Brim antiglau ECO eye drops 0.2%, 5ml

• Open-angle glaucoma;

• ophthalmic hypertension (as monotherapy and in combination with other drugs that reduce intraocular pressure).

Apply topically. In the conjunctival sac of the affected eye, 1 drop is instilled 2 times / day with an interval between injections of 12 hours. The duration of treatment is determined by the doctor.

Eye drops in the form of a clear yellowish-green liquid.

1 ml

brimonidine tartrate 2 mg

Excipients: polyvinyl alcohol 40-88, sodium citrate, citric acid monohydrate, sodium chloride, diluted hydrochloric acid or sodium hydroxide, highly purified water.

• Concomitant use with MAO inhibitors and tricyclic or tetracyclic antidepressants;

• children under 2 years of age (the safety and efficacy of the drug for this age category have not been established);

• lactation period (breastfeeding);

• hypersensitivity to brimonidine.

pharmachologic effect

Selective agonist of ?2-adrenergic receptors for topical use in ophthalmology. It has a dual mechanism of action: it lowers intraocular pressure by reducing the synthesis of intraocular fluid and increasing uveoscleral outflow. With instillation of a 0.2% brimonidine solution, the decrease in intraocular pressure is 10-12 mm Hg. Art., the maximum effect is noted after 2 hours, the duration of action is 12 hours.

Pharmacokinetics

With instillation in the form of eye drops, the Cmax of brimonidine in plasma is reached after 0.5-2.5 hours. After application 2 times / day for 10 days, the average value of Cmax in the blood plasma remains low (on average 0.06 ng / ml). Binding to blood proteins when applied topically is 29%. Systemic absorption of brimonidine when applied topically is slowed down. Brimonidine binds reversibly to melanin. The concentration of brimonidine in the iris, ciliary body and retina after 2 weeks of instillation into the eye was 3-17 times higher than these values ??after instillation of a single dose. It is metabolized mainly in the liver. Brimonidine and its metabolites are excreted by the kidneys. T1 / 2 after topical application averages 2 hours.

Side effect

From the side of the organ of vision: very often - conjunctival hyperemia, burning sensation, itching of the eyelids and mucous membranes of the eyes, foreign body sensation, impaired clarity of visual perception, allergic blepharitis, allergic blepharoconjunctivitis, allergic conjunctivitis, follicular conjunctivitis; often - hyperemia and edema of the eyelids, blepharitis, edema of the conjunctiva and mucous discharge from the eyes, hemorrhage into the conjunctiva, conjunctivitis, retention lacrimation, epiphora, eye pain and lacrimation, conjunctival folliculosis, local allergic reactions of the mucous membrane of the eyes (including ), cataract, keratitis, eyelid lesions, photosensitivity, superficial spotty keratopathy, loss of visual field, functional lesion of the vitreous body, vitreous hemorrhage,floating opacities in the vitreous and decreased visual acuity, photophobia, erosion and opacity of the cornea, dryness and irritation of the mucous membrane of the surface of the eye, blanching of the conjunctiva; infrequently - barley; very rarely - iritis, miosis.

From the nervous system: very often - headache, drowsiness; often - dizziness, violation of taste; infrequently - depression; very rarely - fainting, insomnia.

From the side of the cardiovascular system: infrequently - palpitations / arrhythmias (including bradycardia and tachycardia); very rarely - an increase or decrease in blood pressure.

From the respiratory system: often - bronchitis, pharyngitis, cough, shortness of breath; infrequently - dryness of the nasal mucosa; rarely - shortness of breath.

On the part of the digestive system: very often - dryness of the oral mucosa; often - gastrointestinal disorders dyspepsia).

On the part of the skin and subcutaneous fat: often - a rash. Infectious and parasitic diseases: often - flu-like syndrome, infectious disease (chills and respiratory infection), rhinitis, sinusitis, incl. infectious.

From the immune system: infrequently - systemic allergic reactions.

On the part of laboratory parameters: often - hypercholesterolemia.

Others: very often - fatigue; often asthenia.

In children: apnea, bradycardia, decreased blood pressure, hypothermia, muscle hypotension, pallor, drowsiness, decreased attention.

Application during pregnancy and lactation

The safety of use during pregnancy in humans has not been determined. In animal studies, topical application of brimonidine did not lead to impaired intrauterine development. The use of brimonidine during pregnancy is allowed only in cases where the expected benefit to the mother outweighs the potential risk to the fetus. There is no exact data on the penetration of brimonidine into breast milk when applied topically. However, the risk cannot be completely ruled out. Use during breastfeeding is contraindicated.

Application in children

Brimonidine is contraindicated in children under 2 years of age. Use with caution in children aged 2 to 7 years.

Use in elderly patients

The drug is approved for use in elderly patients

special instructions

Use with caution in patients with renal impairment (CC below 40 ml / min) and hepatic impairment; in patients with orthostatic hypotension, heart failure and cerebrovascular accident, depression, Raynaud's syndrome, thromboangiitis obliterans; in patients simultaneously receiving antihypertensive drugs and / or cardiac glycosides; in childhood and adolescence from 2 to 18 years (safety and efficacy have not been established). In elderly patients, there were no differences in safety or efficacy compared with other adult patients. Cmax and T1 / 2 of brimonidine were similar in the elderly (65 years and older) and younger patients of the adult population, which demonstrates the absence of a significant effect of age on the systemic absorption and elimination of brimonidine.No dose adjustment is required when treating elderly patients. In patients with orthostatic hypotension, heart failure and cerebrovascular insufficiency, depression, Raynaud's syndrome, thromboangiitis obliterans, brimonidine may increase the severity of diseases caused by vascular insufficiency. With the development of allergic reactions, it is necessary to discontinue use. An increase in intraocular pressure is possible in the event of delayed hypersensitivity reactions. Use in pediatrics Brimonidine is contraindicated in children under 2 years of age. In children aged 2 to 7 years, when using 0.2% brimonidine, drowsiness may occur, which may cause discontinuation of treatment. Careful monitoring of the patient's condition should be carried out, due to the high frequency of cases of drowsiness.The frequency of drowsiness may decrease with increasing age, but to a greater extent is determined by body weight: in children with a body weight of? 20 kg, drowsiness may be observed more often than in children with a body weight> 20 kg.

Influence on the ability to drive vehicles and mechanisms

Brimonidine can cause a state of fatigue or drowsiness, a decrease in vision clarity, therefore, during the period of treatment with the drug, one should refrain from driving vehicles and servicing moving machinery.

Drug interactions

Brimonidine is contraindicated in patients taking MAO inhibitors and in patients taking tricyclic or tetracyclic antidepressants (including mianserin). Brimonidine at a concentration of 2 mg / ml can enhance the effect of substances that affect the central nervous system (ethanol, barbiturates, opioids, sedatives or anesthetics). Caution should be exercised when used simultaneously with drugs that can affect the absorption and metabolism of adrenaline, norepinephrine and other so-called biogenic amines (chlorpromazine, methylphenidate, reserpine). In some patients, after using a solution of brimonidine at a concentration of 2 mg / ml, there is a slight decrease in blood pressure. Caution should be exercised when used simultaneously with antihypertensive drugs and / or cardiac glycosides.With the simultaneous systemic administration of agonists or antagonists of adrenergic receptors (for example, isoprenaline or prazosin) for the first time, as well as when changing the dose of these simultaneously administered systemic drugs (regardless of the method of their administration), interaction with ?-adrenergic receptor agonists or an effect on their effects may occur ...