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Indian J Ophthalmol ; 67(8): 1297-1302, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31332113


Purpose: To compare the lipid layer thickness (LLT) using the LipiView® ocular surface interferometer (TearScience® Inc, Morrisville, NC) between the eye treated with glaucoma medication and untreated normal eye in the unilateral glaucoma patients, and evaluate the effect of topical glaucoma medication on the LLT parameters in glaucoma eyes. Methods: The participants in this cross-sectional comparative study were unilateral glaucoma patients treated with topical glaucoma medications for more than 12 months. Three LLT parameters (average, minimum, and maximum) obtained by the LipiView® were compared between the glaucomatous eye and normal eye. The factors associated with LLT parameters in the eyes treated with glaucoma medication were investigated with multiple regression analysis. Results: Thirty patients with unilateral normal tension glaucoma were enrolled in the present study. Lipid layer average, minimum, and maximum were 64.83 ± 16.50, 51.63 ± 16.73, and 82.53 ± 20.62 in glaucomatous eyes, 77.26 ± 17.81, 62.83 ± 20.99, and 86.13 ± 15.42 in normal eyes. Lipid layer average and minimum were significantly thinner than those in normal eyes (P < 0.001, P < 0.001, respectively). Longer duration of glaucoma eye drops and a greater number of glaucoma medications were associated with the lower LLT average (ß = -0.456, P < 0.001, ß = -8.517, P = 0.003, respectively), and increasing glaucoma medications have a significant correlation with lower LLT minimum in glaucoma eyes (ß = -8.814, P = 0.026). Conclusion: The present study highlights that patients with long-term glaucoma medications need to be assessed for LLT parameters objectively evaluate their ocular surface health.

Anti-Hipertensivos/efeitos adversos , Metabolismo dos Lipídeos/efeitos dos fármacos , Glaucoma de Baixa Tensão/tratamento farmacológico , Lágrimas/metabolismo , Administração Oftálmica , Adulto , Idoso , Tartarato de Brimonidina/efeitos adversos , Estudos Transversais , Combinação de Medicamentos , Síndromes do Olho Seco/diagnóstico , Feminino , Gonioscopia , Humanos , Interferometria , Pressão Intraocular/fisiologia , Glaucoma de Baixa Tensão/metabolismo , Masculino , Disfunção da Glândula Tarsal/diagnóstico , Pessoa de Meia-Idade , Soluções Oftálmicas , Sulfonamidas/efeitos adversos , Tiofenos/efeitos adversos , Timolol/efeitos adversos , Tonometria Ocular
Arq Bras Oftalmol ; 82(3): 236-238, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30916215


This report was written to describe a case of unilateral brimonidine-induced conjunctival lichen planus. Because the ophthalmic examination indicated chronic conjunctivitis or drug-induced pseudopemphigoid, the patient underwent thorough ophthalmic and systemic examinations, as well as conjunctival biopsy and direct immunofluorescence studies. A 71-year-old woman with unilateral left eye findings of chronic conjunctivitis was referred to our Ophthalmology Department. The patient reported that chronic conjunctivitis began shortly after she initiated use of topical brimonidine. Ophthalmic examination revealed foreshortening of the inferior fornix and symblepharon. Conjunctival biopsy revealed submucous lymphocytes and shaggy distribution of fibrinogen on direct immunofluorescence; this was suggestive of ocular lichen planus. No other systemic lesions were found that were consistent with the presentation of lichen planus. A good response was observed to topical cyclosporine treatment. To our knowledge, this may be the first report of unilateral ocular lichen planus without systemic findings. The correlation with the initiation of topical brimonidine suggests that this might be the first case of biopsy-confirmed brimonidine-induced ocular lichen planus.

Anti-Hipertensivos/efeitos adversos , Tartarato de Brimonidina/efeitos adversos , Doenças da Túnica Conjuntiva/induzido quimicamente , Líquen Plano/induzido quimicamente , Idoso , Biópsia , Túnica Conjuntiva/patologia , Doenças da Túnica Conjuntiva/tratamento farmacológico , Doenças da Túnica Conjuntiva/patologia , Ciclosporina/uso terapêutico , Feminino , Humanos , Imunossupressores/uso terapêutico , Líquen Plano/tratamento farmacológico , Líquen Plano/patologia
Arch Soc Esp Oftalmol ; 93(10): 511-514, 2018 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29910082


CLINICAL CASE: The case concerns an 81-year-old woman on treatment with a topical fixed combination of timolol and brimonidine who was diagnosed in the Emergency Department with acute anterior granulomatous hypertensive uveitis. The patient responded favourably to the withdrawal of the eye drops without showing any subsequent relapse. DISCUSSION: Uveitis due to brimonidine is a rare adverse effect, but it must be known. Once the diagnosis is suspected, the effective treatment is the withdrawal of brimonidine, with or without the addition of topical corticosteroids to control inflammation depending on the severity of the condition. It is a process with an excellent prognosis.

