[Treatment of glaucoma with brimonidine (Alphagan 0.2%)]

The main purpose of our study was to assess the systemic safety of brimonidine tartrate 0.2%, an alpha 2 highly selective agonist in patients with glaucoma or ocular hypertension

Brimonidine was administered alone or in combination in 128 patients suffering from glaucoma or ocular hypertension in order to improve 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 systemic tolerance to brimonidine.

The average age of our patients was 65.2 +/- 13.8 years and the mean follow up was 4.5 +/- 3.4 months. Brimondine was administered in monotherapy in 15 patients (7.8%) and in combination with another drug in the others (92.2%), the combination with a beta-blocking agent being the most frequent combination. 113 among the 128 patients suffered from POAG. 51.6% of patients described systemic side effects at various degrees (drowsiness, fatigue, 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 systemic concurrent treatment with drugs potentially acting with the noradrenergic transmission (monoamine oxydase inhibitors, tricyclic antidepressants, mianserine, alpha-sympatholytics.). Brimonidine was interrupted in 82 patients (64.1%) secondary to a systemic intolerance in 21 patients, an allergic blepharo-conjunctivitis in 12 patients, and a non optimal IOP reduction in 42 patients. Considering the all patients and treatments, IOP dropped from 20.5 +/- 3.6mmHg 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 achieved with the previous association.

Our medium-term results have shown that brimonidine was an efficient ocular hypotensive agent and had a satisfactory ocular tolerance in nearly all the patients. However, its systemic tolerance appeared to be less favourable than previously reported. A systematic eyelid closure and punctal occlusion following each instillation is advisable in older patients.