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Effectiveness of Mirvaso

Rosacea is a condition affecting mainly the face, in which there is increased skin blood flow and redness, as well as red papules, pimples, and pustules. Brimonidine (the active ingredient in Mirvaso gel) is an alpha blocker, and when applied to reddened areas of skin, it causes constriction of blood vessels and reduced surface blood flow. The effects start within a few minutes and last up to 12 hours, so it is usually applied in the morning. It should not be used more than once in a 24-hour period.

In studies 7 out of 10 subjects reported improved rosacea symptoms 3 hours after an application of Mirvaso. This compares with 4 out 10 subjects reporting improvement when a non-active (dummy) gel was applied.

Mirvaso can worsen symptoms in up to 16% of people and care must be taken when starting treatment - see details below. The redness can get worse soon after Mirvaso is applied or later when the effects are wearing off (after 8 to 12 hrs). In most people any worsening settles on stopping treatment with Mirvaso. Do not use Mirvaso again if it makes your symptoms worse. Consult a GP/dermatologist if the worsening redness does not settle within a few days of stopping.

Mirvaso is for adult use, and should not be used by under 18s as it is untested in this lower age group. It should be kept away from young children, who are at risk of dangerous effects if they swallow the gel. In studies, older subjects (65 years and above) responded to treatment in the same way as younger subjects (18-64 years).

How to apply Mirvaso

Start treatment with a very small amount of gel (less than the maximum dose) for at least 1 week and build-up gradually, based on tolerability and response to treatment. It is important not to exceed the maximum daily dose (which is 1gm of gel in total weight, approximately 5 pea-sized amounts). Apply 1 pea-sized amount to each of the reddened areas of the face; the chin, each cheek, forehead, and nose. Gently smooth as evenly and thinly as possible, over the five areas of the face, avoiding the eyes and lips. Gel should be applied to dry rather than wet skin, to reduce the chance of Mirvaso running into the eyes and mouth. Gel which comes into contact with the eyelids, eyes, lips, or mouth should be washed off with water straight away. Other skin treatments and make-up can be applied once the gel has dried. Wash hands after use to avoid transfer to the eyes and mouth and to reduce unwanted constriction of circulation to the hands and fingers. If symptoms worsen, Mirvaso should be stopped and a doctor consulted.

See video below from the manufacturer Galderma:

Possible side effects of Mirvaso

Mirvaso can actually make rosacea worse in up to 1 in 6 people, so it is necessary to start with a small amount and slowly build up to the full dose, increasing the dose only if it is working for you.

Very little of the active ingredient, brimonidine, is absorbed into the general body circulation. Most significant side effects are localised to the skin where the gel has been applied. The most frequent of these are redness, flushing, and a feeling of burning or itching. There have been a few reports of significant slow heart rate, low blood pressure, and dizziness after using Mirvaso gel and also sometimes a dry mouth or headache.

To reduce absorption, the smallest amount needed should be used and Mirvaso should not be applied to broken skin, particularly after laser therapy, as this can lead to increased absorption and side effects. A full list of possible side effects is detailed in the patient information leaflet.

Mirvaso and thread veins (telangiectasia)

It can often appear that the dilated vessels seem worse when using Mirvaso. This is usually because these thready skin vessels had been hidden in the general redness, which improves when using Mirvaso. The thready blood vessels therefore become more obvious.

Who should NOT use Mirvaso

Checks are carried out during the Dr Fox online consultation to ensure Mirvaso gel is suitable.

Mirvaso gel is only for use by adults over 18, including over 65s, and NOT children.

Most people can use Mirvaso gel without significant side effects. However, as Mirvaso constricts blood vessels it is not suitable for people with poor circulation to the hands and feet. There is also a potential for blood pressure to drop so it is not suitable for people prone to low blood pressure or people with serious heart conditions.

Caution is also required in people who have been diagnosed with liver or kidney disease, or depression, either currently or in the past, and people diagnosed with the uncommon dry skin condition, Sjogren's syndrome, and in people with poor circulation to the brain or heart.

Mirvaso with other medicines

Mirvaso has the potential, in theory at least, to interact with a few other prescription medicines, although the amount absorbed through the skin is minimal.

Do NOT use Mirvaso if taking a Monoamine oxidase inhibitor (MAOI) including selegiline, moclobemide, or imipramine (used to treat depression or Parkinson's disease).

Discuss with your regular GP before using Mirvaso if taking:

• Any blood pressure medication, including: Beta blockers; calcium channel blockers; alpha agonists, e.g. clonidine (also used for migraine); alpha blockers/antagonists, e.g. prazosin (also used for Raynaud's syndrome & benign prostatic hyperplasia); reserpine; isoprenaline
• Digoxin (for heart conditions)
• Chlorpromazine (for psychiatric disorders)
• Methylphenidate (for ADHD)

Pregnancy and breastfeeding

Mirvaso is untested in pregnant and breastfeeding women, and although there is no known risk, these women should avoid use of Mirvaso.

Alcohol and driving

Regular alcohol use is likely to worsen rosacea and is best avoided. Alcohol may increase the risk of dizziness when using Mirvaso. Mirvaso is not known to affect the ability to drive or operate machinery.