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Medicine overview
Indications of Bricoma
Bricoma is a selective alpha-2 adrenergic agonist used in two distinct formulations for different, FDA-approved indications:
Established/FDA-approved uses
- Ophthalmic solution (0.15%/0.2%): Lowering of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension.
- Topical gel (0.33%): Treatment of persistent (non-transient) facial erythema associated with rosacea in adults.
Adjunct use
Bricoma ophthalmic solution is commonly used as an adjunct to other IOP-lowering agents (e.g. beta-blockers, prostaglandin analogues) when a single agent does not achieve adequate pressure control, and is available in fixed-dose combination products with timolol or brimonidine/brinzolamide for this purpose.
Off-label use
Bricoma ophthalmic solution is sometimes used off-label short-term to reduce conjunctival hyperemia (redness) prior to certain ophthalmic procedures, but this is not an FDA-labeled indication.
Composition
Each formulation of Brimonidine Tartrate is available as: ophthalmic solution containing Brimonidine Tartrate 0.15% or 0.2% w/v (with benzalkonium chloride or purite as preservative in most branded products), and as a topical gel containing Brimonidine Tartrate 0.33% w/w for dermatologic use.
Description
Bricoma is a highly selective alpha-2 adrenergic receptor agonist. In ophthalmic use it reduces intraocular pressure by decreasing aqueous humor production and increasing uveoscleral outflow. In dermatologic use, its alpha-2 agonist activity produces direct vasoconstriction of dilated facial blood vessels, temporarily reducing the visible redness (erythema) associated with rosacea.
Bricoma is not a cure for glaucoma or rosacea; it manages the underlying pressure or visible redness and requires continued, regular use as directed by a physician.
Therapeutic Class
Alpha-2 adrenergic receptor agonist; anti-glaucoma agent (ophthalmic) and topical vasoconstrictor for rosacea-associated erythema (dermatologic). Bricoma belongs to this pharmacologic class.
Pharmacology
Brimonidine Tartrate is a relatively selective alpha-2 adrenoceptor agonist with minimal effect on cardiovascular and pulmonary parameters at recommended doses.
Ophthalmic mechanism
Stimulation of alpha-2 receptors in the ciliary body reduces aqueous humor formation, and stimulation of receptors involved in uveoscleral drainage increases outflow, both lowering intraocular pressure. Onset of IOP reduction occurs within about 1 hour, with peak effect at 2 hours.
Dermatologic mechanism
Topical alpha-2 agonism on dermal vascular smooth muscle produces direct vasoconstriction of dilated cutaneous vessels, reducing visible erythema; effect typically begins within 30 minutes and lasts up to 12 hours.
Dosage & Administration of Bricoma
Ophthalmic solution (glaucoma/ocular hypertension)
| Population | Dose |
|---|---|
| Adults | One drop of Bricoma ophthalmic solution in the affected eye(s) three times daily, approximately every 8 hours. |
| Children ≥2 years | Same dosing as adults, with caution (see Use in Special Populations); not recommended under 2 years. |
Topical gel (rosacea erythema)
Apply a pea-sized amount of Bricoma gel once daily in a thin layer to cover the entire face (forehead, chin, nose, each cheek), avoiding eyes, lips, and mucous membranes. Wash hands immediately after application.
Missed dose
Apply or instill the missed dose as soon as remembered; if near the next scheduled dose, skip the missed dose and resume the regular schedule. Do not double the dose.
Administration of Bricoma
Ophthalmic solution is instilled directly into the conjunctival sac of the affected eye(s); if using other ophthalmic products, space administration at least 5-10 minutes apart. Topical gel is applied thinly and evenly to clean, dry facial skin once daily; do not apply to broken or irritated skin, and avoid contact with eyes and mucous membranes.
Interaction of Bricoma
Bricoma has the following well-established, clinically significant interactions:
- Monoamine oxidase inhibitors (MAOIs): Concurrent use is contraindicated; MAOIs may interfere with the metabolism of Bricoma and increase systemic adrenergic effects.
- CNS depressants (alcohol, barbiturates, opioids, sedatives, anesthetics): May cause additive sedation and CNS depression with Bricoma.
- Antihypertensive agents and cardiac glycosides: Bricoma may have an additive or potentiating effect on blood pressure lowering and heart rate reduction.
- Tricyclic antidepressants: May blunt the systemic hypotensive effect of alpha-2 agonists like Bricoma and theoretically affect its ocular pressure-lowering response; use with caution.
Contraindications
Brimonidine Tartrate is contraindicated in:
- Patients with known hypersensitivity to brimonidine or any component of the formulation.
- Neonates and infants (children under 2 years of age), due to reports of serious CNS depression (apnea, bradycardia, hypotension, hypothermia, syncope, and lethargy) with Brimonidine Tartrate in this age group.
- Patients currently receiving monoamine oxidase inhibitor (MAOI) therapy.
Side Effects of Bricoma
Ophthalmic solution
Common: ocular hyperemia (redness), burning or stinging on instillation, blurred vision, foreign body sensation, itching, dry mouth, headache, drowsiness, and allergic conjunctivitis. Less common: eye allergy, eyelid swelling, and (rarely) systemic effects such as fatigue or dizziness.
Topical gel
Common: erythema, flushing, skin irritation, burning or stinging sensation, contact dermatitis, and pruritus at the application site.
Most reactions to Bricoma are mild to moderate and localized; patients should report severe or persistent reactions to their physician.
Pregnancy & Lactation
Bricoma has not been adequately studied in pregnant women. Animal reproduction studies have not shown clear evidence of fetal harm, but human data are limited. Bricoma should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus; consult a physician before use.
