Brimonidine Ophthalmic (patient information)

# Why this medication is prescribed
Ophthalmic brimonidine is used to lower pressure in the eyes in patients who have glaucoma (high pressure in the eyes that may damage nerves and cause vision loss) and ocular hypertension (pressure in the eyes that is higher than normal but not high enough to cause vision loss). Brimonidine is in a class of drugs called alpha adrenergic agonists. Brimonidine works by decreasing the amount of fluid in the eyes.

# How this medication should be used
Brimonidine ophthalmic comes as a solution (liquid) to instill in the eyes. It is usually instilled in the affected eye(s) three times a day. Use brimonidine eye drops at around the same times every day, and try to space your three daily doses about 8 hours apart. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use brimonidine eye drops exactly as directed. Do not use more or less of them or use them more often than prescribed by your doctor.
Brimonidine eye drops may control your condition, but will not cure it. Continue to use brimonidine eye drops even if you feel well. Do not stop using brimonidine eye drops without talking to your doctor.
To use the eye drops, follow these steps:
- Wash your hands thoroughly with soap and water.
- Use a mirror or have someone else put the drops in your eye.
- Remove the protective cap. Make sure that the end of the dropper is not chipped or cracked.
- Avoid touching the dropper tip against your eye or anything else.
- Hold the dropper tip down at all times to prevent drops from flowing back into the bottle and contaminating the remaining contents.
- Lie down or tilt your head back.
- Holding the bottle between your thumb and index finger, place the dropper tip as near as possible to your eyelid without touching it.
- Brace the remaining fingers of that hand against your cheek or nose.
- With the index finger of your other hand, pull the lower lid of the eye down to form a pocket.
- Drop the prescribed number of drops into the pocket made by the lower lid and the eye. Placing drops on the surface of the eyeball can cause stinging.
- Close your eye and keep it closed for a few minutes. Do not blink.
- Replace and tighten the cap right away. Do not wipe or rinse it off.
- Wipe off any excess liquid from your cheek with a clean tissue. Wash your hands again.

# Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

# Special Precautions
Before using brimonidine eye drops:
- tell your doctor or pharmacist if you are allergic to brimonidine eye drops or any other medications.
- do not use brimonidine eye drops if you are taking a monoamine oxidase inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl), or tranylcypromine (Parnate).
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: antidepressants such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); barbiturates such as phenobarbital and secobarbital (Seconal); digoxin (Lanoxin); medications for anxiety, high blood pressure, mental illness, pain, or seizures; sedatives; sleeping pills; and tranquilizers.Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- if you are using any other eye drops, instill them 5 minutes before or 5 minutes after you instill brimonidine eye drops.
- tell your doctor if you often feel dizzy when you sit or stand from a lying position and if you have or have ever had depression; conditions that affect your blood circulation including Raynaud's disease (a condition that causes attacks of low blood circulation to the fingers and toes), thromboangiitis obliterans (a condition that causes poor blood circulation in the hands and feet), and problems with blood flow to your heart or brain; or heart, kidney, or liver disease.
- tell your doctor if you are pregnant or plan to become pregnant. If you become pregnant while you are using brimonidine eye drops, call your doctor. Do not breastfeed while you are using brimonidine eye drops.
- if you are having surgery, including dental surgery, tell your doctor or dentist that you are using brimonidine eye drops.
- you should know that brimonidine eye drops may make you drowsy. Your vision may be blurry for a few minutes after you instill the eye drops. Do not drive a car or operate machinery until you know how this medication affects you.
- ask your doctor about the safe use of alcohol while you are using brimonidine eye drops. *Alcohol can make the drowsiness caused by brimonidine eye drops worse.
- tell your doctor if you wear soft contact lenses. Remove your soft contact lenses before instilling brimonidine eye drops and wait at least 15 minutes after using the medication to replace your lenses.

# What to do if you forget a dose
Instill the missed dose as soon as you remember it. However, if is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not instill a double dose to make up for a missed one.

# Side Effects

## Minor Side Effects
Brimonidine eye drops may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- itchy, irritated, red, stinging, or burning eyes
- dry eyes
- watery or runny eyes
- red or swollen eyelids
- sensitivity to light
- blurred vision
- headache
- drowsiness
- difficulty falling asleep or staying asleep
- dry mouth
- runny nose and other cold symptoms
- cough
- flu-like symptoms
- pain or pressure in the face
- heartburn

## Severe Side Effects
Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:
- rash
- difficulty breathing
- seeing specks or flashes of light
- blind spots
- fainting
- dizziness
- upset stomach
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# Storage conditions needed for this medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# Other information
Keep all appointments with your doctor.
Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Alphagan P