Combination Of Brimonidine Research Articles

Fabrication and efficacy assessment of combination of brimonidine and ivermectin for treatment of papulopustular rosacea.

Rosacea is a chronic inflammatory, multifactorial disease for which combination therapy could be an effective treatment. In this study, we evaluate the effect of the combination therapy of brimonidine 0.33% and ivermectin 1% as a single cream for the treatment of papulopustular rosacea. A stable and appropriate formulation was prepared by adding the aqueous phase to the lipid phase while being stirred. The stability and physicochemical properties of the formulation were evaluated under accelerated conditions. Twelve patients (36-60 years) with mild to moderate papulopustular rosacea and a Demodex count of five or more were treated with the combination of brimonidine 0.33% and ivermectin 1% cream. Clinician's Erythema Assessment (CEA), Patients Self-Assessment (PSA), skin erythema (ΔE) and lightness (ΔL), and skin biophysical parameters including transepidermal water loss (TEWL), skin hydration, pH, and sebum content, as well as erythema and melanin index and ultrasound parameters, were measured before treatment and 4 and 8 weeks after. Adverse drug reactions were also recorded. CEA and PSA decreased significantly from 3 to 2 after 8 weeks, respectively (p-value = 0.014 for CEA and 0.010 for PSA). ΔE and ΔL, as well as skin erythema index and TEWL improved after 8 weeks of treatment (p < 0.05). Two patients withdrew from the study in the first week because of local adverse effects; one developed flushing following treatment and left the investigation after 4 weeks and another patient withdrew from the study after 4 weeks due to deciding to become pregnant. Eight-week treatment with the combination of brimonidine 0.33% and ivermectin 1% was shown to be effective for improvement of erythema and inflammatory lesions in mild to moderate papulopustular rosacea.

DRUG UTILIZATION AND PRESCRIBING PATTERN OF GLAUCOMA IN A TERTIARY CARE HOSPITAL OF DEHRADUN

Glaucoma is a condition in which distinctive changes occur in the optic nerve and visual field. In glaucoma intraocular pressure (IOP) is raised that compresses and damages the optic nerve. As the optic nerve is damaged, it fails to carry the visual information to the brain which induce clinically progressive loss of peripheral visual field and ultimately loss of vision. AIMS AND OBJECTIVES: To Evaluate the drug utilization and prescribing pattern of drugs used for treatment of glaucoma, to analyze current prescribing trends in anti-glaucoma drugs, to perform a drug utilization study, to identify drugs per prescription, category wise identification of drugs prescribed, mono therapy vs combination therapy. MATERIALS AND METHODS: The present study was a prospective, observational study carried out in 105 patients at Shri Mahant Indiresh Hospital, Dehradun, Uttarakhand, India. RESULTS: Out of total 105 patients, 68 were males (64.76%) and 37 were females (35.24%). The most common age group was 46-60 years. Patients were mostly affected by primary open angle glaucoma (95.23%) then angle closer glaucoma (4.76%). Total 184 drugs were prescribed in the treatment of glaucoma. Average number of drugs per prescription was 1.75. Combination therapy was prescribed in 51.43% patients &amp; most common used combination therapy was combination of Brimonidine+ timolol (81.48%) followed by Bimatoprost+ timolol (18.52%). Monotherapy was used in 48.57% patients in which drug dorzolamide (22.31%) was prescribed mostly which is belongs to the category of carbonic anhydrase inhibitors followed by timolol (19.23%) (β- blockers) which was second line choice of drug. Generic drugs were mostly prescribed in 77 patients (73.33%) followed by 28 patients (26.66%) were brand names. CONCLUSION: The prescription analysis of glaucoma patients concluded that monotherapy with dorzolamide was the first line choice for glaucoma therapy and timolol was found to be the second line choice. Timolol+ brimonidine was the mostly prescribed combination of drug. It also showed that all drugs were prescribed in their generic name instead of brand name.

Effects of the Glaucoma Drugs Latanoprost and Brimonidine on Corneal Temperature.

