Mirvaso Gel

What is Mirvaso?

Mirvaso gel is a topical treatments used for reducing facial redness brought on by rosacea, a a common skin condition which can affect the cheeks, chin, forehead and nose.

How does Mirvaso work?

Rosacea is a common skin condition characterised by bouts of racial redness, flushing and spots. It is caused by increased blood flow due to the dilation of small blood vessels in the facial skin. Mirvaso contains the active ingredient brimonidine, a type of medicine known as an alpha agonist, which acts on the alpha receptors in the blood vessels, causing them to contract and narrow.

How long does Mirvaso take to work?

The effects of Mirvaso can become apparent just 30 minutes after application and last for up to 12 hours at a time.

How effective is Mirvaso?

Mirvaso can significantly reduce redness of the face for up to 12 hours at a time. When applied daily, it is an effective ongoing treatment for rosacea.

Active ingredients

The active ingredient in Mirvaso is brimonidine.

Inactive ingredients

The inactive ingredients in Mirvaso are carbomer, methylparahydroxybenzoate (E218), phenoxyethanol, glycerol, titanium dioxide, propylene glycol, sodium hydroxide, and purified water.

Mirvaso dosage

Dosage depends on the size of the affected area. The maximum daily dose of Mirvaso is approximately 1g applied thinly across the whole face.

How to use Mirvaso

Always use Mirvaso and instructed by a doctor or pharmacist. It is recommended to start by applying a smaller amount of gel in case of side effects. If no side effects become apparent, gradually increase the amount of gel used each day. Spread a pea-sized amount of gel over the affected area, making sure coverage is even and very thin. Do not exceed the maximum daily dose of 1g (approximately 5 pea-sized amounts) spread evenly across the whole face.

Mirvaso side effects

Like all medications, Mirvaso can cause side effects in some people. Common side effects (affecting up to 1 in 10 people include):

• Flushing
• Excessive whitening to the treated area
• Skin redness, burning or itching

Less common side effects, which can affect up to 1 in 100 people, include:

• Acne
• Dry mouth
• Feeling of cold in hands and feet
• Feeling hot
• Headache
• Nasal congestion
• Skin rash, pain, discomfort, irritation or inflammation, dryness, warm sensation, tingling or sense of pins and needles
• Swelling of the eyelids
• Swelling of the face
• Urticaria
• Worsening of rosacea
• Dizziness

Rare side effects can affect up to 1 in 1000 people. If you experience any of the following, stop using Mirvaso and contact a doctor immediately:

• Angioedema, a severe allergic reaction causing swelling of the face, mouth or tongue.
• Hypotension (decrease in blood pressure)
• Bradycardia (slow heart rate)  

Contraindications

Do NOT use Mirvaso if you are allergic to any of the ingredients listed on the packaging. This treatment is not suitable for use in children under 2 years of age.

Before using Mirvaso, talk to your doctor if:

• The skin of your face is irritated or has open wounds
• You have depression, decreased blood flow to the brain or heart, fall in blood pressure on standing up, decreased blood flow to the hands, feet or skin, or Sjögren’s syndrome
• You have or have in the past had kidney or liver problems 
• You have had or plan to have any laser procedure on your skin

Drug interactions

Do NOT use Mirvaso if you are taking certain medications for depression or parkinson's disease, such as so-called monoamine oxidase inhibitors (selegiline, moclobemide),  tricyclic antidepressants (such as imipramine) or tetracyclic antidepressants (maprotiline, mianserin, mirtazapin).

Before using Mirvaso, tell your doctor or pharmacist if you are taking any other medications, including those purchased over the counter without a prescription. In particular, tell your doctor or pharmacist if you are taking any of the following:

• Medicines used to treat pain, sleep disorders or anxiety disorders
• Medicines used to treat psychiatric disorders
• Medicines which act on the same body mechanism as Mirvaso, such as other alpha agonists, clonidine, alpha blockers or alpha antagonists
• Cardiac glycosides used to treat heart problems
• Blood pressure lowering medicine such as beta-blockers or calcium channel blockers

Mirvaso and alcohol use

Tell your doctor if you regularly consume alcohol as this could affect your treatment.

Dietary changes to help rosacea

If you regularly suffer from rosacea, you can try making some changes to your diet to reduce the impact of flare ups. Try cutting down on fatty, processed and sugary foods, alcohol and spicy foods, all of which are thought to be triggers of rosacea. You can also try adding foods to your diet that are thought to reduce flare-ups. Green vegetables, lean poultry, nuts and some spices, and foods that are high in omega-3 fatty acids are considered to be anti-inflammatory and may contribute towards reducing redness of the face. It is thought that rosacea is in part triggered by an imbalance in the microorganisms in our gut and skin. Try increasing your intake of fibre, prebiotics and probiotics can to help promote a healthy environment in your gut.

Mirvaso vs other rosacea treatments

Mirvaso is a relatively new treatment for rosacea. Alternatives that may be prescribed by a dermatologist include oral medications such as clonidine, which works by relaxing the blood vessels, beta-blockers to decrease the activity of the heart, and anti-anxiety medication to help reduce blushing. A more expensive option is laser or intense pulsed light (IPL) treatment, which causes blood vessels to shrink without causing damage or scarring to the surrounding area. If your rosacea is presenting as papules or pustules on the skin, topical treatments containing metronidazole (an antibiotic) or azelaic acid are available via the NHS. A doctor may also prescribe an oral antibiotic to help reduce inflammation of the skin.

Can I use Mirvaso with other skin products?

You can use Mirvaso with other skin care products such as moisturisers and creams. Do not use other products directly before applying Mirvaso; apply Mirvaso first and wait until it has been fully absorbed and the skin is dry.

Can I wear make-up when using Mirvaso?

You can wear makeup when using Mirvaso, but you should wait until the gel has been fully absorbed before applying any cosmetics to the affected area. 

Is Mirvaso safe to use continuously?

Mirvaso gel can be safely used continuously, and should be applied daily for as long as your doctor prescribes.

What should I do if I forgot an application?

Mirvaso works on a daily basis, so if you miss an application, your redness will not be reduced for that day. Do not apply extra to make up for a missed dose, just carry on applying the gel as usual.

Sources

• Patient information leaflet
• NHS > Rosacea
• Mirvaso > FAQs