Brimonidine topical gel, 0.33% (Mirvaso; Galderma Laboratories LP), is used for the treatment of facial erythema (rosacea) in adults. Brimonidine is an alpha-2 adrenergic agonist that works by causing local vasoconstriction of capillaries in the skin. However, doses or overdoses that are systemically absorbed may cause central alpha-2 agonism, leading to central nervous system depression, bradycardia, and hypotension. Toxic effects from therapeutic doses of optic formulations of brimonidine have been reported,1,2 but reports of dermal product exposures are rare. We report a case of poisoning from the accidental exposure to brimonidine topical gel.
Montague AJ, Bangh S, Cole JB. Bradycardia in a Child After Using Brimonidine as Toothpaste. JAMA Dermatol. Published online March 15, 2017. doi:10.1001/jamadermatol.2016.6215