Eye drop

Nice case ,thanks for sharing

Eye Drop Cont’

Thanks all for your excellent comments

Brimonidine tartrate is a relatively selective alpha(2) adrenic agonist that lowers elevated intraocular pressure.

After taken orally, it is metabolized in liver and its metabolites are excreted from kidney. Brimonidine is highly lipophilic and cross the blood brain barrier . Serious systemic side effects have been observed in children following overdose or improper use

Clinical Toxicity:

Like Dr Kazzi mention, classic physical findings would be early hypertension from its peripheral effects followed by hypotension.

It can lead to severe central nervous system depression when transmitted to central nervous system.

It can cause fatigue, weakness, lethargy, apnea, bradycardia, hypotension, respiratory depression and coma, especially in children

Management:

All children ≤5 years of age with confirmed brimonidine ingestions should be medically evaluated and monitored for an extended period. Symptomatic treatment can be sufficient in mild cases Indications for the use of naloxone in brimonidine poisoning remain uncertain, however naloxone can be beneficial for patients with central nervous system or respiratory depression.

References:

Brimonidine Tartrate Poisoning in Children: Frequency, Trends, and Use of Naloxone as an Antidote. Pediatrics February 2009, 123 (2) e305-e311; DOI: https://doi.org/10.1542/peds.2008-1951

Brimonidine, an α2-adrenergic agonist commonly prescribed for the treatment of glaucoma and ocular hypertension, is a lipid-soluble compound structurally related to clonidine.

Systemic side effects have been reported after ocular administration of brimonidine, the most severe of which are neuropsychiatric manifestations.

To reduce systemic absorption of topically administered eye drops, simple measures such as eyelid closure for up to five minutes and nasolacrimal duct occlusion may reduce systemic absorption.

Additionally, instillation of only one drop at a time is usually sufficient.

The smallest effective dose should be used, with vigilant monitoring for systemic toxicities.

There is no approved antidote for the treatment of brimonidine toxicity. Paediatric studies have described the use of activated charcoal after inadvertent oral ingestion of brimonidine eye drops, and also intravenous naloxone in established brimonidine toxicity, but no consistent benefit has been observed.

Conservative management with drug cessation and close monitoring was successful in most cases.

One of the classic physical findings would be early hypertension from its peripheral effects followed by hypotension when the central effects take over a few hours later. also can see mitosis. Maybe Naloxone would help if respiratory depression.

One of the classic physical findings would be early hypertension from its peripheral effects followed by hypotension when the central effects take over a few hours later. also can see mitosis. Maybe Naloxone would help if respiratory depression.

Brimonidine is alfa agoinst ( same family of clonidine). Its toxicity depends on absorption and metabolism of this composition.

the worst expacted scenrio is this eye drop get absorbed and it will give picture of clonidine toxicit.