How It Works
Prescription brimonidine eye drops work by lowering the amount of fluid produced in the eye and by helping fluid drain out of the eye more efficiently. Together, these effects reduce pressure inside the eye.
OTC brimonidine eye drops reduce eye redness by narrowing small blood vessels on the surface of the eye, which makes the eye look less red.
| Quick Facts | |
|---|---|
| Common Brands | Alphagan P, Lumify, Lumify Preservative Free, Qoliana |
| Drug Class | Alpha-2 adrenergic agonist |
| Generic Status | Generic versions available |
| Availability | Prescription and OTC |
Dosing
Prescription brimonidine ophthalmic solution comes in three strengths: 0.1%, 0.15%, and 0.2%.
OTC brimonidine eye drops are available in a single strength of 0.025%.
For eye redness, adults can use 1 drop of OTC brimonidine eye drops in the affected eye(s) every 6 to 8 hours, no more than 4 times a day. For preservative-free formulations that come in single-use vials, use 1 drop in the affected eye(s), no more than 4 times a day, and throw the vial away immediately after use.
For the management of high eye pressure associated with glaucoma or ocular hypertension, the recommended dosage is 1 drop of the prescription brimonidine eye drops into the affected eye(s) 3 times daily. Providers typically suggest spacing these doses 8 hours apart.
Your prescription packet will contain specific instructions for using the eye drops. Here are some general guidelines:
- Wash your hands with soap and water.
- Tilt your head back slightly.
- Use your index finger to gently pull down on the lower eyelid and create a small pouch.
- Squeeze 1 drop into the pouch, then close your eye without blinking or rubbing it.
- Gently press your finger against the inside corner of your eye (near the nose) for 1–2 minutes to help keep the medication from draining into your nose.
- Repeat on the other eye if prescribed.
Note: The dosing information below is for educational purposes only. Your prescribing physician will determine your specific dose based on your individual health needs. Always follow your healthcare provider’s instructions for exact dosing.
Uses
FDA-Approved Uses
Prescription brimonidine eye drops are FDA-approved to lower intraocular pressure in people with open-angle glaucoma or ocular hypertension (elevated eye pressure without the optic nerve damage seen in glaucoma).
Over-the-counter brimonidine eye drops are approved to relieve eye redness caused by minor eye irritation.
Off-Label Uses
You may see brimonidine eye drops prescribed for uses that are not FDA-approved. This is a very common and legal practice called off-label prescribing, where a doctor uses their clinical judgment to prescribe a drug for a different purpose.
Brimonidine eye drops have been studied for the management of night vision difficulties, such as halos, star bursts, and glare following laser refractive surgery. Ask your eye doctor whether an off-label use is right for you.
Side Effects
Like all medications, brimonidine eye drops can cause side effects. The side effects below are for prescription brimonidine. OTC redness-relief drops, such as Lumify, have their own directions and warnings on the package.
Some common side effects may improve over time as your body adjusts to the medication. Other side effects may be serious and require medical attention.
If you use OTC brimonidine, such as Lumify, for redness, stop using it and consult a healthcare professional if you have eye pain, changes in vision, or redness or irritation that continues, gets worse, or lasts more than 3 days.
Common Side Effects
- Dry mouth
- Eye burning, stinging, itching, or redness
- Headache
- Blurry vision
- Fatigue or drowsiness
- Small bumps on the inside of the eyelids or on the surface of the eye
- Feeling like there’s something in the eye
- Eye allergy: Red, itchy, or swollen eyes or eyelids. This can start months after you begin treatment. Contact your eye doctor if it happens.
Serious Side Effects
Some side effects can be serious. It’s important to know what to look for if they do occur. Stop using brimonidine eye drops and call your doctor immediately if you experience:
- Severe allergic reactions: Get emergency medical help for swelling of the face, lips, tongue, or throat, or difficulty breathing or swallowing.