Agonistas de Receptores Adrenérgicos alfa 2/efeitos adversos , Tartarato de Brimonidina/efeitos adversos , Soluções Oftálmicas/efeitos adversos , Uveíte Anterior/induzido quimicamente , Doença Aguda , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Idoso de 80 Anos ou mais , Tartarato de Brimonidina/uso terapêutico , Conjuntivite Alérgica/induzido quimicamente , Ciclopentolato/uso terapêutico , Quimioterapia Combinada , Epitélio Anterior/patologia , Feminino , Glaucoma de Ângulo Aberto/tratamento farmacológico , Granuloma/induzido quimicamente , Humanos , Latanoprosta/uso terapêutico , Lubrificantes Oftálmicos , Hipertensão Ocular/induzido quimicamente , Prednisolona/análogos & derivados , Prednisolona/uso terapêutico , Sulfonamidas/uso terapêutico , Tiofenos/uso terapêutico , Timolol/uso terapêutico , Uveíte Anterior/diagnóstico , Uveíte Anterior/tratamento farmacológico
Dermatol Clin ; 36(2): 151-159, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29499798


Persistent centrofacial erythema is a predominant component of rosacea. The authors review the topical and systemic treatments for rosacea-related erythema and flushing to aid in treatment decision making in clinical practice. Databases were searched for literature pertaining to treatment options for erythema related to rosacea. The paucity of large-scale clinical trials in patients with the erythematotelangiectatic rosacea subtype makes it difficult to draw firm conclusions regarding treatment. Although certain topical and oral treatments appear to have modest benefit in reducing erythema, there is a need for high-quality, well-designed, and rigorously reported studies for the treatments for rosacea.

Agonistas alfa-Adrenérgicos/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Tartarato de Brimonidina/uso terapêutico , Eritema/tratamento farmacológico , Eritema/etiologia , Oximetazolina/uso terapêutico , Rosácea/complicações , Administração Cutânea , Anti-Hipertensivos/administração & dosagem , Tartarato de Brimonidina/efeitos adversos , Inibidores de Calcineurina/uso terapêutico , Face , Humanos , Uso Off-Label , Retinoides/administração & dosagem , Tetraciclinas/uso terapêutico
J Ocul Pharmacol Ther ; 34(3): 274-279, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29297751


PURPOSE: To evaluate efficacy and safety of brinzolamide (1%)/brimonidine (0.2%) fixed combination (BBFC) in normal tension glaucoma (NTG). METHODS: This retrospective study included NTG patients treated with BBFC as their primary therapy, NTG patients who had changed their medication to BBFC from brinzolamide or brimonidine, and NTG patients who had changed their medication to BBFC from concomitantly using brinzolamide and brimonidine. The intraocular pressure (IOP), mean deviation value, and adverse drug reactions were evaluated. RESULTS: In the BBFC primary therapy group, the baseline IOP was 17.1 ± 1.4 mmHg, and the mean IOP at 18 months after using BBFC was 12.4 ± 1.8 mmHg. In the brinzolamide monotherapy group, the baseline IOP was 16.2 ± 1.4 mmHg, the mean IOP using brinzolamide was 13.4 ± 1.6 mmHg, and the mean IOP at 18 months after changing to BBFC was 12.3 ± 1.4 mmHg. In the brimonidine monotherapy group, the baseline IOP was 16.5 ± 1.5 mmHg, the mean IOP using brimonidine was 13.3 ± 1.6 mmHg, and the mean IOP at 18 months after changing to BBFC was 12.4 ± 1.4 mmHg. In the unfixed brinzolamide and brimonidine group, the baseline IOP was 17.5 ± 1.3 mmHg, the mean IOP when using unfixed brinzolamide and brimonidine was 12.4 ± 1.4 mmHg, and the mean IOP at 18 months after changing to BBFC was 12.6 ± 1.5 mmHg. There were no serious adverse drug reactions. CONCLUSIONS: BBFC provides a significant IOP reduction and is a safe antiglaucoma medication for NTG patients.

