Mirvaso

Mirvaso is a prescription-only gel for the symptomatic treatment of facial redness (erythema) in rosacea. The active ingredient brimonidine narrows the dilated blood vessels in the skin, thereby reducing the redness.

Unlike Soolantra, Mirvaso does not work against papules and pustules, but specifically against the characteristic facial redness. The effect begins within 30 minutes and lasts about 12 hours.

The medication is intended for situational use – for example, before important engagements.

Brimonidine is an alpha-2 adrenergic receptor agonist:

Mechanism of action:

• Activates alpha-2 receptors in the blood vessels
• Causes narrowing (vasoconstriction) of the dilated vessels
• Reduces blood flow in the skin
• The erythema (redness) decreases

Time course:

• Onset of action: 30 minutes
• Maximum effect: 3-6 hours
• Duration of action: 9-12 hours

No effect on:

• Inflammatory lesions (papules, pustules)
• Telangiectasias (dilated small blood vessels, permanent)
• The underlying disease, rosacea

Mirvaso is suitable for:

• Adults with erythematous rosacea
• Situational use for facial redness
• Use in addition to other rosacea treatments

Particularly suitable:

• Before important occasions
• For severely distressing facial redness
• As a complement to baseline therapy

Not suitable:

• As the sole long-term therapy
• Against papules and pustules
• For children under 18 years of age

Gel:

• Brimonidine 3.3 mg/g (0.33%)

Pack size:

• 30 g tube

Application: Once daily, as needed.

Application: 1. Apply the gel to the whole face (forehead, chin, nose and both cheeks) 2. Spread thinly and evenly 3. Avoid the eyes, eyelids, lips, and mouth 4. Wash your hands after application

Timing:

• As needed, once daily
• The effect begins after 30 minutes
• For important engagements: apply in good time beforehand

Important notes:

• Not more often than once daily and no more than five pea-sized amounts (about 1 g of gel) per day
• Use a smaller amount for at least the first week, then increase gradually depending on tolerability and response
• Not on open wounds or irritated skin
• Avoid contact with the eyes
• Makeup can be applied once the gel has dried

Mirvaso must not be used in cases of:

• Hypersensitivity to brimonidine
• Children under 2 years of age
• Concomitant treatment with MAO inhibitors (e.g. selegiline, moclobemide)
• Concomitant use of tricyclic or tetracyclic antidepressants that affect noradrenergic transmission (e.g. imipramine, maprotiline, mianserin, mirtazapine)

Caution in cases of:

• Severe or unstable cardiovascular disease
• Depression
• Orthostatic hypotension
• Coronary or cerebral insufficiency
• Sjögren's syndrome
• Concomitant use of antidepressants

Pregnancy/breastfeeding: Not recommended due to insufficient data.

Very common (at least 10%):

• Worsening of rosacea (in 16% of treated patients in studies)

Common (1-10%):

• Erythema (paradoxical redness)
• Flushing
• Burning sensation
• Itching

Uncommon:

• Contact dermatitis
• Skin irritation

Rebound effect: As the effect wears off, the redness may temporarily return more intensely than before. Most cases were observed in the first 2 weeks after the start of treatment. If Mirvaso was stopped for this reason, it should be tested on a small area of the face for at least one day before it is applied to the whole face again.

Note: Some patients report a paradoxical increase in redness. In this case, stop using the product.

Caution with:

• CNS depressant medications
• Antihypertensives
• Cardiac glycosides

Do not use together with:

• MAO inhibitors
• Tricyclic or tetracyclic antidepressants that affect noradrenergic transmission

Note: Systemic absorption is low, but caution is advised when certain medications are taken at the same time.