Mirvaso has been approved by the FDA.

[metalgear85]

FYI - In Minnesota a 30g tube of Mirvaso retails for $303.97. I have Blue Cross Blue Shield of Nebraska, so I paid $50. The tube I bought on 9/27/13 expires 05/15. It's made in Canada. The box reads: "Each gram of Mirvaso topical gel contains 5 mg of brimonidine tartrate, equivalent to 3.3 mg of brimonidine free base." We already knew the concentration is 0.33% brimonidine - topical gel. The box tells you to use a pea-sized amount on the forehead, chin, nose, and each cheek (5 areas). I'm going to start with less than a pea-sized amount on my cheeks and nose - the only places I have redness or get flushing. I'm never going to put a photo of myself on the internet, so please dont bother asking.

Inactive ingredients: carbomer homopolymer type B, glycerin, methylparaben, phenoxyethanol, propylene glycol, purified water, sodium hydroxide, and titanium dioxide.

Maybe we should start a new thread that will only be used for posting results? No discussions, just results of people using it first hand.

[Vovin]

FYI - In Minnesota a 30g tube of Mirvaso retails for $303.97.

That can't be right.

[metalgear85]

I started reading the huge 2-sided page of instructions that comes with Mirvaso. Part of one page explains in detail how to take the cap off the tube, which made me laugh. It also says "do not use Mirvaso gel in your eyes, mouth, or vagina". Who would do that? It also tells you not to put Mirvaso on "irritated skin or open wounds".

Random stuff on the instructions: Avoid contact with your eyes and lips. Spread it evenly and thinly over your face. Wash your hands immediately after applying. Apparently Mirvaso gel is dangerous if ingested, especially by children. "Erythema and flushing: Some subjects in the clinical trials discontinued use of Mirvaso because of erythema or flushing. The effect of Mirvaso may begin to diminish hours after application. For some subjects in the clinical trials, erythema was reported to return worse compared to the severity at baseline. Intermittent flushing occurred in some subjects treated with Mirvaso. The onset of flushing relative to application of Mirvaso varied, ranging from approximately 30 min. to several hours. Erythema and flushing appeared to resolve after discontinuation of Mirvaso." There are stats on the study that was done - that info is already available in David's blog or on the Mirvaso website. "Skin redness and flushing may happen about 3 to 4 hours after you apply Mirvaso. Tell your doctor if you get skin redness and flushing that is uncomfortable for you." "Mirvaso can lower blood pressure" "Do you give Mirvaso to other people, even if they have the same symptoms you have. It may harm them" Haha "Mechanism of action: Brimonidine is a relatively selective alpha-2 adrenergic agonist. Topical applicatoin of Mirvaso may reduce erythema through direct vasoconstriction." Mirvaso is metabolized by the liver and excreted in urine.

[metalgear85]

That can't be right.

That's what it reads on my pharmacy receipt. Without a coupon or insurance, that's what I would have paid.

[Vovin]

That would mean it would be cheaper to get laser treatment every month than use Mirvaso.

[maskielli]

FYI - Maybe we should start a new thread that will only be used for posting results? No discussions, just results of people using it first hand.

I think that would be a good idea, this thread is getting pretty crazy

[Starlite]

I guess that Mirvaso <snip>evaluation process.

" I realize that it is a "treatment", not a "cure"." I agree with that

"ALL pharmaceuticals have plusses and minuses. The key is to make the plusses work for you individually. If the minses totally outweigh the plusses, then maybe you should move on to a different product." I also agree with that.

"However, Mirvaso is indicated to be used once per day. As an analogy, if a physician prescribes a blood pressure medication to be used once per day and you skip several days between doses, guess what will happen. On the days that you skip, you will have rebound hypertension. Yes, your blood pressure will be significantly higher on those skip days than it was before you first started the medication. If you stay off the medication, blood pressure will slowly drift back down to your "normal" elevated level. In fact, because of this, skipping blood pressure medication doses puts one at greater risk for stroke than not taking the medicine at all." I completely disagree with this analogy. High blood pressure has profound negative effects on several body systems. The first line of defense for high BP is to make life style changes that bring it down. If it's very high they prescribe meds to help lower it while the life style changes are taking effect. Or at least that's what is supposed to happen Taking the pills some days, then other days not, then maybe some days extra is deadly business. If BP meds would cause the body to adapt to it and raise the tolerance, requiring more medication to achieve the same effect then you could call that rise rebound.

