Who should not use brimonidine eye drops? An essential safety guide

October 10, 2025 •

4 min read

According to reports, serious systemic side effects, including severe central nervous system depression, have been documented in infants receiving brimonidine eye drops. For this reason and others, it is critical to understand who should not use brimonidine eye drops and other important safety considerations before starting treatment.

Quick Summary

This guide details the major contraindications and precautions for brimonidine eye drops. It covers infants, individuals with specific cardiovascular conditions, those on MAO inhibitors, and other key safety considerations.

Key Points

Infants Under 2: Brimonidine is strictly contraindicated in children under two years old due to the risk of severe central nervous system depression and respiratory issues.
Allergies: Patients with a known hypersensitivity to brimonidine or any formulation ingredients should avoid using the eye drops.
MAO Inhibitors: Concomitant use with MAO inhibitors is contraindicated, as it can lead to severe side effects like hypotension.
Heart Conditions: Caution is necessary for patients with severe cardiovascular disease, heart block, or heart failure, as brimonidine can affect heart rate and blood pressure.
Depression: Individuals with mental depression should use brimonidine with caution, as it may worsen symptoms.
Circulation Problems: Brimonidine may exacerbate vascular insufficiency conditions like Raynaud's phenomenon and orthostatic hypotension.
Combined Therapy: The use of brimonidine alongside other CNS depressants, like alcohol or sedatives, can increase drowsiness.

Primary Contraindications for Brimonidine Eye Drops

Brimonidine is a medication widely used to treat conditions like open-angle glaucoma and ocular hypertension by lowering intraocular pressure. While generally safe for many, specific individuals must not use this medication due to a high risk of severe adverse effects. Adherence to these contraindications is crucial for patient safety.

Children Under Two Years Old: A Strict Ban

One of the most critical contraindications for brimonidine is in children under the age of two. The reason for this strict warning stems from documented cases of severe central nervous system (CNS) depression, respiratory issues, and other serious side effects in infants. An infant's underdeveloped blood-brain barrier and smaller body mass mean they are more susceptible to systemic absorption of the medication, leading to potentially life-threatening complications like apnea and bradycardia. Some specific lower-strength formulations may also have cautions for children under five. Accidental oral ingestion of brimonidine eye drops by infants has also led to severe intoxication.

Hypersensitivity or Allergic Reactions

Patients with a known hypersensitivity or allergic reaction to brimonidine or any other ingredient in the eye drop formulation should not use this medication. Allergic reactions can manifest as ocular pruritus, conjunctival hyperemia, or more severe systemic symptoms like hives and breathing difficulties. If a sensitivity reaction occurs, the drug should be immediately discontinued.

Concurrent Use with Monoamine Oxidase (MAO) Inhibitors

Brimonidine is contraindicated for patients receiving Monoamine Oxidase (MAO) inhibitor therapy. MAO inhibitors can interfere with the metabolism of brimonidine, which could potentially lead to increased systemic side effects, most notably a significant drop in blood pressure (hypotension). A list of common MAO inhibitors includes isocarboxazid, phenelzine, and tranylcypromine. A thorough review of all medications, including over-the-counter and herbal products, is necessary before starting brimonidine.

Serious Health Conditions Requiring Caution

Beyond the primary contraindications, several serious health conditions require extra caution and a discussion with your doctor before using brimonidine eye drops. In some cases, the medication may be inappropriate or require close monitoring.

Cardiovascular and Circulatory Disorders

Severe Cardiovascular Disease: Patients with severe, unstable cardiovascular disease should use brimonidine with caution. This includes conditions such as severe heart block, cardiogenic shock, and heart failure, as the medication can have effects on blood pressure and heart rate.
Orthostatic Hypotension: Individuals with a history of orthostatic hypotension (low blood pressure upon standing) should be monitored closely, as brimonidine may exacerbate this condition.
Vascular Insufficiency: Conditions affecting blood circulation, such as Raynaud's phenomenon or thromboangiitis obliterans, may be worsened by brimonidine.

