Brimolol Overdosage

Bradycardia has been in association with use of a higher than recommended dose. If overdosage occurs, treatment should be symptomatic and supportive; a patent airway should be maintained.
Inadvertent overdosage with timolol ophthalmic solution resulting in systemic effects similar to those seen with systemic beta-adrenergic blocking agents such as dizziness, headache, shortness of breath, bradycardia, hypotension, bronchospasm and cardiac arrest. Patients with renal do not dialyse timolol readily.
Brimonidine: Ophthalmic overdose: In cases where brimonidine has been used as part of the medical treatment of congenital glaucoma, symptoms of brimonidine overdose such as a loss of consciousness, hypotension, hypotonia, bradycardia, hypothermia, cyanosis and apnoea, coma, lethargy, pallor, respiratory depression and somnolence have been reported in neonates and infants (less than 2 years of age) receiving brimonidine.
Systemic overdose resulting from accidental ingestion: Several reports of serious adverse events following inadvertent ingestion of brimonidine by paediatric subjects have been published or reported to Allergan. The subjects experienced symptoms of CNS depression, typically temporary coma or low level of consciousness, hypotonia, bradycardia, hypothermia and apnoea and required admission to intensive care with intubation if indicated. All subjects were reported to have made a full recovery, usually within 6-24 hours.
Two cases of adverse effects following inadvertent ingestion of 9-10 drops of brimonidine by adult subjects have been received. The subjects experienced a hypotensive episode, followed in one instance by rebound hypertension approximately 8 hours after ingestion. Both subjects were reported to have made a full recovery within 24 hours. No adverse effects were noted in a third subject who ingested an unknown amount of brimonidine orally.
Oral overdoses of other alpha-2-agonists have been reported to cause symptoms such as hypotension, asthenia, vomiting, lethargy, sedation, bradycardia, arrhythmias, miosis, apnoea, hypotonia, hypothermia, respiratory depression and seizure.
Timolol: Symptoms of systemic timolol overdose are: bradycardia, hypotension, bronchospasm, headache, dizziness and cardia arrest. Timolol does not dialyse readily.
If overdose occurs treatment should be symptomatic and supportive.