PurposeThe aim of this study was to investigate the effects of the glaucoma drugs latanoprost, brimonidine, and the combination of both on the central corneal temperature (CT) of healthy subjects by means of infrared thermography. Changes of the central CT may reflect changes of ocular blood flow.MethodsBefore application and during 2 hours after the application of latanoprost, brimonidine, or the combination of both in one eye, the CT in both eyes of 40 healthy subjects was measured repeatedly.ResultsBrimonidine reduced CT by approximately 0.5°C. This effect was statistically significant (P < 0.0001). Latanoprost, however, had a very small and insignificant influence (P = 0.47). Accordingly, the combination of brimonidine and latanoprost also reduced CT up to 0.5°C, and this effect was statistically significant (P < 0.0001).ConclusionsBrimonidine, but not latanoprost, had a significant effect on central CT. This cooling effect of brimonidine is most probably due to a drug-induced reduction of blood circulation in the ciliary body and iris and to a certain extent also to a reduction of blood flow in the fundus of the eye.Translational RelevanceThis study shows evidence that thermography of the cornea provides indirect information on the influence of drugs on the blood flow to the anterior segment of the patient's eye.

Safety and Efficacy for the combination of Brimonidine and Timolol in patients for the treatment of Glaucoma

Safety and Efficacy for the combination of Brimonidine and Timolol in patients for the treatment of Glaucoma

Topical Brimonidine as an Effective Adjuvant to Local Anesthetics for Post Treatment Erythema and Pain Reduction.

BackgroundThere are few pharmacologic options to reduce laser-associated post treatment erythema and to extend topical anesthesia duration. To improve the tolerability of painful laser treatment, dermatologists should encourage development of a novel adjuvant agent to topical lidocaine cream.ObjectiveTo report the efficacy and safety of a combination of topical brimonidine and anesthetic cream as an aid for post treatment erythema and pain.MethodsA total of 15 Korean subjects were randomized to receive a split-face application of a mixture of brimonidine and anesthetics on one side and only anesthetics on the other side of the face for anesthesia. After non-ablative fractional full-face skin resurfacing, Clinician's Erythema Assessment, erythema index, and visual analogue scale were assessed at four time points: immediately after resurfacing, 30 minutes after, 60 minutes after, and 1 day after.ResultsA combination of brimonidine and anesthetics significantly lowered post treatment erythema until 60 minutes after the laser procedure. Furthermore, patients reported significantly lower post-procedural pain from the side of their face that received the mixture of anesthetics and brimonidine than they did for the side that only received anesthetics.ConclusionTopical brimonidine can be used as an effective adjuvant agent to lidocaine-based topical anesthetics.

Treatment of patients with primary open-angle glaucoma with a fixed combination of brimonidine 0.2%/timolol 0.5%: multicenter, open-label, observational study in Germany

ABSTRACTObjective: At the introduction of the fixed-combination of brimonidine/timolol in Germany in 2006, a non-interventional, multicenter, observational, open-label study was initiated to evaluate efficacy, tolerability, and safety of this preparation in a broad patient population.Methods: The study population comprised patients with bilateral primary open-angle glaucoma or ocular hypertension with insufficient intraocular pressure (IOP) control who participating physicians determined required a change of medication, and who switched to exclusive use of the new fixed-combination brimonidine 0.2%/timolol 0.5%. Patient demographics and information on specific risk factors were collected. IOP readings were recorded for each eye at treated baseline (previous therapy), 4 to 6 weeks, and 12 weeks after changing to twice-daily brimonidine/timolol. Tolerability was measured using a four-step scale ranging from excellent to poor. All adverse events were recorded.Results: Mean treated baseline IOP (±SD) for all patients (N = 861) was 20.8 ± 3.5 mmHg. Five hundred sixty-five patients switched from monotherapy, 138 patients switched from other fixed combinations, and 158 patients had been using non-fixed combinations of up to four different active agents. The brimonidine/timolol fixed combination provided an additional IOP decrease in most pretreatment subgroups, with an overall reduction to 16.9 ± 2.6 mmHg after 4 to 6 weeks and to 16.5 ± 2.7 mmHg after 12 weeks. Both of these values were significantly lower than baseline IOP (p < 0.001). A target pressure of <18 mmHg was achieved in 79.5% of all eyes at week 12. Tolerability of fixed-combination brimonidine/timolol was rated excellent or good by the physicians for 97.1% of patients, and by 93.4% of the patients themselves. Few adverse events occurred during the treatment period.Conclusions: Although this study was limited by its observational design, our results show that the fixed combination of brimonidine 0.2%/timolol 0.5% was effective, well tolerated, and safe in a broad POAG patient population.

