Alphagan (brimonidine tartrate ophthalmic solution) is a prescription medication specifically formulated to reduce elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. As a selective alpha-2 adrenergic agonist, it represents a critical therapeutic option in ophthalmology for preserving visual field and preventing optic nerve damage. Its dual mechanism of action—reducing aqueous humor production and increasing uveoscleral outflow—makes it particularly valuable in clinical practice. This medication is available in various concentrations, including 0.1%, 0.15%, and 0.2%, with Alphagan P containing the purite preservative system for enhanced tolerability.

Features

• Contains brimonidine tartrate as active pharmaceutical ingredient
• Available in multiple concentrations: 0.1%, 0.15%, and 0.2% ophthalmic solutions
• Selective alpha-2 adrenergic receptor agonist mechanism
• Purite-preserved formulation available (Alphagan P) for reduced allergic reactions
• Typically supplied in 5mL, 10mL, or 15mL sterile plastic dispensers with controlled dropper tips
• pH-balanced formulation for optimal ocular comfort
• Preservative-free unit dose options available for sensitive patients
• Rapid onset of action with peak effect within 2-3 hours post-instillation

Benefits

• Effectively lowers intraocular pressure by 20-27% from baseline measurements
• Provides neuroprotective benefits beyond pressure reduction through alpha-2 receptor activation
• Offers convenient twice-daily dosing regimen for improved patient compliance
• Demonstrates excellent safety profile with minimal systemic absorption
• Maintains consistent 24-hour IOP control with proper dosing schedule
• Preserves visual field and optic nerve structure through sustained pressure management

Common use

Alphagan is primarily indicated for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension. It is frequently prescribed as monotherapy or as part of combination therapy when additional IOP reduction is required beyond what single agents can achieve. Ophthalmologists may initiate Alphagan therapy when patients require additional pressure control beyond beta-blockers or when beta-blockers are contraindicated. The medication is particularly valuable for patients who require neuroprotective benefits in addition to pressure reduction. Clinical studies have demonstrated its efficacy across diverse patient populations, including those with early to moderate stage glaucoma.

Dosage and direction

The recommended dosage is one drop in the affected eye(s) twice daily, approximately 12 hours apart. Patients should wash hands thoroughly before administration. To administer, tilt the head backward, pull the lower eyelid away from the eye to form a pouch, and instill one drop into the conjunctival sac. Avoid touching the dropper tip to any surface to prevent contamination. If using more than one ophthalmic medication, wait at least 5 minutes between applications. Contact lenses should be removed before instillation and may be reinserted 15 minutes post-application. Dosage adjustments should only be made under ophthalmologist supervision.

Precautions

Patients should be monitored for ocular allergic reactions, which may include conjunctival hyperemia, itching, and follicular conjunctivitis. Use with caution in patients with cardiovascular disease, particularly those with hypotension, bradycardia, or Raynaud’s phenomenon. Exercise caution in patients with depression, cerebral or coronary insufficiency, or orthostatic hypotension. Hepatic or renal impairment may affect drug metabolism and elimination. Pediatric patients may experience increased susceptibility to systemic effects such as somnolence and fatigue. Elderly patients may require closer monitoring due to potential age-related changes in drug metabolism.

Contraindications

Alphagan is contraindicated in patients with known hypersensitivity to brimonidine tartrate or any component of the formulation. It should not be used in patients taking monoamine oxidase (MAO) inhibitors concurrently. Contraindicated in patients with uncontrolled cardiovascular disease, particularly those with severe hypotension or bradycardia. Not recommended for use in neonates and infants due to risk of severe central nervous system depression. Patients with a history of severe allergic reactions to alpha-agonists should avoid this medication.

Possible side effect

Common ocular side effects include allergic conjunctivitis (approximately 10-15% of patients), conjunctival hyperemia (15-30%), ocular burning or stinging (5-10%), blurred vision (5-15%), and foreign body sensation (5-10%). Systemic side effects may include oral dryness (10-20%), fatigue and drowsiness (5-15%), headache (5-15%), and dizziness (2-5%). Less common effects include corneal erosion/ulceration, photophobia, eyelid dermatitis, and conjunctival follicles. Serious but rare side effects include bradycardia, hypotension, syncope, and apnea, particularly in pediatric patients.

Drug interaction

Concomitant use with CNS depressants (alcohol, barbiturates, opioids) may enhance sedative effects. Caution required with antihypertensive agents and cardiac glycosides due to potential additive effects on blood pressure and heart rate. Tricyclic antidepressants may decrease Alphagan’s effectiveness. MAO inhibitors are absolutely contraindicated. Beta-blockers, carbonic anhydrase inhibitors, and prostaglandin analogs may have additive IOP-lowering effects when used in combination therapy. CYP450 interactions are minimal due to low systemic absorption.

Missed dose

If a dose is missed, instill it as soon as possible. However, if it is nearly time for the next scheduled dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed administration. Maintain the approximate 12-hour interval between doses to ensure consistent therapeutic effect. Patients should not discontinue therapy without consulting their ophthalmologist, as abrupt cessation may lead to rebound elevated intraocular pressure.

Overdose

Ocular overdose may result in increased ocular irritation, conjunctival blanching, or systemic effects including hypotension, bradycardia, sedation, and respiratory depression. In case of accidental ingestion, seek immediate medical attention. Treatment is supportive and symptomatic. Activated charcoal may be administered if ingestion occurred within previous 1-2 hours. Cardiovascular monitoring is recommended for significant systemic absorption. Ocular irrigation with sterile saline may be considered for excessive topical application.

Storage

Store at controlled room temperature (15-30°C or 59-86°F). Protect from light and excessive heat. Keep the container tightly closed when not in use. Do not freeze the solution. Discard any unused medication 28 days after opening the container, even if some solution remains. Do not use if the solution changes color or becomes cloudy. Keep out of reach of children and pets. Do not transfer the solution to any other container.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment recommendations. Individual patient responses may vary. The prescribing physician should be consulted regarding specific medical conditions or concerns. Full prescribing information should be reviewed before initiating therapy.

Reviews

Clinical studies demonstrate Alphagan’s efficacy in reducing intraocular pressure by 20-27% from baseline. In a 12-month multicenter trial, 78% of patients maintained target IOP levels with twice-daily dosing. Patient satisfaction surveys indicate good tolerability, though 15% of users discontinue due to ocular allergy. Ophthalmologists report reliable performance in combination therapy regimens. Long-term studies show preserved efficacy over 24 months of continuous use with proper monitoring.