It is not known whether Bricoma is excreted in human breast milk. Because many drugs are excreted in breast milk and systemic absorption can occur (particularly with ophthalmic use in infants), caution is advised and a physician should be consulted before using Bricoma while breastfeeding.
Precautions & Warnings
Bricoma should be used with caution in patients with:
- Severe or unstable cardiovascular disease.
- Depression, cerebral or coronary insufficiency, Raynaud's phenomenon, orthostatic hypotension, or thromboangiitis obliterans.
- Renal or hepatic impairment (limited data on systemic accumulation).
Bricoma ophthalmic solution may cause drowsiness or blurred vision; patients should use caution when driving or operating machinery. Contact lenses should be removed before instillation and may be reinserted 15 minutes later. Keep the container tightly closed and avoid contaminating the tip. For the topical gel, avoid application to broken, irritated, or eczematous skin, and avoid contact with eyes and mucous membranes. Rebound erythema may occasionally occur after discontinuing the gel. See Contraindications for absolute restrictions and Use in Special Populations for pediatric risk.
Overdose Effects of Bricoma
Accidental ingestion of Bricoma (ophthalmic solution or gel), particularly by young children, can cause serious CNS depression, including drowsiness, lethargy, hypotonia, bradycardia, hypothermia, and respiratory depression, and can be life-threatening. Adults may experience hypotension, bradycardia, and drowsiness with significant overdose. If overdose or accidental ingestion of Bricoma is suspected, seek immediate medical attention or contact a poison control center/emergency services right away; do not attempt to manage overdose at home.
Storage Conditions
Store at room temperature (below 30°C), away from light and moisture. Keep the bottle/tube tightly closed and out of reach of children.
Use In Special Populations
Pediatric use
Bricoma is contraindicated in children under 2 years of age due to risk of serious CNS depression. In children aged 2 years and older, safety and efficacy have been evaluated for ophthalmic use, but caution is advised due to lower body weight increasing systemic exposure risk; the topical gel's safety and efficacy in children under 18 years have not been established.
Elderly
No specific dose adjustment is required for Bricoma in elderly patients, though age-related cardiovascular changes warrant routine clinical monitoring.
Renal/hepatic impairment
Limited data are available; use Bricoma with caution and monitor patients with significant renal or hepatic impairment.
Duration Of Treatment
For glaucoma/ocular hypertension, Bricoma ophthalmic solution is typically used long-term/chronically as directed by an ophthalmologist, with regular monitoring of intraocular pressure. For rosacea, the topical gel is used once daily on an ongoing basis for as long as the physician recommends to control facial erythema; effect is not permanent and redness returns if treatment is stopped.
Drug Classes
Alpha-2 adrenergic agonist
Mode Of Action
Brimonidine Tartrate selectively stimulates alpha-2 adrenergic receptors. In the eye, this reduces aqueous humor production by the ciliary body and increases uveoscleral outflow, lowering intraocular pressure. In the skin, alpha-2 receptor stimulation on cutaneous blood vessels causes direct vasoconstriction, reducing the visible redness of rosacea-associated erythema.
Pregnancy
Category B
Pediatric Uses
Bricoma ophthalmic solution is contraindicated in neonates and infants and is not recommended in children under 2 years of age because of reported CNS depression (apnea, bradycardia, hypotension, hypothermia, and somnolence). Use in children 2 years and older should be with caution and physician supervision. Safety and efficacy of the topical gel formulation of Bricoma have not been established in patients under 18 years of age.
Frequently Asked Questions
Q: What is Bricoma 0.2% Ophthalmic Solution used for?
A: Bricoma 0.2% Ophthalmic Solution ophthalmic solution is used to lower elevated eye pressure in open-angle glaucoma or ocular hypertension, while the topical gel formulation of Bricoma 0.2% Ophthalmic Solution is used to reduce persistent facial redness caused by rosacea.
Q: How often should I use Bricoma 0.2% Ophthalmic Solution eye drops?
A: The typical dose of Bricoma 0.2% Ophthalmic Solution ophthalmic solution is one drop in the affected eye(s) three times a day, about every 8 hours, unless your physician has instructed otherwise.
Q: Can children use Bricoma 0.2% Ophthalmic Solution?
A: Bricoma 0.2% Ophthalmic Solution is contraindicated in children under 2 years old because it can cause serious central nervous system depression such as slowed breathing, low blood pressure, low body temperature, and excessive sleepiness in young children. Use in older children requires physician supervision.
Q: Is Bricoma 0.2% Ophthalmic Solution safe during pregnancy?
A: Bricoma 0.2% Ophthalmic Solution has not been well studied in pregnant women. It should only be used during pregnancy if your physician determines that the potential benefit justifies the potential risk to the baby; always consult your physician before use.
Q: What should I do if I accidentally swallow Bricoma 0.2% Ophthalmic Solution?
A: Accidental ingestion of Bricoma 0.2% Ophthalmic Solution, especially by a child, can be serious and cause severe drowsiness, slowed breathing, or low blood pressure. Seek immediate medical attention or contact emergency services/poison control right away rather than treating it at home.
Q: Can I use Bricoma 0.2% Ophthalmic Solution with other eye drops or medicines?
A: Bricoma 0.2% Ophthalmic Solution should not be used with monoamine oxidase inhibitors (MAOIs). It can also add to the sedating effects of alcohol and other CNS depressants and may enhance blood-pressure-lowering medicines. Tell your physician about all medicines you take before starting Bricoma 0.2% Ophthalmic Solution.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.
