Drug General Information (ID: DDIQ0Y9D1U)
Drug Name			Brimonidine (topical)		Drug Info		Amoxapine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Ophthalmic Glaucoma Agents				Antidepressants
Structure

Mechanism of Brimonidine (topical)-Amoxapine Interaction (Severity Level: Moderate)
Additive CNS depression effects Click to Show/Hide Mechanism Graph
Drug Name		Brimonidine (topical)				Amoxapine
Mechanism		CNS depression effects				CNS depression effects
Key Mechanism Factor 1
		Factor Name		CNS depression effects
		Factor Description		CNS depressants are drugs that inhibit or suppress brain activity and can reduce mental and physical processes. Excessive CNS depression can lead to decreased heart rate, slow breathing (less than 10 breaths per minute), extreme confusion or loss of memory, nausea and vomiting, poor judgment, blue lips or fingertips, irritability and aggression, and clammy or cold skin.
Mechanism Description		Additive CNS depression effects by the combination of Brimonidine (topical) and Amoxapine

Recommended Action
Management		Patients receiving topical alpha-2 adrenergic receptor agonists in combination with tricyclic and tetracyclic antidepressants should be made aware of the potential for increased adverse effects such as drowsiness, dizziness, lightheadedness, confusion, hypotension and syncope, and counseled to avoid activities requiring mental alertness until they know how these agents affect them. Patients should also avoid rising abruptly from a sitting or recumbent position and notify their physician if they experience orthostasis or tachycardia. No data are available on the level of circulating catecholamines after withdrawal of a topical alpha-2 adrenergic receptor agonist. Since tricyclic antidepressants can affect the metabolism and uptake of circulating amines, caution is advised.

References
1	Product Information. Alphagan (brimonidine ophthalmic). Allergan Inc, Irvine, CA.
2	Product Information. Mirvaso (brimonidine topical). Galderma Laboratories Inc, Cranbury, NJ.