Bradycardia, hypotension and dizziness have been reported after application of brimonidine gel (Mirvaso) in patients with rosacea, in some cases requiring hospitalisation.
Brimonidine, used for the symptomatic treatment of facial erythema of rosacea in adults, is an α2 adrenergic agonist. The reports of cardiovascular reactions, identified in a routine European review, were consistent with systemic α2 adrenergic effects.
In approximately 30% of the cases most strongly suggestive of a cardiovascular effect, the reactions occurred when brimonidine gel was applied after laser therapy to the skin, which may have caused increased absorption of the gel.
Prescribers should warn patients not to apply brimonidine gel to irritated or damaged skin, including after laser therapy.
Dizziness is known to be an uncommon adverse effect of brimonidine gel, and hypotension and bradycardia are known to occur rarely.