- Eye infections: Contamination of the eye drop bottle can lead to an eye infection. Symptoms may include eye pain, unusual drainage or oozing, worsening irritation, vision changes, redness, sensitivity to light, or excessive tearing.
- Low blood pressure or slow heartbeat: Fainting, feeling very dizzy, or a slow heartbeat.
Contact your healthcare provider if you experience any concerning or prolonged symptoms.
Pharmacist Tips
Protect Eye Drops From Contamination
Contamination of the bottle can introduce bacteria into the eye, potentially leading to eye infections. To prevent this, wash your hands thoroughly before and after handling the eye drops. Never allow the dropper tip to touch your eye, eyelashes, fingers, or any other surface.
Remove Contact Lenses Before Applying Drops
Some brimonidine eye drops contain a preservative called benzalkonium chloride, which can be absorbed by soft contact lenses. For many prescription brimonidine products, the instructions say to wait at least 15 minutes before putting your lenses back in. Follow the directions for your product.
Wait at Least 5 Minutes Between Using Different Eye Drops in the Same Eye
This gives the first medication enough time to be absorbed and helps reduce how much is washed away by the next drops.
Avoid Driving Until You Know How the Medication Affects You
Brimonidine can cause drowsiness, sleepiness, and blurred vision, so it’s recommended to avoid driving or other tasks that require clear vision and mental alertness until you are fully aware of how the drops affect you.
Continue Using The Medication as Prescribed
Eye pressure fluctuations are not easily felt at home, so it is important to use the prescription medication exactly as directed every day, even if you do not notice an immediate difference in how your eyes feel. Keep your eye doctor appointments so your eye pressure and response to treatment can be checked.
Store At Room Temperature
Follow the storage directions on your product’s label, including the temperature range and any instruction to protect it from light, moisture, or heat.
Try To Avoid Missing A Dose
If you miss a dose of brimonidine eye drops, apply them as soon as you remember, unless it is almost time for your next dose. In that case, skip the missed dose and apply your next dose at the regular time. Do not take double or extra doses.
Drug Interactions
Certain medications and substances can interact with brimonidine eye drops, potentially altering how it works or increasing the risk of side effects. For example:
- Alcohol: Consuming alcohol while using these eye drops may increase the risk of drowsiness and fatigue.
- Central nervous system (CNS) depressants: Certain anxiety medications, prescription sleep aids, or pain relievers can compound the sleepiness and dizziness caused by brimonidine.
- High blood pressure medications: Brimonidine may lower blood pressure, so extra care is needed when it is used with blood pressure medicines. Tell your doctor about any blood pressure medicine you take.
- Digoxin: This is a heart medicine. Brimonidine may lower blood pressure, so extra care is needed when the two are used together. Tell your doctor if you take digoxin.
- Tricyclic antidepressants: Brimonidine eye drops may interact with medications like amitriptyline or nortriptyline.
- Monoamine oxidase inhibitors (MAOIs): Some brimonidine products should not be used with MAOIs at all, and others say to use the two together with care. Tell your doctor if you take one.
Always give your doctor and pharmacist a complete list of all your medications, vitamins, and supplements to check for potential interactions. Do not stop any medicine without checking with your doctor first.
FAQs
How does brimonidine reduce pressure for those with open-angle glaucoma?
As an alpha-2 adrenergic agonist, brimonidine reduces intraocular pressure by both decreasing the amount of fluid produced inside the eye and increasing the amount of fluid drained from the eye.
How many times a day should brimonidine eye drops be used?
When prescribed for high intraocular pressure, the recommended dose is one drop in the affected eye(s) three times a day, with each dose spaced roughly 8 hours apart.
Does applying brimonidine eye drops cause temporary blurred vision or a burning sensation?
Yes, brimonidine eye drops can cause temporary blurred vision and burning or stinging in the eye. If your vision is blurry after using the drops, wait until it clears before driving or doing anything that requires clear vision. Tell your doctor if burning, stinging, or other eye irritation is severe or does not go away.
