# A-11 — Brimonidine

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.

- **Canonical:** https://www.30plusskin.care/actives/brimonidine
- **Site:** 30+/SKIN — Skincare, published as a spec sheet.
- **Issue:** ISSUE NO. 13 / REV. 2026.10
- **Standing terms:** INDEPENDENT · AFFILIATE-FUNDED · NOT MEDICAL ADVICE

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## Datasheet

- **INN / INCI:** Brimonidine tartrate
- **Family:** Alpha-2 adrenergic agonist
- **Molecular weight:** 442.24 g/mol
- **Layer reached:** STRATUM CORNEUM
- **Prescription only:** yes
- **Evidence grade:** A
- **Controlled trials on file:** 1
- **Strength range recorded:** 0.33%–0.33%
- **Representative reference concentration:** 0.33%
- **Irritation (0–10):** 5
- **Onset:** 3 H
- **Stability:** STABLE

## Mechanism

The concentration marker is not a recommended dose or a claim that other strengths are untested. Compare the vehicle, indication and trial population.

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.

## Measured endpoints

| Endpoint | Effect vs comparator | Window | Record |
| --- | --- | --- | --- |
| Two-grade improvement on both erythema scales | +20% | 4 WK | REF-12 — Mirvaso — study 1, hour 3 on day 29 (Randomised, vehicle-controlled; composite of clinician and patient scales at four timepoints, n=260, grade A) |

## Layering

- **Do not layer with:** Rebound erythema, Indefinite use without review
- **Pairs with:** Ivermectin, Azelaic acid

## 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.

## Products in the register containing it

| No. | Product | Stance | Score | Document |
| --- | --- | --- | --- | --- |
| R-47 | Galderma Mirvaso | CAUTION | 66/100 | /reviews/mirvaso-brimonidine-gel-review |

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## Elsewhere in the register

- [Review register](/reviews)
- [Active monographs](/actives)
- [Brand register](/brands)
- [Evidence register](/evidence)
- [The ledger](/ledger)
- [How we test](/how-we-test)
- [Agent guide](/llms.txt)
- [Sitemap](/sitemap.xml)

_SOURCE-BASED ASSESSMENTS. PUBLISHER PREFERENCES ARE IDENTIFIED SEPARATELY._