Brimonidine (Alphagan P, Mirvaso) is an eye drop that lowers eye pressure in people with open-angle glaucoma (OAG) and ocular hypertension, as well as reduces redness from minor irritation. Eye pressure that is too high can lead to vision loss so it’s important to control eye pressure. Learn more about this prescription-only eye drop, which should be used in a specific way to ensure effectiveness and avoid unwanted side effects.* 

Precautions when using brimonidine eye drops

Brimonidine eye drops are not recommended for pediatric patients under two years old and should be avoided in those on Iobenguane I 131 injections (Azedra) for cancer treatment. It’s also advised to avoid these drops if you are taking a monoamine oxidase (MAO) inhibitor, such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl), or tranylcypromine (Parnate).

If you have the following conditions, let your doctor know so they can determine if the drops could make your condition worse:

• Depression
• Heart attack or history of them
• Heart disease
• Orthostatic hypotension (low blood pressure when standing up)
• Raynaud disease (blood vessel disease)
• Stroke or history of them
• Thromboangiitis obliterans (blood vessel disease)

Lastly, it’s important to talk with your doctor about food, tobacco, and alcohol use and how they might interact with the eye drops.

How to use the eye drops

To ensure your eye drops stay effective, make sure to store them at room temperature and away from heat, moisture, direct light, and freezing temperatures.

When administering the drops, you will want to do the following after determining the number of drops you need in one or both eyes, as prescribed by your doctor:

1. Wash your hands with soap and water.
2. Check to make sure the dropper is intact and not cracked. Avoid touching the dropper tip against your eye.
3. Tilt your head back and pull down the lower lid of your eye to form a pocket.
4. Hold the dropper with the other hand as close to the eye as possible without touching it.
5. While looking up, gently squeeze the dropper so that only a single drop falls into the lower eyelid and then close your eye for two to three (2 to 3) minutes and tip your head down as if you were looking at the floor. Try not to blink or squeeze your eyelids.
6. Place a finger on the tear duct (corner of your eye) and apply gentle pressure.
7. If prescribed, repeat this process in the other eye.
8. If you use more than one type of eye drop in the same eye, wait at least five (5) minutes before putting in the next drop.
9. When you finish, wash your hands to remove any medication.

If you missed a dose, administer the eye drop as soon as you remember. If it’s almost time for the next dose, however, skip the missed dose and continue your regular dosing schedule. It’s important to avoid administering a double dose to make up for a missed one.

Possible side effects

If you find that you’re developing any unwanted side effects after administering your eye drops, let your doctor know right away so they can make adjustments. 

Some common symptoms include:

• Blurred vision or loss of vision
• Burning, dry, or itching eyes
• Discharge or excessive tearing
• Disturbed color perception
• Double vision
• Eyelid swelling
• Halos around lights
• Headache
• Night blindness
• Overbright appearance of lights
• Redness (eye or inner lining of eyelid)
• Tearing of the eye
• Tunnel vision

Some side effects do not require medical attention and may wear off as you adjust to your new medication. Check with your healthcare provider if these side effects continue. You may also report side effects directly to the U.S. Food and Drug Administration (FDA) at 1-800-FDA-1088.

Additional information on ophthalmic brimonidine can be found on MedlinePlus.

*Mayo Clinic. (2018, July 15). Brimonidine (Ophthalmic Route). https://www.mayoclinic.org/drugs-supplements/brimonidine-ophthalmic-route/description/drg-20067572

Any sources from outside of Prevent Blindness do not imply an endorsement from Prevent Blindness. The contents of the material used are the responsibility of the authoring organization, Responsum Health.