Brimonidine tartrate
Glaucoma · Rx
Trade namesAlphagan P, Qoliana
Drug classSelective alpha-2 adrenergic agonist
Strength0.1%, 0.15%, 0.2%
AvailabilityRx
Mechanism of actionAlpha-2 agonist; reduces aqueous production and increases uveoscleral outflow. Possible neuroprotective effect (studied but unproven clinically). ~20% IOP reduction.
Indication / reason for useOpen-angle glaucoma and ocular hypertension; short-term adjunct; peri-laser IOP spike prophylaxis.
Usual adult dosing1 drop three times daily (or twice daily as adjunct).
PreservativePurite (stabilized oxychloride) in Alphagan P, gentler than BAK
Contact lensesRemove lenses; reinsert after 15 minutes.
Common / important adverse effectsOcular allergy / follicular conjunctivitis (common, often months in, a frequent reason for discontinuation), dry mouth, fatigue, drowsiness, hypotension; CNS depression and apnea in infants.
Contraindications & cautionsChildren <2 years (CNS depression, apnea), avoid under 5-6 in practice; patients on MAO inhibitors; caution with tricyclics, CNS depressants, severe cardiovascular disease, orthostatic hypotension.
Pregnancy / lactationCategory B historically, but stop before delivery and avoid during breastfeeding (infant CNS depression).
Practice notesThe one ocular hypotensive to specifically avoid in young children. Delayed-onset allergic conjunctivitis is classic, ask about it at follow-up.
Chair-side reference only. Dosing, contraindications and pregnancy guidance here are not exhaustive. Confirm against the current prescribing information and the patient’s full history before prescribing or advising.