Brimonidine Toxicity Secondary to Topical Use for an Ulcerated Hemangioma

Gill, Kamalvir; Bayart, Cheryl B.; Desai, Ritu; Golden, Alex; Raimer, Patricia; Tamburro, Joan

doi:10.1111/pde.12868

Cited by 17 publications

(8 citation statements)

References 3 publications

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“…Local absorption can lead to clinically significant systemic exposure that may be increased in highly vascularized and/or ulcerated VA [25]. SADRs have occurred in patients treated topically for a VA, including symptomatic bradycardia due to systemic absorption of timolol [25-27] and respiratory depression with brimonidine [28]. Local drug absorption is generally underestimated by patients and families, and therefore they should be informed to respect the prescribed posology.…”

Section: Discussionmentioning

confidence: 99%

Off-Label Use and Safety of Drug Use in Vascular Anomalies

Kleiber¹,

Gariépy-Assal²,

Coulombe³

et al. 2021

Dermatology

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Background: Off-label drug use is associated with an increased risk of adverse drug reactions. It is common in pediatrics and in rare diseases, which are two characteristics applying to vascular anomalies (VA). Objectives: The aim of this work was to quantify off-label drug use in VA and assess its safety. Methods: A review was conducted to extract a list of drugs used in VA management. A drug was considered to have significant safety concerns if a black box warning was present or if a serious adverse drug reaction (SADR) was reported in at least 1% of the patients (SADR is defined as a noxious and unintended response to a drug that occurs at any dose and results in hospitalization, prolongation of existing hospitalization, congenital malformation, persistent or significant disability or incapacity, life-threatening condition, or death). The labelling status and safety of each drug was assessed based on the product monograph, Micromedex, and the FDA data. Results: We found that 98.9% of the inventoried drugs were used off-label or unlicensed for VA management. Only the oral solution of propranolol hydrochloride (Hemangeol®) for the treatment of infantile hemangiomas is approved. Significant safety issues concerned 73% of the drugs and were more frequent among systemic than locally delivered drugs. Conclusions: Off-label drug use in VA is the rule and not the exception. Significant safety concerns are common. It is necessary to carefully weigh risk and benefits for every patient when using systemic and local treatments carrying safety concerns. Patients should be openly informed and involved in the decision-making process.

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Section: Discussionmentioning

confidence: 99%

Off-Label Use and Safety of Drug Use in Vascular Anomalies

Kleiber¹,

Gariépy-Assal²,

Coulombe³

et al. 2021

Dermatology

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“…Almebayadh et al presented two cases of the successful treatment of ulcerated hemangiomas treated with brimonidine 0.2%-timolol 0.5% cream (a combination of a selective alpha-2-adrenergic agonist and a non-selective beta-blocker), although it is not recommended to combine the treatment with oral propranolol as the risk of severe side effects increases [55,56].…”

Section: Timololmentioning

confidence: 99%

Infantile Hemangiomas: An Update on Pathogenesis and Treatment

Kowalska

Dębek

Matuszczak

2021

JCM

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Infantile hemangiomas are the most common benign vascular tumors in infancy. This review includes an update on the current knowledge on pathogenesis, a discussion on indications for treatment, and a review of the mechanisms underlying the different treatment methods. Although most infantile hemangiomas require only active observation because of their natural course, which results in involution, about 10% present with complications that require immediate treatment. The basic treatment includes systemic and topical options. In cases of insufficient response or rebound growth, other forms of treatment should be considered. In some cases, combined therapy might be initiated.

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“…[29] Topical brimonidine 0.2% and timolol 0.5% combination treatment (Combigan ® Allergan, Irvine, CA) has shown efficacious for ulcerated lesions, however, is strongly contraindicated in children less than 2 years of age because of lethal brimonidine toxicity of central nervous system depression. [33] In the past, systemic, intralesional injection, and topical steroids were the mainstay of treatment. However, rebound growth after stoppage, and side effects of systemic steroids such as gastrointestinal ulceration, dyspepsia, insomnia, stunted growth, immunosuppression, adrenal suppression, behavioral disturbances, Cushingoid features, hyperglycemia, delayed wound healing, arterial hypertension, and hypertrophic cardiomyopathy made the therapy suboptimal.…”

Section: Medical Managementmentioning

confidence: 99%

Capillary hemangioma – A review

Wadhwani¹,

Singh²

2020

cleverjournal

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Capillary hemangioma (CH) also known as strawberry nevi can present as a small red raised isolated lesion. Imaging techniques such as ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) may be used to differentiate CH from other vascular tumors, to identify the extent of tumor. Management should be customized according to the age of the child, extent and size of the tumor(s), growth rate, depth (superficial, deep or mixed).

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Brimonidine Toxicity Secondary to Topical Use for an Ulcerated Hemangioma

Cited by 17 publications

References 3 publications

Off-Label Use and Safety of Drug Use in Vascular Anomalies

Off-Label Use and Safety of Drug Use in Vascular Anomalies

Infantile Hemangiomas: An Update on Pathogenesis and Treatment

Capillary hemangioma – A review

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