title: Brimonidine hypersensitivity when switching between 0.2% and 0.15% formulations.
abstract: OBJECTIVE
  To investigate hypersensitivity rates in patients switched from brimonidine-purite 0.15% to generic brimonidine 0.2%, and to then investigate hypersensitivity rates to re-initiated brimonidine-purite 0.15% in patients who developed hypersensitivity to brimonidine 0.2%.
  
  
  METHODS
  Ocular hypersensitivity reactions to generic brimonidine 0.2% were identified by retrospective chart review after all Albuquerque Veterans Administration Medical Center patients taking brimonidine-purite 0.15% were switched to generic brimonidine 0.2% due to a facility formulary change. Because brimonidine-purite 0.15% was subsequently re-initiated in some patients who developed hypersensitivity to brimonidine 0.2%, hypersensitivity reactions to re-initiated brimonidine-purite 0.15% were also identified.
  
  
  RESULTS
  Three hundred thirteen subjects met inclusion criteria for this study. Of these, 24 [7.7%; 95% confidence interval (CI): 5.0, 11.2] developed hypersensitivity to brimonidine 0.2% after being switched from brimonidine-purite 0.15%. Fifteen of these 24 patients were subsequently instructed to resume use of brimonidine-purite 0.15%; 3 of these 15 (20%; 95% CI: 4.3, 48.1) developed hypersensitivity to brimonidine-purite 0.15%.
  
  
  CONCLUSIONS
  Our results suggest that the hypersensitivity rate to generic brimonidine 0.2% in previously successful users of brimonidine-purite 0.15% is similar to hypersensitivity rates in brimonidine-naive populations. Additionally, our findings suggest that re-initiation of brimonidine 0.15% may be a reasonable treatment option for patients with brimonidine 0.2% hypersensitivity.
authors.affiliation: Department of Surgery/section Optometry, Albuquerque VA Medical Center, Albuquerque, New Mexico 87108, USA. michael.sullivan-mee@va.gov
authors.forename: Michael
authors.initials: M
authors.lastname: Sullivan-Mee
authors.forename: Denise
authors.initials: D
authors.lastname: Pensyl
authors.forename: Brooks
authors.initials: B
authors.lastname: Alldredge
authors.forename: Kathy
authors.initials: K
authors.lastname: Halverson
authors.forename: Gretchen
authors.initials: G
authors.lastname: Gerhardt
authors.forename: Clifford
authors.initials: C
authors.lastname: Qualls
mesh_terms: D000287:Administration, Topical; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000068438:Brimonidine Tartrate; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004342:Drug Hypersensitivity / Q000209:etiology*; D005123:Eye; D005260:Female; D005901:Glaucoma / Q000188:drug therapy; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D011810:Quinoxalines / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000316:Adrenergic alpha-Agonists; D009883:Ophthalmic Solutions; D011810:Quinoxalines; D000068438:Brimonidine Tartrate