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|Type of medicine||Alpha agonist|
|Works by||Reduces the redness of the skin by decreasing the blood flow to the area.|
|Active ingredient||Brimonidine tartrate|
|Effective within||1-2 months|
|Common side effects||Redness, Itching, Flushing|
|Use with alcohol||Use with caution|
Mirvaso Gel Information
What is Mirvaso gel and what is it used for?
Mirvaso gel has been specially designed to reduce increased redness of the face due to the skin condition rosacea. The active ingredient in Mirvaso rosacea gel, brimonidine tartrate, belongs to a group of medicines called alpha agonists that reduce the redness of the skin by decreasing the blood flow to the area.
Mirvaso gel is a prescription-only treatment for rosacea suitable for adults over the age of 18 years. For this treatment to be effective, it needs to be applied every day to the affected areas. Topical Mirvaso gel is manufactured by Galderma and comes in a 30g tube.
What is rosacea?
Rosacea is a chronic condition characterised by recurrent episodes of facial flushing, redness and spots. The areas of the face commonly affected are the cheeks, nose, forehead and chin. Rosacea occurs when the blood flow to the facial skin increases. This is due to the small blood vessels in the skin dilating, allowing for an increase in blood flow.
There’s no set cure for rosacea: it all depends on the severity of your symptoms. Those with more severe symptoms may be prescribed an oral antibiotic to reduce inflammation. The antibiotics commonly used to treat rosacea include tetracycline, oxytetracycline, doxycycline and erythromycin.
Triggers that can make symptoms of rosacea worse include:
- direct sunlight
- wearing too much makeup
- harsh skincare products
- emotional stress
- spicy foods
- hot baths
- extreme weather
- caffeine withdrawal
How does Mirvaso gel work?
The active ingredient brimonidine is an alpha agonist. These medicines work by stimulating the alpha receptors found in the muscle walls of the blood vessels. When applied topically to areas of reddened skin, it causes the blood vessels under the skin to contract. This decreases the flow of blood through the vessels, resulting in the reduction of redness.
Alternatives to Mirvaso
Dermalex Rosacea Treatment is a non-prescription alternative to Mirvaso Gel that can be bought online from The Independent Pharmacy.
We also stock a range of alternative prescription-only gels and creams, including Soolantra Cream and Rozex Gel. To find out more about rosacea and see all the available treatments, see our rosacea advice page.
Mirvaso gel warnings
Mirvaso gel is a prescription medication for rosacea. Always ensure you read the Patient Information Leaflet enclosed with Mirvaso before using the gel. You will need a rosacea prescription in order to buy Mirvaso gel online.
- Keep out of the reach and sight of children
- Not to be used in children less than 18 years
- Do not use if you are allergic to any of the listed ingredients
- Do not apply to closed eyes
- Mirvaso has not been studied in patients with renal or hepatic impairment
- Mirvaso should not be used during pregnancy or breastfeeding
Mirvaso is not suitable for use if you suffer with any of the following conditions:
- The skin of your face is irritated or has open wounds
- You have problems with your heart or circulation
- You have depression, decreased blood flow to the brain or the heart, fall in blood pressure on standing up, decreased blood flow to the hands, feet or skin, or Sjögren’s syndrome
- You have kidney or liver problems or have had them in the past
Mirvaso and other medicines
Mirvaso is not suitable if you take any of the following:
- Medicines used for depression or Parkinson’s disease, including monoamine oxidase (MAO) inhibitors
- Tricyclic antidepressants (such as imipramine) or tetracyclic antidepressants (such as maprotiline, mianserin or mirtazapine)
- Medicines used for the treatment of pain, sleep disorders, or anxiety disorders
- Medicines used for the treatment of psychiatric disorders (chlorpromazine) or used for hyperactivity (methylphenidate) or for high blood pressure (reserpine)
- Medicines that act on the same body mechanism as Mirvaso (other alpha agonists)
- Cardiac glycosides (e.g. digoxin) used to treat heart problems
- Blood pressure lowering medicines such as beta-blockers or calcium channel blockers (e.g. propranolol, amlodipine)
Mirvaso gel, pregnancy and breastfeeding
You should not use this gel if you think you might be or you are currently pregnant. You also should not use this gel if you are breastfeeding.
