Topical selective α2-adrenergic agonist for ophthalmic use
ATC code: S01EA05 (Brimonidine)
Brand names
Alphagan P, Lumify, Mirvaso
Selective α2-adrenergic agonist. Lowers IOP by two mechanisms: reduced aqueous humour production by the ciliary body and increased uveoscleral outflow. Instillation of a 0.1–0.2% solution 2–3 times daily lowers IOP by 18–25%. Conjunctival vasoconstriction additionally reduces redness (the basis of US-approved Lumify 0.025% for cosmetic redness). Systemic absorption is variable; in young children it causes marked CNS depression and bradycardia.
Second line
Brimonidine lowers IOP in ocular hypertension when prostaglandins are contraindicated (history of uveitis) or do not reach target reduction. EGS 2024 recommends brimonidine as second-line monotherapy or add-on to a prostaglandin.
Second line
Brimonidine is used as second-line monotherapy or as add-on to a prostaglandin when IOP control is insufficient. EGS 2024 and SEG/SEO 2023 recommend brimonidine as an alternative or adjunct, especially when beta blockers are contraindicated (COPD, asthma, bradycardia). IOP reduction is 18–25% with 2–3 daily instillations. A possible neuroprotective effect on retinal ganglion cells is discussed but not firmly confirmed by RCTs.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Brimonidine 0.1–0.2% in Spain is registered by AEMPS only for IOP lowering in glaucoma. A separate -approved product Lumify 0.025% addresses cosmetic eye redness in the US; AEMPS has NOT registered such a product in Spain. Using the glaucoma 0.2% formulation for tired eyes or hangover does not work as a cosmetic agent and is dangerous: rebound hyperaemia worse than baseline appears after withdrawal, allergic conjunctivitis develops in up to 25% of patients by month six, and infants under six years can develop CNS depression and bradycardia. If brimonidine was suggested as daily whitening drops, consider seeking a second opinion.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Direct links to regulator labels. Open in a new tab.
FDA Category B. Pregnancy data are limited. Systemic absorption from ophthalmic instillation is modest. AEMPS permits use in pregnancy when benefit outweighs potential risk, with punctal occlusion.
Not preferred. Hale L4. Passes into milk and may theoretically cause sedation, hypotension and bradycardia in the breastfed infant. AEMPS recommends temporary breastfeeding suspension or switching to a topical beta blocker or carbonic anhydrase inhibitor.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Brimonidine is evaluated for the following indications with varying evidence strength: Open-angle glaucoma (evidence tier A), Ocular hypertension (evidence tier A), Cosmetic eye redness (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Brimonidine (≥ 1 in 100): Allergic conjunctivitis (up to 25% by month 6), Burning and dry eyes, Blurred vision, Drowsiness and fatigue, Dry mouth, Headache. See the Safety section for uncommon and serious reactions.
FDA category B. FDA Category B. Pregnancy data are limited. Systemic absorption from ophthalmic instillation is modest. AEMPS permits use in pregnancy when benefit outweighs potential risk, with punctal occlusion.
Not preferred. Hale L4. Passes into milk and may theoretically cause sedation, hypotension and bradycardia in the breastfed infant. AEMPS recommends temporary breastfeeding suspension or switching to a topical beta blocker or carbonic anhydrase inhibitor.
Brimonidine is contraindicated in: Hypersensitivity to brimonidine or other components; Under 2 years of age (risk of CNS depression, apnoea, bradycardia); Concurrent MAO inhibitors; Concurrent tricyclic antidepressants. Full list in the Safety section.