The drug atlas
Ophthalmology/α₂-agonist (glaucoma)
α₂-agonist eye drops
also: brimonidine · apraclonidine · sympathomimetic glaucoma
Overview
Glaucoma drops that both reduce production and increase outflow. Note: brimonidine is an α₂-agonist (a common labelling error is "α₁").
Mechanism
Selective α₂-adrenoceptor agonists → REDUCE aqueous production AND increase uveoscleral outflow → lower IOP. (Not α₁ — the legacy mislabel.)
Indications
- Open-angle glaucoma (add-on / β-blocker-intolerant)
- Acute angle-closure glaucoma (apraclonidine in the combination)
The agents
Brimonidineα₂-agonist
BD
Allergic conjunctivitis is common; avoid with MAOIs/TCAs.
Apraclonidineα₂-agonist
Short-term / peri-laser; acute AACG combination.
Adverse effects
Ocular allergy / hyperaemiacommon
Common cause of discontinuation.
Dry mouth, drowsiness/fatiguecommon
Apnoea/CNS depression in infantsserious
Avoid in young children.
Cautions & contraindications
MAOIs / TCAsall
Sympathomimetic interaction.
Young childrenpaediatric
CNS depression/apnoea.
Interactions
- MAOIs, TCAs, CNS depressants
Monitoring & kinetics
IOP; ocular allergy
Topical BD.
Source: NICE NG81 — Glaucoma · BNF — Sympathomimetics (eye)