A European Perspective on Costs and Cost Effectiveness of Ophthalmic Combinations in the Treatment of Open-Angle Glaucoma

Efficacy, safety, and cost implications are important considerations when choosing an ophthalmic treatment. Fixed-combination glaucoma medications containing brimonidine 0.2% and timolol 0.5%, or dorzolamide 2% and timolol 0.5%, were compared with brimonidine 0.2% and dorzolamide 2% that were used as adjunctive therapy to timolol 0.5%. A literature review was conducted to determine the outcome parameters of intraocular pressure reduction and tolerability after 3 months of use of brimonidine or dorzolamide, each together with timolol as a fixed-combination or in concomitant therapy. Modelled cost-minimization and cost-effectiveness analyses were performed to investigate the economic consequences of ophthalmic therapy with brimonidine, dorzolamide, and timolol from a societal perspective. The literature review found that brimonidine and dorzolamide used as fixed combinations with timolol as well as in adjunctive therapy to timolol were equally effective and safe. Furthermore, in the European countries studied, the fixed combination of brimonidine/timolol represented a less costly option when compared to the fixed combination of dorzolamide/timolol evaluated over both a 3-month and a 12-month horizon. Brimonidine used as a fixed-combination therapy with timolol provided better cost value than dorzolamide/timolol in all the countries studied. For most countries, the fixed combination of brimonidine and timolol also provided better cost value than adjunctive therapy with brimonidine, which was more cost effective than adjunctive therapy with dorzolamide.

12-week study comparing the fixed combination of brimonidine and timolol with concomitant use of the individual components in patients with glaucoma and ocular hypertension.

To evaluate the efficacy and safety of fixed-combination brimonidine tartrate 0.2%/timolol 0.5% ophthalmic solution dosed BID and demonstrate non-inferiority to concomitant use of brimonidine tartrate 0.2% BID and timolol 0.5% BID in glaucoma and ocular hypertension patients with intraocular pressure (IOP) uncontrolled on monotherapy. Randomized, multicenter, double-masked, parallel-group study involving 371 patients with inadequate IOP control (IOP from 22 to 34 mmHg) after >=3 weeks of run-in on any monotherapy. Patients were treated with fixed-combination brimonidine/timolol BID (fixed-combination group, n=188) or concomitant brimonidine BID and timolol BID (concomitant group, n=183). IOP was assessed pre-dose and 2 hours after morning dosing at weeks 2, 6, and 12. A total of 355 patients (96%) completed the study. Patient demographics, run-in monotherapy, and baseline mean IOP on monotherapy were comparable between treatment groups. During follow-up, the mean reduction from baseline IOP was significant (p<0.001) at all time points and ranged from 4.4 to 5.3 mmHg in each group. Brimonidine/timolol fixed combination was as effective as concomitant therapy with respect to mean IOP and mean change from baseline IOP at all time points and visits. Between-group differences were <=0.35 mmHg for mean IOP and <=0.30 mmHg for mean change from baseline IOP; none were significant. No unexpected side effects were associated with the fixed combination. Both treatments were well tolerated with no difference in adverse events between groups. Brimonidine/timolol fixed-combination therapy is as safe and effective as concomitant treatment with the individual components. Its simplified dosing regimen has the potential to improve compliance. (Eur J Ophthalmol 2005; 15: 581-90).

The Short-Term Effect of Adding Brimonidine 0.2% to Timolol Treatment in Patients with Open-Angle Glaucoma

Brimonidine, a highly selective α₂-adrenoceptor agonist, was studied to determine its ocular hypotensive effect and side effects in patients with elevated intraocular pressure (IOP) while on continuing therapy with timolol. This was a prospective, randomized, placebo-controlled study in 15 patients with primary open-angle or pseudoexfoliation glaucoma on therapy receiving timolol 0.5% twice daily, with IOP greater than or equal to 22 mm Hg in one eye. IOP measurements, blood pressure and pulse rate were assessed on 2 days at a baseline and 1, 2, 4, 6 and 8 h later. A single drop of brimonidine 0.2% or placebo was added to treatment with timolol. The reductions in IOP at all time intervals observed with brimonidine + timolol were significantly greater than those with timolol + placebo. The maximum mean net decrease in IOP was 19.23 ± 10.60% at 4 h. Statistically significant decreases in systemic blood pressure and pulse rate without clinical symptoms were observed in the group receiving brimonidine + timolol. This study suggests that a combination of brimonidine and timolol may have potential in the treatment of glaucoma. Further clinical trials with brimonidine are indicated to assess its further role as adjunctive agent.