Brimonidine
Brimonidine tartrate
The other approved treatment for rosacea redness, roughly twice as effective on paper — and the only molecule here whose label says the presenting complaint can come back worse.
The marker is a representative concentration from the cited records. The bar includes approved and compounded preparations recorded here. It is not a recommended dose, a minimum effective strength or a claim that other concentrations are untested. Evidence depends on the vehicle, indication and trial population.
The shaded band is the depth this molecule is understood to reach. Anything below it is out of scope, whatever the label says.
Mechanism
Alpha-2 agonism constricts cutaneous vessels. Sustained daily agonism at the same vascular bed is the plausible mechanism for the tachyphylaxis and rebound its own label records.
HOUSE NOTES
- From the warnings section: some subjects reported a rebound phenomenon, with erythema returning worse than at baseline. No rate, no time-to-onset, no predictor and no management guidance.
- Erythema was reported by 4% of treated subjects against 1% on vehicle, and flushing by 3% against zero. A vasoconstrictor for redness causing redness.
- Controlled trials ran 29 days for a condition managed over decades, and 99% of subjects were Caucasian — the narrowest population in this register.
Layering
- Rebound erythema
- Indefinite use without review
- Ivermectin
- Azelaic acid