Mao Inhibitors
Contraindicated
Database
Risk of hypertensive crisis and CNS effects; brimonidine is an alpha-2 agonist.
Contraindicated. Wait 14 days after MAOI discontinuation before starting brimonidine.
Source: Kimi deep-research + Cla
Drug reference
Brimonidine
Selective alpha-2 adrenergic receptor agonist · Antiglaucoma agent
Also known as Brimonidine Tartrate, Alphagan P
START
Baseline IOP measurement. Verify no MAO inhibitor use. Counsel on proper instillation technique (punctal occlusion to reduce systemic absorption).
TYPICAL MAX
0.2% BID. No additional benefit with higher concentration or more frequent dosing.
STOP IF
Severe hypersensitivity, severe hypotension, syncope, severe CNS depression, intolerable ocular side effects.
WATCH
IOP every 4-6 weeks initially. Tachyphylaxis (loss of effect) can occur after months of use. Systemic alpha-2 effects (dry mouth, drowsiness, hypotension)—more common in elderly. Do not use in infants due to CNS depression risk.
CDSCO approvedSchedule HJan AushadhiATC S01EA05
KDIGO 2024 + manufacturer label
- ONSET
- 1h · IOP reduction 1 hour
- PEAK
- 2.5h · Peak IOP reduction 2-3 hours
- t½
- 3h · Systemic t½ ~3 hours
- DURATION
- 12h · 12 hours (BID)
EXCRETION
Renal as metabolites (~75%)
route + CYP
INTERACTIONS
1 major
incl. contraindicated
PREGNANCY
Limited data; minimal systemic absorption with ophthalmic use. Use only if benefit outweighs risk.
FDA category + note
Top interactions
- Mao InhibitorsContraindicatedDatabaseKimi deep-research + Cla
Available in India
33 branded formulations and 67 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Jan Aushadhi — generic available at GoI pharmacies
Mechanism
Selective alpha-2 adrenergic agonism reduces aqueous humor production and increases uveoscleral outflow, lowering intraocular pressure. More selective than apraclonidine (less alpha-1 effect = fewer allergic reactions).
Indications
Open-angle glaucomaOcular hypertensionRosacea (topical gel—Mirvaso)Facial erythema of rosacea
Dosing
- Adult
- Ophthalmic: 1 drop of 0.1-0.2% solution in affected eye(s) BID (approximately 12 hours apart). Rosacea: Apply thin layer of 0.33% gel to affected facial areas once daily.
- Pediatric
- ≥2 years (glaucoma): same as adult dosing. <2 years: contraindicated.
- Renal adjustment
- No adjustment (topical/minimal systemic absorption).
- Hepatic adjustment
- Use caution; hepatic impairment may increase systemic levels.
- Geriatric
- No specific adjustment; increased risk of CNS depression and hypotension.
- Max dose
- 1 drop 0.2% BID per eye
Pharmacokinetics
Onset
IOP reduction within 1 hour
Peak effect
Tmax 2-3 hours; peak IOP reduction at 2-3 hours
Duration
12 hours (BID dosing)
Half-life
~3 hours (systemic)
Bioavailability
Ophthalmic: minimal systemic absorption (~1-4% reaches systemic circulation)
Protein binding
~29%
Metabolism
Hepatic via CYP2D6 and aldehyde oxidase
Excretion
~75% renal (metabolites); ~16% fecal
Contraindications
- Hypersensitivity to brimonidine or apraclonidine
- Concomitant MAO inhibitor therapy
- Neonates and infants (risk of CNS depression, apnea, hypotension)
- Severe cardiovascular disease
Side effects
Common
Ocular hyperemia (conjunctival redness)Dry mouthBurning/stinging sensationForeign body sensationFatigue / drowsiness (CNS penetration)HeadacheBlurred vision
Serious
- Severe hypotension / syncope
- Bradycardia
- CNS depression (somnolence, apnea in infants)
- Severe allergic conjunctivitis
- Macular edema (aphakic patients)
- Depression
Pregnancy & lactation
Pregnancy
Limited data; minimal systemic absorption with ophthalmic use. Use only if benefit outweighs risk.
Lactation
Excretion in breast milk unknown; minimal systemic absorption suggests low risk. Monitor infant for sedation and dry mouth.
Drug interactions
11 additional low-confidence interactions hidden — those rows lack a documented mechanism or management plan in our sources.
Related guidelines
Ask House about Brimonidine
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19