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Brimonidine (Brimonidine Tartrate Ophthalmic) - Description and Clinical Pharmacology


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Brimonidine Tartrate Ophthalmic Solution 0.2% is a relatively selective alpha-2 adrenergic agonist for ophthalmic use. In solution, brimonidine tartrate ophthalmic solution 0.2% has a clear, greenish-yellow color. It has an osmolality of 280-330 mOsml/kg and a pH of 5.6-6.6 The structural formula is

C11H10BrN5 • C4H6O6

Mol. Wt. 442.24 (as the tartrate salt)

Chemical Name: 5-bromo-6-(2-imidazolidinylideneamino) quinoxaline L-tartrate.

CAS Number 59803-98-4

Each mL Contains:

ACTIVE: Brimonidine tartrate: 0.2% (2 mg/mL).

INACTIVES: Citric Acid, Polyvinyl Alcohol, Sodium Chloride, Sodium Citrate, Purified Water. Hydrochloric Acid and/or Sodium Hydroxide may be added to adjust pH.

PRESERVATIVE ADDED: Benzalkonium Chloride (0.05 mg).


Mechanism of Action

Brimonidine tartrate ophthalmic solution 0.2% is an alpha adrenergic receptor agonist. It has a peak ocular hypotensive effect occurring at two hours post-dosing. Fluorophotometric studies in animals and humans suggest that brimonidine tartrate has a dual mechanism of action by reducing aqueous humor production and increasing uveoscleral outflow.


After ocular administration of a 0.2% solution, plasma concentrations peaked within 1 to 4 hours and declined with a systemic half-life of approximately 3 hours. In humans, systemic metabolism of brimonidine is extensive. It is metabolized primarily by the liver. Urinary excretion is the major route of elimination of the drug and its metabolites. Approximately 87% of an orally administered radioactive dose was eliminated within 120 hours, with 74% found in the urine.

Clinical Evaluations

Elevated IOP presents a major risk factor in glaucomatous field loss. The higher the level of lOP, the greater the likelihood of optic nerve damage and visual field loss. Brimonidine tartrate has the action of lowering intraocular pressure with minimal effect on cardiovascular and pulmonary parameters.

In comparative clinical studies with timolol 0.5%, lasting up to one year, the lOP lowering effect of brimonidine tartrate ophthalmic solution 0.2% was approximately 4-6 mmHg compared with approximately 6 mmHg for timolol. In these studies, both patient groups were dosed BID; however, due to the duration of action of brimonidine tartrate ophthalmic solution 0.2%, it is recommended that brimonidine tartrate ophthalmic solution 0.2% be dosed TID. Eight percent of subjects were discontinued from studies due to inadequately controlled intraocular pressure, which in 30% of these patients occurred during the first month of therapy. Approximately 20% were discontinued due to adverse experiences.

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