimonidine (Mirvaso) can affect blood flow and might worsen certain conditions like coronary artery disease (CAD) or Sjögren's syndrome. Make sure your prescriber knows about all your current and past medical conditions before starting this medication. If your symptoms of any of these conditions worsen, stop using brimonidine (Mirvaso) and contact your care team right away.
Risk of low blood pressure
Risk factors: History of heart disease | Taking medications for blood pressure
Though rare, brimonidine (Mirvaso) can cause low blood pressure and low heart rate, especially in people who have a history of certain heart problems who are taking heart medication, such as beta blockers or digoxin (Lanoxin). If you experience difficulty breathing, slow heart rate, dizziness, feeling faint, or chest pain while taking brimonidine (Mirvaso), get medical attention right away. These can be signs that your heart or blood pressure conditions have worsened.
Flushing and skin color changes
Brimonidine (Mirvaso) can cause flushing and changes in skin color, such as whiteness or redness. In clinical studies, this usually happened 30 minutes to a few hours after applying the medication. These side effects usually go away after you stop using the medication. Talk to your dermatologist or healthcare professional if you have any of these problems.
Brimonidine (Mirvaso) dosage forms
Typical dosing for Brimonidine (Mirvaso)
Apply a pea-sized amount once per day as a thin layer to each of the five areas of the face: forehead, chin, nose, and each cheek.
Interactions between Brimonidine (Mirvaso) and other drugs
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Iobenguane I 131
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References
Best studies we foundAnderson, M. S., et al. (2017). Spotlight on brimonidine topical gel 0.33% for facial erythema of rosacea: Safety, efficacy, and patient acceptability. Patient Preference and Adherence.
Fowler, J., et al. (2013). Efficacy and safety of once-daily topical brimonidine tartrate gel 0.5% for the treatment of moderate to severe facial erythema of rosacea: Results of two randomized, double-blind, and vehicle-controlled pivotal studies. Journal of Drugs in Dermatology.
Galderma Laboratories, L.P. (2022). Mirvaso- brimonidine tartrate gel [package insert]. DailyMed.
Holmes, A. D., et al. (2015). Dermatological adverse events associated with topical brimonidine gel 0.33% in subjects with erythema of rosacea: A retrospective review of clinical studies. The Journal of Clinical and Aesthetic Dermatology.
Werner, K., et al. (2015). Dermatitis medicamentosa: Severe rebound erythema secondary to topical brimonidine in rosacea. Dermatology Online Journal.
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