Generic Name

Qtern

Mechanism

• Selective α₂‑adrenergic receptor agonist
• Binds α₂‑A receptors on cutaneous vascular smooth muscle
• Induces rapid vasoconstriction → reduces erythema
• Minimal interaction with α₁ or β receptors → lower systemic cardiovascular impact
• Reduces vascular tone without altering immune or inflammatory pathways directly

---

Pharmacokinetics

| Systemic Exposure | Detectable plasma levels Key Point: Systemic exposure is negligible, allowing for safe use in patients receiving other systemic medications.

--
•

Indications

• Inflammatory lesions (erythematotelangiectatic and papulopustular) of rosacea in adults (≥ 18 years)
• Use when antibiotics or topical retinoids are contraindicated or poorly tolerated

---

Contraindications

• Contraindications
• Hypersensitivity to brimonidine tartrate, propylene glycol, or polyethylene glycol
• Active, untreated dermatologic infections or severe skin barrier disruption
• Warnings
• Cardiovascular Disease – mild systemic vasoconstriction; caution in patients with coronary artery disease, uncontrolled hypertension, or arrhythmias
• Eye Contact – may cause conjunctival hyperemia and transient blurred vision – avoid contact with ocular surface
• Rebound Erythema – transient flare of redness < 24 h post‑discontinuation; not an allergic reaction
• Precautions
• Use in pregnancy and lactation: limited data, consider risk/benefit
• Use with caution in patients with a history of seizures or neuro‑vascular disorders

---

Dosing

• Adults (≥ 18 yrs):
• Apply a thin, even film of 0.1 % brimonidine gel to the affected area once daily (prior to bedtime or as directed by provider)
• Ensure the skin is dry; wash hands after application
• Use no more than 4 g per day (≈ 4 applications of 1 g gel)
• Application Technique
• Do not apply to broken or inflamed skin
• Avoid contact with eyes, mucous membranes, or sensitive areas (nose, mouth)
• If using more than once per day, spacing ≥ 6 h between doses
• Re‑treatment – Once 2–3 consecutive days of therapy reach satisfactory response, you may reduce frequency to every other day or as needed

---

Adverse Effects

--
•

Monitoring

• Clinical response – Evaluate reduction in erythema and papulopustular lesions at 2‑4 weeks
• Adverse effects – Observe for skin irritation or systemic symptoms
• No routine lab monitoring required due to minimal systemic exposure

---

Clinical Pearls

• Use on Dry Skin: Moist skin can dilute the gel, reducing efficacy; apply immediately after washing and drying.
• Gradual Dose Taper: To avoid rebound erythema, taper frequency slowly rather than abrupt cessation.
• Adjunctive Therapies: Combine with topical azelaic acid or metronidazole for optimal control of papulopustular rosacea; avoid simultaneous use of other potent vasodilators.
• Sun Protection Needed: Since vasoconstriction may mask erythema, patients should still use broad‑spectrum sunscreen to manage photosensitivity.
• Avoid Over‑application: The gel is highly potent; exceeding 4 g/day offers no additional benefit and can increase irritation risk.
• Special Populations: Limited data in pregnancy; if necessary, use within pregnancy category B with a risk–benefit assessment.
• Patch Test Not Required: Unless a prior brimonidine hypersensitivity is suspected, routine patch testing is unnecessary.

---