Anti-Hipertensivos/uso terapêutico , Tartarato de Brimonidina/uso terapêutico , Pressão Intraocular/efeitos dos fármacos , Glaucoma de Baixa Tensão/tratamento farmacológico , Soluções Oftálmicas/uso terapêutico , Sulfonamidas/uso terapêutico , Tiazinas/uso terapêutico , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/efeitos adversos , Tartarato de Brimonidina/administração & dosagem , Tartarato de Brimonidina/efeitos adversos , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas/administração & dosagem , Soluções Oftálmicas/efeitos adversos , Estudos Retrospectivos , Sulfonamidas/administração & dosagem , Sulfonamidas/efeitos adversos , Tiazinas/administração & dosagem , Tiazinas/efeitos adversos
Drugs R D ; 18(1): 87-90, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29374829


BACKGROUND: Topical α-adrenergic agonist therapy has been developed to treat the persistent erythema of rosacea patients. Brimonidine and oxymetazoline are both topical α-adrenergic agonists. OBJECTIVES: The objective of this in vitro safety pharmacology study was to compare the potential safety profiles of brimonidine and oxymetazoline. METHODS: Brimonidine and oxymetazoline underwent pharmacological profiling with a standard panel of 151 assays, including α-adrenergic receptors and 5-hydroxytryptamine (5-HT) receptors. A valvular interstitial cell (VIC) proliferation assay was performed with oxymetazoline hydrochloride. RESULTS: Brimonidine was highly selective for the α2 adrenergic receptors, specifically α2A, whereas oxymetazoline was found to be much less selective and was highly active against a wide range of targets. Negligible activity was observed with brimonidine at the 5-HT2B receptor, whereas oxymetazoline had significant 5-HT2B receptor agonist activity and caused proliferation of mitral VICs in vitro. CONCLUSION: As the 5-HT2B receptor is potentially involved in drug-induced valvulopathy, the benefit/risk ratio should be carefully considered, especially in patients with cardiovascular disease or other comorbidities.

Bioensaio , Tartarato de Brimonidina/efeitos adversos , Proliferação de Células/efeitos dos fármacos , Oximetazolina/efeitos adversos , Administração Tópica , Agonistas alfa-Adrenérgicos/administração & dosagem , Agonistas alfa-Adrenérgicos/efeitos adversos , Agonistas alfa-Adrenérgicos/farmacologia , Tartarato de Brimonidina/administração & dosagem , Tartarato de Brimonidina/farmacologia , Células Cultivadas , Valvas Cardíacas/efeitos dos fármacos , Humanos , Oximetazolina/administração & dosagem , Oximetazolina/farmacologia
J Drugs Dermatol ; 16(9): 909-916, 2017 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-28915286


BACKGROUND: There is currently a lack of data on the simultaneous treatment of different features of rosacea. Individually, ivermectin 1% (IVM) cream and brimonidine 0.33% (BR) gel have demonstrated efficacy on inflammatory lesions and persistent erythema, respectively. OBJECTIVE: To evaluate the efficacy, safety, patient satisfaction, and optimal timing of administration of IVM associated with BR (IVM+BR) versus their vehicles in rosacea (investigator global assessment [IGA] ≥3). METHODS: Multicenter, randomized, double-blind study including subjects with rosacea characterized by moderate to severe persistent erythema and inflammatory lesions. The active treatment group included the IVM+BR/12 weeks subgroup (once-daily BR and once-daily IVM for 12 weeks), and the IVM+BR/8 weeks subgroup (once-daily BR vehicle for 4 weeks followed by once-daily BR for the remaining 8 weeks and once-daily IVM for 12 weeks). The vehicle group received once-daily BR vehicle and once-daily IVM vehicle for 12 weeks. RESULTS: The association showed superior efficacy (IGA success [clear/almost clear]) for erythema and inflammatory lesions in the total active group (combined active subgroups) compared to vehicle (55.8% vs. 36.8%, P=0.007) at week 12. The success rate increased from 32.7% to 61.2% at hour 0 and hour 3, respectively, in the IVM+BR/12 weeks subgroup, and from 28.3% to 50% in the IVM+BR/8 weeks subgroup. Reductions in erythema and inflammatory lesion counts confirmed the additive effect of BR to IVM treatment. Subjects reported greater improvement in the active subgroups than in the vehicle group, and similar rates for facial appearance satisfaction after the first 4 weeks of treatment in both active subgroups. All groups showed similar tolerability profiles. CONCLUSION: Concomitant administration of IVM cream with BR gel demonstrated good efficacy and safety, endorsing the comprehensive approach to this complex disease. Early introduction of BR, along with a complete daily skin care regimen may accelerate treatment success without impairing tolerability.

