I don’t usually pay too much attention to the articles in Prescriber touting new drugs, but this one actually fills a gap in the market and is thus worth remembering – brimonidine gel (Mirvaso), which has been found to treat erythema in rosacea.
Effectiveness (or do I mean efficacy? sorry, can’t remember the official difference): NNT 5 (by the criterion of proportion of patients who were ‘satisfied’ or ‘very satisfied’ with their treatment). Symptoms improve around half an hour after treatment.
Dose: Up to 1g once daily, which equates to 5 pea-sized amounts – one for forehead, one for nose, one for chin, and one for each cheek. I assume that any unaffected areas from those don’t get treated and thus correspondingly less is used. Which would be good, as at a dose of 1g daily a month’s worth costs £33.69, so good to stretch that if we can.
Avoid getting gel in eyes, on eyelids, on lips or in mouth, or in nose. Wash hands after application. If a patient wishes to apply other creams, or make-up, they can do so after the gel has dried.
Side-effects: Flushing, itching, burning sensation, contact dermatitis, erythema (uh, what? You mean that the erythema they’re already taking the stuff for gets worse, or that it shows up in other areas, or what?), rebound erythema which can come on within 6 – 12 hours as the effect wears off. In the trials, which were both short-term, rebound erythema after drug cessation didn’t seem to be an issue, but there is now some anecdotal evidence that that may be a problem with longer use, so worth bearing in mind. Side effects occur in about 1% (absolute difference from placebo group).
Interactions: MAOIs or tricyclic/tetracyclic antidepressants, both of which contraindicate concurrent brimonidine use (the article didn’t say why).
Cautions: Cardiovascular disorders. Vascular dermatological conditions.