How to apply Mirvaso gel
For use by adults over the age of 18 years:
- Mirvaso topical gel is applied once daily at any time of day, for as long as facial erythema (redness) is present
- Apply a pea-sized amount to the forehead, nose, chin and cheeks
- Spread a thin layer smoothly and evenly across the entire area, avoiding the eyes, eyelids, lips, mouth and membrane of the inner nose. Mirvaso should only be applied over the face
- Wash your hands immediately after applying
- The maximum daily recommended dose is 1g in total weight (five pea-sized applications)
Mirvaso can be used in conjunction with other rosacea creams. It can also be used with makeup and cosmetics. They should only be used after the applied Mirvaso has been absorbed into your skin.
Mirvaso gel ingredients
Mirvaso rosacea gel contains the active ingredient: brimonidine tartrate 0.33%.
Mirvaso gel also contains the inactive ingredients: Carbomer, Methyl parahydroxybenzoate (E218), Phenoxyethanol, Glycerol, Titanium dioxide, Propylene glycol, Sodium hydroxide, Purified water,
Brimonidine side effects
Like all medicines, Mirvaso can cause side effects, although not everybody gets them. Common side effects include:
- Skin burning sensation
They are typically mild to moderate in severity, and usually do not require Mirvaso use to be stopped. These side effects can feel like a worsening of your initial symptoms, and it is impossible to predict if you will experience them before you try Mirvaso. For this reason, we recommend that you order just one tube to start with, and use the gel on a small area of the face at first.
Less common side effects include:
- Dry mouth
- Cold hands and feet
- Feeling hot
- Nasal congestion
- Skin rash, pain or inflammation
- Dry skin
- Warm tingling sensation
- Swelling of the eyelids or face
- Urticaria (itching)
- Worsening of rosacea
Mirvaso Gel reviews
Mirvaso Gel FAQs
Mirvaso gel is the only licensed product available to treat redness and flushing in rosacea. It contains the active ingredient brimonidine. It starts to work in as little as 30 minutes and lasts for up to 12 hours. Mirvaso is effective at reducing redness in 70% of patients suffering from rosacea. It can be used by patients of any age over 18 years old and it is just as effective for teenagers and the elderly alike.
The symptoms of rosacea can include facial redness (around the central part of the face), swollen blood vessels on the nose and skin, and tender bumps and lumps on the skin, which can be hot and tender to touch. These symptoms are believed to be caused by the dilation of blood vessels and increased blood flow to the area.
Mirvaso constricts or narrows the blood vessels, which reduces the blood flow and therefore reduces the symptoms of rosacea.
You can also help to keep the symptoms under control by using by using these self-help techniques.
Apply Mirvaso gel once daily to dry skin (application to wet skin can cause the gel to run into the eyes or mouth).
Using a clean fingertip, apply one small pea-sized amount of gel to each of the following affected areas - forehead, both cheeks, nose and chin - up to five in total.
Allow the gel to dry before applying makeup or other cosmetics.
Take special care when applying around the eyes. If any gel gels in the eyes it should be washed out thoroughly with water straight away.
Wash your hands after use to limit the constriction of blood vessels in the hands and fingers.
There are multiple treatments for rosacea that are split into two distinct groups - one to reduce the symptoms of redness and flushing, and the other to fight the infection on the skin that often causes rosacea. The groups and treatments are compared below:
Papules and pustules - These are lumps and bumps on the surface of the skin which may be red, hot and tender to touch. They are normally caused by bacteria that live on the skin.
Azelaic Acid and Metronidazole are used to treat mild to moderate pustules and papules. They are applied once or twice a day. The Azelaic Acid is more effective but comes with a greater incidence of side effects. Treatment needs to be continued for a few weeks before a significant difference is usually seen.
Erythromycin (antibiotic) is used to treat papules and pustules which are greater in number and severity and unresponsive to other medicines. It is also used when there is inflammation. Erythromycin needs to be taken for 4 - 6 weeks before a significant difference is seen.
Facial redness and flushing - symptoms caused by expanded blood vessels.
Mirvaso reduces the blood flow thought to be responsible for the redness and flushing. When it is applied once a day a difference can be seen in as little as 30 minutes, lasting for up to 12 hours. Some patients may experience a worsening of the redness, usually within the first 2 weeks of treatment. If you stop using the gel this will get better by itself. You should test a small portion of the skin with the gel before restarting and if it occurs again the treatment should be discontinued.
Oral Treatments – Clonidine, beta-blockers and anxiety medication prescribed under the supervision of a dermatologist can reduce redness and flushing. The mode of action in reducing rosacea symptoms remains unclear.
