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Brymonidyna na twarz - Tajemnicze Piękno Naturalnej Pielęgnacji
MATERIALS AND METHODS
Animals
Hairless female C3.Cg/TifBomTac immunocompetent mice (n = 125), aged 14–22 weeks at the beginning of the experiment, purchased from Taconic (Ry, Denmark) were used in this study. Mice were anesthetized with 0.05 mL of HypDorm (0.158 mg/mL fentanyl citrate, 5 mg/mL fluanisone, 2.5 mg/mL midazolam), tattooed with consecutive numbers on the abdomen and randomized into five groups. Each group was housed in an individual cage with access to water and a standard diet (Table 1 ) and maintained at 23–24°C under a 12‐h light‐dark cycle. This study followed recommendations described by national guidelines. All protocols were approved by national (permit number 2014‐15‐0201‐00096) and institutional ethical committees.
TABLE 1
Treatment schedule and median number of days until 50% of the mice had a first, second, and third tumor.
| Group | Treatment | Irradiation dose (SEDs) | Median days to first tumor (Q3–Q1) † | Median days to second tumor (Q3–Q1) † | Median days to third tumor (Q3–Q1) † |
|---|---|---|---|---|---|
| 1 | 1% brimonidine cream before UVR | 3 | 295 (302–288) | 302 (309–302) | 309 (316–302) |
| P‐value ‡ | 0.000006 | 0.000004 | 0.000001 | ||
| 2 | 0.33% brimonidine gel before UVR | 3 | 267 (295–254) | 281 (295–267) | 288 (295–274) |
| P‐value ‡ | 0.313 | 0.447 | 0.372 | ||
| 3 | 1% brimonidine cream after UVR | 3 | 274 (281–261) | 288 (295–274) | 295 (295–288) |
| P‐value ‡ | 0.252 | 0.172 | 0.080 | ||
| 4 | UVR, no drug treatment (UVR control) | 3 | 267 (274–254) | 274 (281–267) | 274 (288–267) |
| 5 | 1% brimonidine cream | NA | No tumor | No tumor | No tumor |
Case Presentation
At a physical examination, the child was drowsy and rousable for brief moments with persistent crying, hypotonia, and bilateral miosis. Upon palpation of the skull, no swellings or bony steps were observed. The child had pinkish, pale skin, a pernicious, diffusely harsh vesicular murmur in the chest with good air penetration, and strong and rhythmic cardiac activity. Her abdomen was treatable. She was afebrile, with an SpO2 of 99% in room air, an ABP of 99/51 mmHg, and a heart rate of 113/min.
In an attempt to identify a possible toxic agent, the parents were asked to check the home environment within the child’s reach. Later on, the mother reported that the vials of brimonidine-based eye drops used by the grandfather were found empty on the sofa near where the little girl had been playing.
References
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Associated Data
The data presented in this study are available in article and Supplementary Materials.
Brimonidine, a selective alpha-2 adrenergic agonist used for the 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 accidental brimonidine toxicity was suspected and then confirmed by a toxicology study. The healthy 8-month-old girl was taken to the pediatric ER since she was drowsy and hypotonic with miosis. The computed tomography scan of her brain and toxicological workup of her blood and urine were negative. Starting from the fourth hour, the child progressively improved, and by the sixth hour, she recovered to a normal state of consciousness. A survey of available drugs within the child’s reach showed the presence of brimonidine. Thus, ultra-performance liquid chromatography–tandem mass spectrometry (UPLC-MS/MS) was applied to quantify the brimonidine in urine and plasma samples, showing levels of 8.40 ng/mL and 0.79 ng/mL, respectively. To our knowledge, this is the first report to determine brimonidine levels in urine and plasma using UPLC-MS/MS. Insufficient knowledge on the part of 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 given to parents with greater care when prescribing this medication.
Keywords: brimonidine, eye drop poisoning, tandem mass spectrometryBrimonidine Eye Drops within the Reach of Children: A Possible Foe
3 Department of Innovative Technologies in Medicine and Dentistry, “Gabriele d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
Carmela Salladini
Patrizia Ballerini
3 Department of Innovative Technologies in Medicine and Dentistry, “Gabriele d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
Claudia Rossi
3 Department of Innovative Technologies in Medicine and Dentistry, “Gabriele d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
Maurizio Aricò
3 Department of Innovative Technologies in Medicine and Dentistry, “Gabriele d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
Received 2024 Jan 29, Revised 2024 Feb 26, Accepted 2024 Mar 5.Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).