title: Association of Central Nervous System Depression With Topical Brimonidine When Used for Hemostasis: A Serious Adverse Event.
abstract: Minor bleeding is the most common complication of dermatologic surgery. Topical brimonidine, 0.33%, gel has been reported for the use of hemostasis in dermatologic surgery. The safety profile and risk of systemic toxic effects when brimonidine is used topically for hemostasis is unknown.
  
  
  
  To determine the risk of systemic toxic effects of topical brimonidine, 0.33%, gel when used for hemostasis.
  
  
  
  In this case series from a private practice (Hollywood Dermatology), 2 patients presented for dermatologic procedures, complicated by persistent bleeding.
  
  
  
  Patients were treated with 10 g of brimonidine, 0.33%, gel applied under occlusion for hemostasis.
  
  
  
  Mental status, cardiopulmonary function.
  
  
  
  Both patients experienced deterioration of mental status, respiratory depression, and somnolence. Results from cardiac testing, laboratory workup, and imaging were negative for cardiac or neurologic etiology. Both patients improved in less than 24 hours.
  
  
  
  Topical brimonidine, 0.33%, gel can result in systemic central nervous system toxic effects when used as a hemostatic agent. At present, it is not possible to define a quantity with which brimonidine can be used safely, nor can a safe wound size be defined. We, therefore, urge against the use of topical brimonidine as a hemostatic agent until its safety is further investigated.
authors.affiliation: Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: Devorah R
authors.initials: DR
authors.lastname: Shagalov
authors.affiliation: Mohs Micrographic Surgery and Dermatologic Oncology Fellowship, Skin Institute of South Florida, Coral Springs3Cosmetic Dermatologic Surgery Fellowship, Hollywood Dermatology and Cosmetic Surgery, Hollywood, Florida.
authors.forename: Drew
authors.initials: D
authors.lastname: Taylor
authors.affiliation: Department of Dermatology, University of Maryland, Baltimore.
authors.forename: Rachel
authors.initials: R
authors.lastname: Schleichert
authors.affiliation: Department of Dermatology, Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Weiss
authors.affiliation: Dermatology and Cutaneous Surgery, Florida International University, Miami7Mohs and Procedural Dermatology Fellowship, Skin Institute of South Florida, Coral Springs8Dermatology and Dermatological Surgery, Miller School of Medicine, University of Miami, Miami, Florida9Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Weiss
mesh_terms: D000279:Administration, Cutaneous; D000368:Aged; D000369:Aged, 80 and over; D000068438:Brimonidine Tartrate / Q000008:administration & dosage / Q000009:adverse effects*; D006970:Disorders of Excessive Somnolence / Q000139:chemically induced; D005782:Gels; D006490:Hemostatics / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced*; D012131:Respiratory Insufficiency / Q000139:chemically induced
chemical_list: D005782:Gels; D006490:Hemostatics; D000068438:Brimonidine Tartrate