Neurological and Psychiatric Concerns

Depression: Brimonidine should be used with caution in patients with mental depression, as the drug may worsen symptoms.
Central Nervous System (CNS) Depressants: Brimonidine has a synergistic effect with CNS depressants like alcohol, sedatives, or opioid pain relievers, increasing the risk of drowsiness and reduced alertness.

Other Important Patient Groups

Pregnant or Breastfeeding Individuals: There is limited information on the effects of brimonidine on unborn babies or nursing infants. A doctor must carefully weigh the potential benefits against the risks before use during pregnancy or breastfeeding.
Liver and Kidney Impairment: The systemic metabolism of brimonidine occurs primarily in the liver, and it is excreted in the urine. Therefore, caution is advised for patients with significant hepatic or renal impairment.

Brimonidine vs. Other Glaucoma Drops: A Comparison of Contraindications


Contraindication	Brimonidine	Beta-blocker Eye Drops (e.g., Timolol)	Prostaglandin Analogues (e.g., Latanoprost)
Infants (<2 years)	Contraindicated due to CNS effects	Contraindicated due to risk of bradycardia and systemic effects	Generally not recommended, requires specialist consultation
MAO Inhibitor Use	Contraindicated due to risk of increased systemic side effects	No specific contraindication, but interactions with other antidepressants exist	No specific contraindication
Severe Cardiovascular Disease	Use with caution, can affect blood pressure	Contraindicated due to risk of heart failure, bradycardia	Generally safe, fewer systemic effects
Hypersensitivity	Yes, to brimonidine or ingredients	Yes, to timolol or ingredients	Yes, to latanoprost or ingredients
Asthma/COPD	Use with caution, can impact respiration	Contraindicated due to risk of bronchospasm	Generally safe

Conclusion

While brimonidine eye drops are a valuable tool in managing glaucoma and ocular hypertension, they are not suitable for everyone. Patients must have an open conversation with their doctor about their complete medical history, including all existing conditions and medications. Key groups who should avoid brimonidine include children under two, individuals with known allergies, and those taking MAO inhibitors. Additionally, those with severe cardiovascular disease, depression, or specific vascular issues should exercise caution and be closely monitored. By understanding these contraindications and discussing them with a healthcare provider, patients can ensure their eye treatment is both effective and safe.

For more detailed patient information on brimonidine, consult the MedlinePlus drug information page. MedlinePlus: Brimonidine Ophthalmic

Frequently Asked Questions

There is not enough data to confirm the safety of brimonidine during pregnancy or breastfeeding. You must inform your doctor if you are pregnant, planning to become pregnant, or nursing so they can assess the risks and benefits for your specific situation.

If you experience symptoms of a severe allergic reaction, such as swelling of the face, tongue, or throat, or have difficulty breathing, stop using the eye drops immediately and seek emergency medical help.

Yes, different concentrations and formulations exist. For instance, the prescription strength for glaucoma is different from the lower-strength over-the-counter version used for eye redness. The OTC product, like Lumify, is not for use in children under five, while prescription-strength brimonidine is generally for ages two and older. Always check the specific product's instructions and consult a doctor.

Yes. Brimonidine can interact with medications like MAO inhibitors, certain antidepressants, and other drugs that cause drowsiness. Inform your healthcare provider about all medicines you are taking to avoid potential interactions.

Brimonidine can cause drowsiness, fatigue, or blurred vision in some people. You should not drive or operate heavy machinery until you understand how the medication affects you.

If you wear soft contact lenses, you should remove them before using brimonidine eye drops. The preservative (benzalkonium chloride) can be absorbed by the lenses. Wait at least 15 minutes after instilling the drops before reinserting your lenses.

Appropriate studies have shown no specific problems limiting the use of brimonidine eye drops in the elderly. However, because older adults may have underlying health conditions, it is important to discuss all medical history with a doctor.