BRIMONIDINE
BRIMONIDINE- brimonidine tartrate gel
Bryant Ranch Prepack
1 INDICATIONS AND USAGE
Brimonidine topical gel, 0.33% is an alpha adrenergic agonist indicated for the topical treatment of persistent (nontransient) erythema of rosacea in adults 18 years of age or older.
2 DOSAGE AND ADMINISTRATION
Apply a pea-sized amount once daily to each of the five areas of the face: central forehead, chin, nose, each cheek. Brimonidine topical gel should be applied smoothly and evenly as a thin layer across the entire face avoiding the eyes and lips.
Wash hands after applying brimonidine topical gel.
Brimonidine topical gel is for topical use only and not for oral, ophthalmic, or intravaginal use.
3 DOSAGE FORMS AND STRENGTHS
Brimonidine Topical Gel, 0.33% is a white to light yellow opaque aqueous gel. Each gram of gel contains 5 mg of brimonidine tartrate, equivalent to 3.3 mg of brimonidine free base.
4 CONTRAINDICATIONS
Brimonidine topical gel is contraindicated in patients who have experienced a hypersensitivity reaction to any component. Reactions have included angioedema, urticarial, and contact dermatitis [see Warnings and Precautions (5.6) and Adverse Reactions (6.1, 6.2)].
5 WARNINGS AND PRECAUTIONS
5.1 Potentiation of Vascular Insufficiency
Brimonidine topical gel should be used with caution in patients with depression, cerebral or coronary insufficiency, Raynaud’s phenomenon, orthostatic hypotension, thrombangiitis obliterans, scleroderma, or Sjögren’s syndrome.
5.2 Severe Cardiovascular Disease
Alpha-2 adrenergic agonists can lower blood pressure. Brimonidine topical gel should be used with caution in patients with severe or unstable or uncontrolled cardiovascular disease.
5.3 Serious Adverse Reactions Following Ingestion of Brimonidine Topical Gel
Two young children of a subject in a clinical trial experienced serious adverse reactions following accidental ingestion of brimonidine topical gel. Adverse reactions experienced by one or both children included lethargy, respiratory distress with apneic episodes (requiring intubation), sinus bradycardia, confusion, psychomotor hyperactivity, and diaphoresis. Both children were hospitalized overnight and discharged the following day without sequelae.
Keep brimonidine topical gel out of the reach of children.
5.4 Systemic Adverse Reactions of Alpha 2-adrenergic agonists
Postmarketing cases of bradycardia, hypotension (including orthostatic hypotension) and dizziness have been reported. Some cases required hospitalization. Some cases involved application of brimonidine topical gel in unapproved dosing regimens and for unapproved indications, including the application of brimonidine topical gel following laser procedures.
Avoid applying brimonidine topical gel to irritated skin or open wounds.
5.5 Local Vasomotor Adverse Reactions
Erythema
Some subjects in the clinical trials discontinued use of brimonidine topical gel because of erythema. Some subjects in the clinical trials reported a rebound phenomenon, where erythema was reported to return worse compared to the severity at baseline. Erythema appeared to resolve after discontinuation of brimonidine topical gel [see Adverse Reactions (6.1) ].
The treatment effect of brimonidine topical gel may begin to diminish hours after application.
From postmarketing reports, some patients have experienced erythema involving areas of the face that were previously not affected by erythema and in areas (e.g., neck and chest) outside of the treatment sites.
Flushing
Some subjects in the clinical trials discontinued use of brimonidine topical gel because of flushing.
Intermittent flushing occurred in some subjects treated with brimonidine topical gel in the clinical trials. The onset of flushing relative to application of brimonidine topical gel varied, ranging from approximately 30 minutes to several hours [see Adverse Reactions (6.1) ]. Flushing appeared to resolve after discontinuation of brimonidine topical gel.
From postmarketing reports, some patients have experienced increased frequency of flushing and/or increased depth of erythema with the flushing. Additionally, some patients reported new onset of flushing.
Pallor and Excessive Whitening
From postmarketing reports, some patients have experienced pallor or excessive whitening at or outside the application site following treatment with brimonidine topical gel.
5.6 Hypersensitivity
Allergic contact dermatitis was reported in the clinical trials for brimonidine topical gel [see Adverse Reactions (6.1) ].
Events reported post marketing with the use of brimonidine topical gel include angioedema, throat tightening, tongue swelling, and urticarial [see Adverse Reactions (6.2) ]. Institute appropriate therapy and discontinue brimonidine topical gel, if clinically significant hypersensitivity reaction occurs.
6 ADVERSE REACTIONS
The following adverse drug reactions are discussed in greater detail in other sections of the label:
- •
- Systemic Adverse Reactions of Alpha-2 Adrenergic Agonists [see Warnings and Precautions (5.4) ]
- •
- Local Vasomotor Adverse Reactions [see Warnings and Precautions (5.5) ]
- •
- Hypersensitivity [see Warnings and Precautions (5.6) ]
6.1 Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
During clinical trials, 1210 subjects were exposed to brimonidine topical gel. A total of 833 subjects were treated for persistent (nontransient) erythema associated with rosacea, and 330 of those were treated once daily for 29 days in vehicle-controlled trials.
Adverse reactions that occurred in at least 1% of subjects treated with brimonidine topical gel once daily for 29 days and for which the rate for brimonidine topical gel exceeded the rate for vehicle are presented in Table 1.
Table 1 — Adverse Reactions Reported in Clinical Trials by at Least 1% of Subjects Treated for 29 Days
| Preferred Term | Brimonidine Topical Gel (N=330) n (%) | Vehicle Gel (N=331) n (%) |
| Subjects with at least one adverse reaction, Number (%) of Subjects | 109 (33) | 91 (28) |
| Erythema | 12 (4%) | 3 (1%) |
| Flushing | 9 (3%) | 0 |
| Skin burning sensation | 5 (2%) | 2 (1%) |
| Dermatitis contact | 3 (1%) | 1 (˂1%) |
| Dermatitis | 3 (1%) | 1 (˂1%) |
| Skin warm | 3 (1%) | 0 |
| Paraesthesia | 2 (1%) | 1 (˂1%) |
| Acne | 2 (1%) | 1 (˂1%) |
| Pain of skin | 2 (1%) | 0 |
| Vision blurred | 2 (1%) | 0 |
| Nasal congestion | 2 (1%) | 0 |
Open-label, Long-term Study
An open-label study of brimonidine topical gel when applied once daily for up to one year was conducted in subjects with persistent (nontransient) facial erythema of rosacea. Subjects were allowed to use other rosacea therapies. A total of 276 subjects applied brimonidine topical gel for at least one year. The most common adverse events (≥ 4% of subjects) for the entire study were flushing (10%), erythema (8%), rosacea (5%), nasopharyngitis (5%), skin burning sensation (4%), increased intraocular pressure (4%), and headache (4%).
Allergic contact dermatitis
Allergic contact dermatitis to brimonidine topical gel was reported in approximately 1% of subjects across the clinical development program. Two subjects underwent patch testing with individual product ingredients. One subject was found to be sensitive to brimonidine tartrate, and one subject was sensitive to phenoxyethanol (a preservative).
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