Why do you have to wait 15 minutes after using brimonidine before using contact lenses?
Some brimonidine eye drops contain benzalkonium chloride, a preservative that can be absorbed by soft contact lenses. Not every product contains it, so check the ingredients on your product. For products that contain benzalkonium chloride, waiting helps keep the preservative from being absorbed by soft lenses. Follow the wait time for your product. Many prescription brimonidine products say to wait at least 15 minutes.
Can brimonidine eye drops cause a sudden drop in blood pressure?
Although brimonidine is applied to the eye, some of the medication can be absorbed into the bloodstream, which may lower blood pressure. If you feel dizzy or lightheaded after using brimonidine, sit or lie down until you feel steady and contact your doctor if the symptoms are severe or do not go away.
Does brimonidine interact with antidepressants?
Brimonidine can interact with specific classes of antidepressants, notably monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants. Tell your healthcare provider if you take either of these medications before starting brimonidine. Some brimonidine products should not be used with MAOIs, while others may be used with caution. Your healthcare provider can check the instructions for your exact product.
Is brimonidine safe for use during pregnancy?
It is not fully known if or how brimonidine eye drops might affect a pregnancy or potentially harm an unborn baby, and risk cannot be ruled out. It is recommended for people who are pregnant or planning to become pregnant to discuss the potential risks and benefits with their healthcare team before use.
Can brimonidine eye drops be used while breastfeeding?
Some prescription brimonidine labels, including Alphagan P, do not recommend using the medication while breastfeeding. If you are breastfeeding, talk with your doctor before using brimonidine eye drops. For OTC Lumify, ask a health professional before use.
What should I do if my brimonidine eye drops change color or become cloudy?
Do not use the eye drops if you notice that the liquid in the bottle has changed color or looks cloudy. Contact your pharmacist or healthcare provider if you have questions or need a replacement.
Can brimonidine eye drops be safely used by those with severe cardiovascular disease?
People with severe cardiovascular disease, circulation problems, or orthostatic hypotension (a drop in blood pressure when standing) should approach this medication with caution. Brimonidine has the potential to worsen symptoms of poor blood flow or vascular insufficiency, so a healthcare provider must carefully evaluate if it is a safe option.
Brimonidine should also be used with caution in people with depression. Before you start, tell your doctor if you have or have had depression, Raynaud’s disease (a condition that causes attacks of low blood circulation to the fingers and toes), problems with blood flow to your heart or brain, or heart, kidney, or liver disease.
Comparable Medications
Brimonidine eye drops, latanoprost, timolol, brimonidine-timolol, or Lumify?
Several other prescription eye drops can be used to lower eye pressure. Some are used in combination. Your doctor can help you decide which option is right for you. Here are a few possible alternatives below.
Latanoprost
From $29.99
A once-daily prescription eye drop used to lower high eye pressure in people with open-angle glaucoma or ocular hypertension.
Timolol Eye Drops
From $27.99
A once- or twice-daily prescription eye drop used to lower high eye pressure in people with open-angle glaucoma or ocular hypertension.
Brimonidine-Timolol Eye Drops
From $37.99
A twice-daily prescription eye drop that combines brimonidine with timolol. It is used to lower high eye pressure in people with glaucoma or ocular hypertension who need an added or replacement treatment because their eye pressure is not well controlled.
Lumify
An OTC eye drop with a lower strength of brimonidine. It is used to relieve eye redness from minor irritation and is not a substitute for prescription glaucoma treatment.
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Important: Information on this page is for educational purposes only. Prescribing decisions are made by independent, licensed providers. TelyRx operates technology-enabled pharmacies and a telehealth platform that connects patients with licensed providers. Prescriptions, when provider-approved and issued, are filled and shipped by TelyRx-affiliated pharmacies. We do not employ physicians or make prescribing decisions. Learn more about our editorial standards here.