Alphagan Z (Brimonidine tartrate 0.1%) Eye Drops

Alphagan Z general information

What is Alphagan Z used for?

Your eye keeps its shape because it is filled with a fluid called aqueous humour that is produced by the eye.  This clear fluid nourishes the cornea (the transparent covering) and lens of the eye.  It also maintains the correct pressure within the eye called intraocular pressure, which is essential for the eye to work properly to give you good vision.  Aqueous humour is continuously secreted by a structure called the ciliary body and drains out of the eye at the same rate as it is produced, to keep a balance and prevent a build-up of fluid in the eye.  If the fluid drains more slowly from the eye than it is released into the eye, this causes a fluid build-up in the eye that increases intraocular pressure and can lead to a condition called glaucoma.  

How does glaucoma cause vision loss?

If intraocular pressure continues to increase, it can cause progressive damage to the optic nerve, which is a bundle of nerve fibres that takes messages leading out from the back of the eye to the brain, where the image that we see is produced.  This is a significant cause of permanent blindness, but it is preventable if recognised early.  There are usually no glaucoma symptoms, and it is also possible that glaucoma can develop even with normal eye pressure, so you will only know by having an eye check.  If untreated, glaucoma will begin to cause changes in your vision, usually starting with the loss of peripheral vision, which eventually becomes total blindness in that eye.  Once the optic nerve is damaged, this is permanent and cannot be reversed.  

Types of glaucoma

Glaucoma is described according to how it is caused.  Chronic open-angle glaucoma is the most common form of glaucoma and is caused by damage to the drainage channels that allow fluid to drain from the eye.  Acute angle-closure glaucoma is caused by a blockage in the drainage channel and can develop suddenly with symptoms including eye pain, red-eye and nausea.  This is serious and needs immediate medical treatment.  Ocular hypertension is a condition of increased intraocular pressure that has not caused damage to the optic nerve and is not diagnosed as glaucoma. 

Alphagan Z eye drops are used to treat chronic open-angle glaucoma and also ocular hypertension without glaucoma, to lower intraocular pressure and reduce the risk of vision loss.  It is possible to use other types of eye drops in combination with Alphagan Z, that have a different mechanism of action, particularly if using a single type of medication has not reduced eye pressure sufficiently to reduce the risk of glaucoma.

How does Alphagan Z work?

Alphagan Z eye drops 0.1% contains brimonidine, an alpha-2 adrenergic agonist that is a medication used to treat glaucoma to lower eye pressure.  An alpha-2 adrenergic agonist is a chemical that stimulates the alpha-2 adrenergic receptor, which can be described as the docking port for adrenaline and noradrenaline, chemicals produced by nerve cells.  These nerve chemicals bind to their receptors and initiate specific cellular responses, such as contraction of smooth muscle in blood vessels. 

Many alpha-2 adrenergic receptors are found in various structures of the eye, including the ciliary bodies that produce the aqueous humour.  Brimonidine works by binding to the alpha-2 adrenergic receptors in the eye and stimulating a specific response, which in the case of the eye is to block the production of aqueous humour by the ciliary bodies primarily by causing constriction of the small blood vessels in this structure.  Brimonidine also helps fluid drain out of the eye.  Normally fluid drains through a spongy structure called the trabecular network between the cornea and the iris.  If this becomes blocked, the fluid remains in the eye, which increases pressure.  Uveoscleral outflow refers to another drainage route through the ciliary body.  Brimonidine helps direct fluid out through this route by relaxing the muscles of the ciliary body to allow fluid to escape. 

With continual use of Alphagan Z eye drops 0.1% the balance returns between fluid flow into and out of the eye.  Intraocular pressure is lowered, which reduces the risk of damage to the optic nerve and loss of sight.  Alphagan eye drops begin to work quickly.  The maximum reduction in IOP can be seen about two hours after you start using Alphagan eye drops and lasts for about 12 hours.

What does Alphagan Z contain?

Alphagan Z eye drops 1% contains the active ingredient Brimonidine tartrate 1 mg/mL (0.1% w/v), an alpha-2 adrenergic agonist used to treat glaucoma by lowering intraocular pressure (IOP).  They also contain stabilized oxychloro complex (Purite™) 0.05 mg (0.005% w/v) and purified water.

What are the side effects of Alphagan Z?

Most medications have some side effects, but they are not experienced by everyone.  Some side effects are commonly experienced when taking Alphagan Z, but others are not so common, and you should discuss any problems or concerns with your primary care physician. 

Common side effects that may occur when taking Alphagan Z include burning, stinging, itching eyes, conjunctivitis, dry eyes, watering and redness of the eye, allergic reactions including redness and swelling of the eye, swelling of the eyelid (blepharitis), blurred vision, sensitivity to light, irritation or feeling of having something in the eye, abnormal taste, dryness of the mouth, upper respiratory symptoms, dizziness, gastrointestinal symptoms, asthenia (weakness), headache, fatigue, drowsiness.

When should Alphagan Z not be used?

Have a talk with your primary healthcare physician before taking Alphagan Z eye drops so that you have a full understanding of what this medicine is for and how to use it.  There are some reasons for not taking a medication; these are called contraindications, and for Alphagan Z you should consider the following before taking Alphagan Z:

• Have you ever had an unusual reaction or an allergy when taking Alphagan Z?
• Are you pregnant or breastfeeding?
• Do you have any problems with your kidneys or your liver?
• Do you have severe, uncontrolled cardiovascular disease?
• If you wear soft contact lenses; you should remove your contacts and replace them 15 minutes after using
• If you are taking monoamine oxidase (MAO) inhibitor medication for depression

What medications interact with Alphagan Z?

Some medicines interact with Alphagan Z eye drops and may affect the way it works, or are affected by Alphagan Z or increase side effects; you should discuss possible interactions with your primary care physician.  These may include monoamine oxidase (MAO) inhibitor for depression and tricyclic antidepressants, beta-blockers for high blood pressure, sedatives including barbiturates and alcohol. 

If other medications may interact with Alphagan Z, your doctor will discuss these with you. 

How should Alphagan Z be used and for how long?

You should use your Alphagan eye drops by applying one drop into the affected eye, three times daily following the instructions provided.  If you are wearing contact lenses, remove them before applying your Alphagan eye drops and then replace them at least 15 minutes after applying your drops.  If you are using other eye drops for glaucoma, wait 5-10 minutes in between applying them. 

You should continue to use your Alphagan eye drops 2mg/mL drops daily for as long as recommended by your doctor, which may be for several months or years, as they will help maintain normal eye pressure but will not cure glaucoma.

Missed dose of Alphagan Z

If you miss a dose of Alphagan Z eye drops apply it as soon as you remember, unless it is time to apply the next dose, then skip the missed dose.  Do not apply a double dose.

How should Alphagan Z be stored?

You should store your Alphagan Z eye drops below 25°C in a cool dry place.