Case Report
Version 1
Preserved in Portico This version is not peer-reviewed
Brimonidine Eye Drops at the Children Reach: A Possible Foe
Version 1
: Received: 30 January 2024 / Approved: 30 January 2024 / Online: 30 January 2024 (12:44:49 CET)
A peer-reviewed article of this Preprint also exists.
Trotta, D.; Zucchelli, M.; Salladini, C.; Ballerini, P.; Rossi, C.; Aricò, M. Brimonidine Eye Drops within the Reach of Children: A Possible Foe. Children 2024, 11, 317. Trotta, D.; Zucchelli, M.; Salladini, C.; Ballerini, P.; Rossi, C.; Aricò, M. Brimonidine Eye Drops within the Reach of Children: A Possible Foe. Children 2024, 11, 317.
Abstract
Brimonidine, a selective alpha-2 adrenergic agonist, used for treatment of open-angle glaucoma, has been shown to cause neurological side effects such as unresponsiveness, lethargy, hypoventilation, and stupor, mimicking opioid toxicity. We report one case of transient encephalopathy in a toddler, in whom brimonidine accidental toxicity was sus-pected and then confirmed by a toxicology study.
The 8-month-old healthy girl child was taken to the pediatric ER since she was drowsy and hypotonic, with miosis. Brain CT scan and toxicological work-up on blood and urine were negative. Starting from hour +4, the child progressively improved, and by hour +6, she recovered to a normal state of consciousness. A survey of available drugs at the child’s reach showed the presence of brimonidine. Thus, ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) was applied to quantify brimonidine in urine and plasma samples, showing 8.40 ng/mL level and 0.79 ng/mL, respectively.
To our knowledge, this is the first report for determining brimonidine levels in urine and plasma by UPLC-MS/MS. Insufficient knowledge of the family members about the potential hazards of an apparently innocuous, topical medication such as eye drops may put children at a greater risk of poisoning. Necessary warnings should be better given to parents when prescribing this medication.
Keywords
Brimonidine, eye-drop poisoning, tandem mass spectrometry
Subject
Medicine and Pharmacology, Pediatrics, Perinatology and Child Health
Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Comments (0)
We encourage comments and feedback from a broad range of readers. See criteria for comments and our Diversity statement.
Leave a public commentSend a private comment to the author(s)
* All users must log in before leaving a comment