J Drugs Dermatol. 2017;16(9):909-916.


Tartarato de Brimonidina/administração & dosagem , Fármacos Dermatológicos/administração & dosagem , Ivermectina/administração & dosagem , Rosácea/tratamento farmacológico , Administração Cutânea , Adulto , Idoso , Idoso de 80 Anos ou mais , Tartarato de Brimonidina/efeitos adversos , Fármacos Dermatológicos/efeitos adversos , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Géis , Humanos , Ivermectina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Creme para a Pele , Resultado do Tratamento , Adulto Jovem
Cornea ; 36(12): 1567-1569, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28938378


PURPOSE: The primary side effects associated with 0.1% brimonidine tartrate (BT) ophthalmic solution with sodium chlorite are allergic conjunctivitis, blepharitis, and conjunctival hyperemia. However, cornea-related side effects are rare. In this study, we report 2 similar cases in which corneal neovascularization, corneal infiltration, and corneal opacity developed after BT eye-drop use. METHODS: Retrospective report of 2 cases of corneal infiltration after BT eye-drop use. RESULTS: Case 1 involved a 78-year-old woman with follicular conjunctivitis, corneal neovascularization, and infiltration in her left eye after unilateral instillation of BT eye drops in that eye. Case 2 involved a 75-year-old woman with bilateral corneal neovascularization and infiltration after instillation of BT eye drops. In both cases, the corneal complications were deemed to be side effects of BT, so those eye drops were replaced with 0.1% fluorometholone eye drops. After replacement, blepharitis and corneal neovascularization successfully resolved; however, a layer of opacity remained across the transparent layer of the cornea in both cases. CONCLUSIONS: We encountered 2 cases of corneal and conjunctival complications that developed as side effects after BT eye-drop use, thus indicating that strict attention should be paid to the possibility of side effects after initiation of antiglaucoma eye-drop use.

Anti-Hipertensivos/efeitos adversos , Tartarato de Brimonidina/efeitos adversos , Conjuntivite/induzido quimicamente , Neovascularização da Córnea/induzido quimicamente , Soluções Oftálmicas/efeitos adversos , Idoso , Feminino , Glaucoma/tratamento farmacológico , Humanos
Expert Opin Drug Saf ; 16(9): 1071-1078, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28656780


INTRODUCTION: Brimonidine tartrate and brinzolamide eye drops are often used as third and fourth line treatment options to reduce intraocular pressure (IOP) in the management of glaucoma and ocular hypertension. Better tolerated, more effective topical agents requiring once daily instillation including prostaglandin analogues and beta-blockers usually are preferred as initial therapy, unless there are contraindications. Brimonidine and brinzolamide are often required owing to progressive glaucoma or intolerances to or ineffectiveness of front-line agents. Areas covered: We review the safety of formulations containing brimonidine tartrate and/or brinzolamide. Safety considerations for these agents in higher risk populations are highlighted. Expert opinion: Each class of ocular hypotensive eye drop has a unique set of possible side effects. Brimonidine might have neuro-protective capabilities and offer reasonable IOP control, but its use is limited by a relatively high rate of ocular allergy, hyperemia and discomfort. Brinzolamide is generally well tolerated, but often lacks efficacy. The introduction of brimonidine/brinzolamide fixed combination suspension improves adherence (by simplifying the medical regimen) and reduces preservative load on the ocular surface. New drug delivery systems incorporating brimonidine and brinzolamide are in development and promise to improve the safety profiles of both drugs.

Tartarato de Brimonidina/efeitos adversos , Glaucoma , Sulfonamidas/efeitos adversos , Tiazinas/efeitos adversos , Administração Oftálmica , Animais , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/efeitos adversos , Tartarato de Brimonidina/administração & dosagem , Inibidores da Anidrase Carbônica/administração & dosagem , Inibidores da Anidrase Carbônica/efeitos adversos , Sistemas de Liberação de Medicamentos , Glaucoma/tratamento farmacológico , Humanos , Hipertensão Ocular/tratamento farmacológico , Sulfonamidas/administração & dosagem , Tiazinas/administração & dosagem
Adv Ther ; 34(6): 1438-1448, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28508306


