Start brimonidine gel at low dose in rosacea, cautions MHRA

Treatment with the topical rosacea treatment brimonidine (Mirvaso) should be started at a low dose and increased gradually to reduce the risk of exacerbating the condition, the MHRA has advised.

In most cases, exacerbation of erythema and flushing resolves after stopping treatment with brimonidine gel. | SCIENCE PHOTO LIBRARY
In most cases, exacerbation of erythema and flushing resolves after stopping treatment with brimonidine gel. | SCIENCE PHOTO LIBRARY

Symptom exacerbation is a very common side-effect of treatment with brimonidine gel, affecting 16% of rosacea patients in clinical studies of the drug.

Exacerbation may occur soon after the gel is applied or as a rebound in symptoms after the therapeutic effect wears off, approximately 8–12 hours after application. In most cases, the symptoms of erythema and flushing resolve after stopping treatment.

The mechanism of exacerbation is currently unknown.

Reduce starting dose

To minimise the risk of exacerbation, prescribers should advise patients to initiate treatment with a small amount of gel for at least 1 week and increase the dose gradually, based on tolerability and response to treatment. The initial dose should be less than the recommended maximum daily dose of 1g (equivalent to 5 roughly pea-sized amounts applied to the forehead, chin, nose and each cheek).

Patients should be carefully advised how to apply the gel and counselled on the importance of not exceeding the maximum daily dose. If patients experience increased redness or burning during treatment, they should stop using the gel and consult their prescriber.

Launched in 2014 as a rosacea treatment, brimonidine is an alpha2 agonist that directly reduces the erythema of rosacea by causing cutaneous vasoconstriction.

Want news like this straight to your inbox?
Sign up for our bulletins

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Already registered?
Sign in

Register or Subscribe to MIMS

GPs can get MIMS print & online and GPonline for free when they register online – take 2 minutes, and make sure you get your free MIMS access! If you're not a GP, you can subscribe to MIMS for full access.

Register or subscribe

MIMS bulletins

News and updates straight to your inbox.

Prescribing Update: Fortnightly news bulletin
Urgent prescribing updates
Spotlight: Disease-themed monthly round-up

Sign me up

MIMS Dermatology

Read the latest issue online exclusively on MIMS Learning.

Read MIMS Dermatology

MIMS Adviser

Especially created for prescribing influencers.

Request free copy

Mobile apps

MIMS: access the full drug database and quick-reference tables on the go

MIMS Diagnosis and Management: concise information on signs and symptoms, investigations and diseases