Alphagan (Brimonidine Tartrate)

(bri moe' ni deen)

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.

Ophthalmic brimonidine 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 3 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 instill the eye drops, follow these steps:

• Wash your hands thoroughly with soap and water.
• Check the dropper tip to make sure that it is not chipped or cracked.
• Avoid touching the dropper tip against your eye or anything else; eye drops and droppers must be kept clean.
• While tilting your head back, pull down the lower lid of your eye with your index finger to form a pocket.
• Hold the dropper (tip down) with the other hand, as close to the eye as possible without touching it.
• Brace the remaining fingers of that hand against your face.
• While looking up, gently squeeze the dropper so that a single drop falls into the pocket made by the lower eyelid. Remove your index finger from the lower eyelid.
• Close your eye for 2 to 3 minutes and tip your head down as though looking at the floor. Try not to blink or squeeze your eyelids.
• Place a finger on the tear duct and apply gentle pressure.
• Wipe any excess liquid from your face with a tissue.
• If you are to use more than one drop in the same eye, wait at least 5 minutes before instilling the next drop.
• Replace and tighten the cap on the dropper bottle. Do not wipe or rinse the dropper tip.
• Wash your hands to remove any medication.

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 (MAO) 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 topical eye medications, 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 breast-feed 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.

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.

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
• sore throat
• flu-like symptoms
• pain or pressure in the face
• heartburn

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
• nausea

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). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

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. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.