INTRODUCTION: This study compared the efficacy and safety of adjunctive brimonidine tartrate 0.1% ophthalmic solution (brimonidine) and timolol maleate 0.5% ophthalmic solution (timolol) in prostaglandin analogue (PGA)-treated normal-tension glaucoma (NTG), assessing the non-inferiority of brimonidine in terms of intraocular pressure (IOP) reduction. METHODS: In this multicenter, randomized, investigator-masked, parallel-group, clinical study, adjunctive brimonidine or timolol was administered twice daily for 12 weeks in eyes with NTG that had been treated with PGA for at least 90 days and required additional treatment despite an IOP of 16 mmHg or less. IOP was measured on at least three visits before add-on therapy (mean baseline IOP), and at weeks 4, 8, and 12 after adjunctive administration. Systolic/diastolic blood pressure, pulse rate, and adverse events (AEs) were recorded at each visit. RESULTS: A total of 152 individuals were enrolled and 128 (84.2%) were eligible for efficacy analyses. IOP in both groups at each visit decreased significantly from baseline (P < 0.001). However, the difference in the change from baseline IOP at week 12 between the brimonidine (-1.05 ± 1.81 mmHg) and timolol (-1.41 ± 1.40 mmHg) groups was 0.36 mmHg (95% confidence interval [CI] [-0.21, 0.92]), which exceeded the value of the non-inferiority margin (0.75 mmHg). Baseline systolic/diastolic blood pressure decreased significantly in both groups at certain visits (P < 0.05), while baseline pulse rates decreased significantly in the timolol group (P < 0.001), with no significant differences in the brimonidine group. AE-related treatment discontinuation occurred in 2/71 (2.8%) and 2/75 (2.7%) patients in the brimonidine and timolol groups, respectively. CONCLUSION: This study demonstrated an add-on effect of brimonidine to PGAs, although non-inferiority of brimonidine to timolol as adjunctive therapy in PGA-treated NTG in terms of IOP reduction was not observed. Brimonidine was associated with no adverse effects on pulse rate. FUNDING: Senju Pharmaceutical Co., Ltd. TRIAL REGISTRATION: UMIN Clinical Trials Registry identifier, UMIN000014810.

Anti-Hipertensivos/uso terapêutico , Tartarato de Brimonidina/uso terapêutico , Glaucoma de Baixa Tensão/tratamento farmacológico , Prostaglandinas Sintéticas/uso terapêutico , Timolol/uso terapêutico , Idoso , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/efeitos adversos , Tartarato de Brimonidina/administração & dosagem , Tartarato de Brimonidina/efeitos adversos , Feminino , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas/administração & dosagem , Prostaglandinas Sintéticas/administração & dosagem , Prostaglandinas Sintéticas/efeitos adversos , Método Simples-Cego , Timolol/administração & dosagem , Timolol/efeitos adversos
JAMA Dermatol ; 153(6): 575-577, 2017 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-28403392


Importance: Minor bleeding is the most common complication of dermatologic surgery. Topical brimonidine, 0.33%, gel has been reported for the use of hemostasis in dermatologic surgery. The safety profile and risk of systemic toxic effects when brimonidine is used topically for hemostasis is unknown. Objective: To determine the risk of systemic toxic effects of topical brimonidine, 0.33%, gel when used for hemostasis. Design, Setting, and Participants: In this case series from a private practice (Hollywood Dermatology), 2 patients presented for dermatologic procedures, complicated by persistent bleeding. Interventions: Patients were treated with 10 g of brimonidine, 0.33%, gel applied under occlusion for hemostasis. Main Outcomes and Measures: Mental status, cardiopulmonary function. Results: Both patients experienced deterioration of mental status, respiratory depression, and somnolence. Results from cardiac testing, laboratory workup, and imaging were negative for cardiac or neurologic etiology. Both patients improved in less than 24 hours. Conclusions and Relevance: Topical brimonidine, 0.33%, gel can result in systemic central nervous system toxic effects when used as a hemostatic agent. At present, it is not possible to define a quantity with which brimonidine can be used safely, nor can a safe wound size be defined. We, therefore, urge against the use of topical brimonidine as a hemostatic agent until its safety is further investigated.

Tartarato de Brimonidina/efeitos adversos , Hemostáticos/efeitos adversos , Transtornos Mentais/induzido quimicamente , Administração Cutânea , Idoso , Idoso de 80 Anos ou mais , Tartarato de Brimonidina/administração & dosagem , Distúrbios do Sono por Sonolência Excessiva/induzido quimicamente , Géis , Hemostáticos/administração & dosagem , Humanos , Masculino , Insuficiência Respiratória/induzido quimicamente