This usually occurs on the nose (rhinophyma) and if severe can be treated with surgery, dermabrasion or laser treatment. Laser treatment involves having narrow lasers aimed at the visible blood vessels in the skin, causing them to shrink so they're no longer visible. It can be mildly painful, with possible side effects including temporary bruising and swelling.
Mirvaso can be used continuously. It needs to be used every day for the redness and flushing to be controlled.
Very little Mirvaso gel is absorbed into the bloodstream and circulated around the body. It is applied in smaller amounts where it is needed, therefore it is well tolerated and most of the side effects occur where the gel is applied.
Some patients find that the gel makes the redness worse (this may be coupled with itching and burning sensation too). This usually happens within the first 2 weeks of treatment. If this happens stop the gel and treat accordingly with painkillers and antihistamines where necessary.
Test using a small amount of gel before restarting treatment. Discontinue if the redness worsens again.
Mirvaso may also cause acne, dry mouth and cold feeling in the hands and feet in less than 1% of users.
Mirvaso will start to work in as little as 30 minutes and lasts for up to 12 hours.
The effects of Mirvaso last for up to a day. It needs to be applied daily to be effective. If you miss an application you won't experience any reduced redness for that day.
Do not apply two or more applications in a day as this increases the chance of side effects without an increase in a reduction in redness.
Apply Mirvaso gel as usual and allow to dry completely before applying makeup and other cosmetics (including camouflage creams like Veil cover cream). As long as Mirvaso has had time to absorb into the skin there is no problem applying makeup or cosmetics over the top.
- Patients who are pregnant or breast-feeding should not use Mirvaso because it may affect development of the unborn baby. The concentration of Mirvaso in breast milk has not been established.
- Mirvaso does not have any effect on fertility.
- Mirvaso is not to be used by patients under the age of 18 years old.
- Mirvaso should not to be used by patients with liver or kidney problems as the effects have not been established.
- Do not use on irritated or open/broken skin.
- Patients with poor circulation in their hands and feet or with low blood pressure or a tendency for their blood pressure to fall should not use Mirvaso gel.
Mirvaso should not be taken with the following medication:
- Antidepressants called Monoamine Oxidase Inhibitors or MAOI for short
- Imipramine and other tricyclic antidepressants
- Moclobemide and maprotiline used to treat depression (not very commonly used in the UK)
- Medication used to treat Parkinson’s, namely selegiline.
- (If you are not sure what type of antidepressant medication you are taking, then contact us or talk to your doctor.)
- Chlorpromazine used to treat psychiatric disorders.
- Methylphenidate for the treatment of hyperactivity.
- Reserpine for high blood pressure (not commonly used in the UK).
- Digoxin and other cardiac glycosides used in treating heart failure.
- Propranolol and other beta-blockers for treating high blood pressure.
- Amlodipine and other calcium channel blocker commonly used to treat high blood pressure.
- Alpha agonist drugs like clonidine.
- Alpha blocking drugs like prazosin used for treating high blood pressure, asthma or a slow heart rate.
Galderma, the manufacturers of Mirvaso, are currently the only licensed manufacturers of the brimonidine gel in the UK. As the patent for this product has not yet expired, there is no unbranded or generic alternate on the UK market.
The two skin conditions can appear very similar. The main difference is that couperose occurs due to the capillary walls expanding, whereas rosacea is an inflammation of the skin. However, some rosacea sufferers may experience couperose skin as an initial symptom. Prevalence of couperose is usually down to sun exposure, extreme temperatures and lifestyle habits, such as smoking and drinking alcohol.
Certain dietary changes may help to reduce the symptoms of rosacea. It’s a good idea to avoid trigger foods and drinks, including certain vegetables, alcohol, caffeine, citrus fruits, refined sugar, beef and seafood. Some vitamins and minerals also have anti-inflammatory effects – seek professional advice before adding supplements to your diet.
Seborrheic dermatitis is also an inflammatory skin disorder, and most commonly appears inside the ears, on the forehead, in the eyebrows, and around the nose. It’s characterised by scaly/greasy/yellow patches of skin and is often accompanied by dandruff – but no acne bumps or pustules, as with rosacea.
If you’re uncertain what you’re suffering from, get a free online consultation and we’ll help to identify your condition. Often, people with rosacea also have seborrheic dermatitis, and these different conditions must be treated separately. If you’re only suffering from dermatitis, you will likely be prescribed a treatment like E45 Itch Relief Cream or Dermol Cream.
Mirvaso is the brand name for the active Ingredient brimonidine.