brimonidine, topical

(bri-moe-ni-deen ) brimonidinetopical,

Mirvaso

(trade name)

Classification

Therapeutic: cosmetic agents
Pharmacologic: alpha adrenergic agonists
Pregnancy Category: B

Indications

Topical management of persistent (nontransient) facial erythema due to rosacea.

Action

Acts as a seletive alpha-2 adrenergic agonist, causes direct vasoconstriction.

Therapeutic effects

Decreased erythema in rosacea.

Pharmacokinetics

Absorption: Some absorption follows topical use.Distribution: Unk Metabolism and Excretion: Extensively metabolized by the liver; drug and metabolites are excreted in urine.Half-life: unk

Time/action profile (decreased erythema)

ROUTE	ONSET	PEAK	DURATION
top	within 3 hr	3–6 hr	at least 12 hr

Contraindications/Precautions

Contraindicated in: Lactation: Discontinue breast feeding or drugUse Cautiously in: Depression;Cerebral/coronary insufficiency;Reynaud's phenomenon;Severe/unstable/uncontrolled cardiovascular disease;Orthostatic hypotension;Thromboangiitis obliterans;scleroderma;Sjögren's syndrome;Vascular insufficiency (may potentiate) Obstetric: Use only if potential benefit justifies potential fetal risk Pediatric: Safe and effective use in children has not been established; inadvertent ingestion has caused serious adverse effects.

Adverse Reactions/Side Effects

Central nervous system

headache

Ear, Eye, Nose, Throat

nasopharyngitis

Dermatologic

flushing (most frequent)
contact dermatitis
erythema
skin burning sensation

Interactions

Drug-Drug interaction

Due to possible ↓ in blood pressure, use cautiously with antihypertensives, beta-adrenergic blockers, digitalis glycosides May ↑ risk of sedation with alcohol, anti-anxiety agents, barbiturates and opioidssedative/hypnotics.Concurrent use with MAO inhibitors may ↑ risk of systemic side effects, including hypotension, undertake concurrent use with caution.

Route/Dosage

Topical (Adults >18 yr) Apply pea-sized amount to each of five areas on the face (forehead, chin, nose and each cheek) once daily.

Availability

Topical gel: 0.33%

Nursing implications

Nursing assessment

Assess face for erythema of rosacea periodically during therapy.

Potential Nursing Diagnoses

Impaired skin integrity (Indications)
Risk for situational low self-esteem (Indications)

Implementation

Topical: Apply a pea-size amount to central forehead, chin, nose, and each cheek. Spread smoothly and evenly as a thin layer across entire face, avoiding eyes and lips. Do not apply to irritated skin or open wounds. Wash hands after application.
- Not for oral, ophthalmic, or intravaginal use.

Patient/Family Teaching

Instruct patient in correct application of brimonidine. Caution patient not to use more gel than prescribed. Advise patient to read Patient Information Leaflet prior to therapy and with each Rx refill in case of changes.
Inform patient that erythema or flushing may occur; usually diminishes 30 min to several hrs after application; resolves after discontinuation.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.

Evaluation/Desired Outcomes

Decreased facial erythema of rosacea.