Brimonidine Toxicity Secondary to Topical Use for an Ulcerated Hemangioma.
Combigan (Allergan, Irvine, CA) is an ophthalmic solution that combines 0.2% brimonidine, a selective α-2 adrenergic agonist, with 0.5% timolol, a nonselective β-adrenergic antagonist. It is approved for the reduction of intraocular pressure in patients with glaucoma or ocular hypertension. There have been recent reports of successful treatment of superficial infantile hemangiomas (IHs) using Combigan topically. We report the case of a 2-month-old girl who developed life-threatening brimonidine toxicity requiring intubation and mechanical ventilation secondary to central nervous system depression and apnea after topical application to an ulcerated IH.
Department of Pediatrics, Cleveland Clinic, Cleveland, Ohio.
Kamalvir
K
Gill
Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.
Cheryl
C
Bayart
Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio.
Ritu
R
Desai
Department of Pediatric Cardiology, Cleveland Clinic, Cleveland, Ohio.
Alex
A
Golden
Department of Pediatric Intensive Care, Cleveland Clinic, Cleveland, Ohio.
Patricia
P
Raimer
Department of Pediatrics, Cleveland Clinic, Cleveland, Ohio.
Joan
J
Tamburro
D000287:Administration, Topical; D000316:Adrenergic alpha-Agonists / Q000633:toxicity*; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D001049:Apnea / Q000139:chemically induced; D000068438:Brimonidine Tartrate / Q000008:administration & dosage / Q000633:toxicity*; D005260:Female; D018324:Hemangioma, Capillary / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007035:Hypothermia / Q000139:chemically induced; D007223:Infant; D009883:Ophthalmic Solutions; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000139:chemically induced; D012878:Skin Neoplasms / Q000188:drug therapy*; D012883:Skin Ulcer / Q000188:drug therapy*; D013999:Timolol / Q000008:administration & dosage
D000316:Adrenergic alpha-Agonists; D000319:Adrenergic beta-Antagonists; D009883:Ophthalmic Solutions; D000068438:Brimonidine Tartrate; D013999:Timolol