Experience with topical brimonidine (Alphagan (R) 0,2%) in the treatment of glaucomas

Purpose: The main purpose of our study was to assess the systemic safety of brimonidine tartrate 0.2 %, an alpha 2 highly selective agonist in patient s with glaucoma or ocular hypertension Material-Methods: Brimonidine was administered alone or in combination in 1 28 patients suffering from glaucoma or ocular hypertension in order to impr ove the IOP effect and/or to replace a drug which prescription was limited due to its secondary effects. in addition to the standard follow up and IOP reduction evaluation, our study was focused on the appreciation of the sys temic tolerance to brimonidine. Results: The average age of our patients was 65.2 +/- 13.8 years and the me an follow up was 4.5 +/- 3.4 months. Brimondine was administered in monothe rapy in 15 patients (7.8%) and in combination with another drug in the othe rs (92.2%), the combination with a beta-blocking agent being the most frequ ent combination. 113 among the 128 patients suffered from POAG. 51.6% of pa tients described systemic side effects at various degrees (drowsiness. fati gue, general uneasiness, mouth dryness...). All these systemic side effects were significantly more frequent in patients older than 60 years (p < 0.05 ). They did not seem to be influenced by an intercurrent illness or a syste mic concurrent treatment with drugs potentially acting with the noradrenerg ic transmission (monoamine oxydase inhibitors, tricyclic antidepressants, m ianserine, alpha-sympatholytics...). Brimonidine was interrupted in 82 patients (64.1%) secondary to a systemic intolerance in 21 patients, an allergic blepharo-conjunctivitis in 12 patie nts, and a non optimal IOP reduction in 42 patients. Considering the all patients and treatments, IOP dropped from 20.5 +/- 3.6m mHg to 19.8 +/- 4.6mmHg at the last examination (p < 0.05). in bitherapies, the observed IOP reduction was not significantly different from the one ac hieved with the previous association. Conclusion: Our medium-term results have shown that brimonidine was an effi cient ocular hypotensive agent and had a satisfactory ocular tolerance in n early all the patients. However, its systemic tolerance appeared to be less favourable than previously reported. A systematic eyelid closure and punct al occlusion following each instillation is advisable in older patients.