Drug General Information (ID: DDI9QOA3H4)
  Drug Name Minoxidil Drug Info Brimonidine (ophthalmic) Drug Info
  Drug Type Small molecule Small molecule
  Therapeutic Class Antihypertensive Agents Ophthalmic Glaucoma Agents
  Structure

 Mechanism of Minoxidil-Brimonidine (ophthalmic) Interaction (Severity Level: Moderate)
     Additive hypotensive effects Click to Show/Hide Mechanism Graph
Could Not Find 2D Structure
      Drug Name Minoxidil Brimonidine (ophthalmic)
      Mechanism Antihypertensive agent
ATP-sensitive inward rectifier potassium channel  Inducer
Hypotensive effects
Alpha-2 adrenergic receptor  Agonist
      Key Mechanism Factor 1
Factor Name Inward rectifier potassium channel Structure Sequence
Protein Family Inward rectifier-type potassium channel (TC 1.A.2.1) family
Protein Function
This receptor is controlled by G proteins. Inward rectifier potassium channels are characterized by a greater tendency to allow potassium to flow into the cell rather than out of it. Their voltage dependence is regulated by the concentration of extracellular potassium; as external potassium is raised, the voltage range of the channel opening shifts to more positive voltages. The inward rectification is mainly due to the blockage of outward current by internal magnesium. Can be blocked by extracellular barium (By similarity). Subunit of ATP-sensitive potassium channels (KATP). Can form cardiac and smooth muscle-type KATP channels with ABCC9. KCNJ11 forms the channel pore while ABCC9 is required for activation and regulation.
    Click to Show/Hide
      Key Mechanism Factor 2
Factor Name Adrenergic receptor alpha-2 Structure Sequence
Protein Family G-protein coupled receptor 1 family
Protein Function
Alpha-2 adrenergic receptors mediate the catecholamine-induced inhibition of adenylate cyclase through the action of G proteins. The rank order of potency for agonists of this receptor is oxymetazoline > clonidine > epinephrine > norepinephrine > phenylephrine > dopamine > p-synephrine > p-tyramine > serotonin = p-octopamine. For antagonists, the rank order is yohimbine > phentolamine = mianserine > chlorpromazine = spiperone = prazosin > propanolol > alprenolol = pindolol.
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      Mechanism Description
  • Additive hypotensive effects by the combination of Minoxidil and Brimonidine (ophthalmic) 

Recommended Action
      Management Blood pressure and pulse rate should be monitored regularly when topical alpha-2 adrenergic receptor agonists are prescribed in combination with cardiovascular drugs. Patients should be advised to notify their physician if they experience slow pulse, irregular heartbeat, dizziness, lightheadedness, or syncope.

References
1 Product Information. Alphagan (brimonidine ophthalmic). Allergan Inc, Irvine, CA.
2 Product Information. Mirvaso (brimonidine topical). Galderma Laboratories Inc, Cranbury, NJ.
3 Walters TR "Development and use of brimonidine in treating acute and chronic elevations of intraocular pressure: a review of safety, efficacy, dose response, and dosing studies." Surv Ophthalmol 41 ( Suppl (1996): s19-26