We are talking here about a topical medication that is NOT intended to become systemic. They make that clear by their instructions about not getting it on any mucus membranes (thus the comment about not applying to vagina), and washing hands afterwards. Patch testing topical medication, in my opinion, is the responsibility of every consumer because this gives them the power to control adverse affects and keep them to a minimum.

People are concerned about rebound flushing, meaning break through flushing, as a tolerance build up that is worse then anything they experienced before using this medication because it was reported by people who used the active ingredient Brimonidine and by people in the study using the gel mix. Not everyone experiences this so it makes sense to see if you personally are reactive to this medication.

"The subjects in the phase 3 trial (who overall, did great) used Mirvaso as indicated, every day on all areas of their face. They did not micro-scrutinize one millimeter of their face over another and they did not decide to "take days off" to "see what will happen". The "test subjects" were doing a test trial so all applied as instructed. It is your assumption that the ones who did as they were told were the ones who did well. Nothing in any of the data I have read suggests this is true. If I missed it, please quote that here for me.

"Also, many medications require a "priming" or "loading dose" before complete effectiveness is achieved." This is true, and maybe true for this medication but it does not say that in the anything I have read about it.

"Try using the med daily as indicated for a month or 2 and then write in some feedback. Hour to hour updates about particular patches of skin treated by intermittent dosing is not helpful in the evaluation process." The hour to hour up dates are at the request of members who are anxiously wondering if this medicine is the magic they have been waiting for and other members who have access are helping them out. It is very reasonable to try a patch test on a small spot, then wait a day or two to see if you react negatively, then go for two weeks straight on that small test spot. THEN try the whole areas you plan to treat. Just using a sulfur based product as an example... if you are highly allergic to sulfur your one day, small area patch test would show very reactive skin there. It would not make sense to use it on your whole face then. If you progressed to the two week step you may have an increase in symptoms as mites die off, but your skin would not react with extreme red inflammation and swelling if this is a medication you can tolerate. It would then make sense to treat the whole face.

In other words.. pick an area on your worse spot, about the size of a dime and apply a small amount of the medication. Do not apply the next two days and see how that area does. You are watching for extreme reactions like rash, inflammation, redness, and/or swelling. If you do not get that, then treat that same spot for the next two weeks as directed to see what your body does with this medication. You will know by then if this is for you or not.. most likely. Then move on to treat the areas you plan to treat. You could develop problems at any time but they will most likely show themselves early on. It's ok to tell us how you are doing daily too if you would like. I am sure many would like to know.

There is some very clever marketing going on with this medication. Look at how people are begging for it. The way they dropped hints about this thing for years... until folks are demanding they get access to it. (Maybe those were real people, maybe not.. maybe they were paid marketers) Then look at the tiny sample set they show us for the trials?!? In all these years, only this small number of people for 30 days and an even smaller number for a year?!? Then look at the outrageous price. LOL PLEASE! Of course after coupons and such no one pays more then $50 (still too high) but all part of a marketing plan that works all to well and has for ever...

[nat007]

" I realize that it is a "treatment", not a "cure"." I agree with that

"ALL pharmaceuticals have plusses and minuses. The key is to make the plusses work for you individually. If the minses totally outweigh the plusses, then maybe you should move on to a different product." I also agree with that. ........
There is some very clever marketing going on with this medication. Look at how people are begging for it. The way they dropped hints about this thing for years... until folks are demanding they get access to it. (Maybe those were real people, maybe not.. maybe they were paid marketers) Then look at the tiny sample set they show us for the trials?!? In all these years, only this small number of people for 30 days and an even smaller number for a year?!? Then look at the outrageous price. LOL PLEASE! Of course after coupons and such no one pays more then $50 (still too high) but all part of a marketing plan that works all to well and has for ever...

Very well said Starlite. Don´t think anyone can reason with any of that. Wjs was the same who repeatedly advised people here to just add hydrocortisone to the mix in order to prevent rebound flushing, which is really an almost outrageous thing to advice people here given the contraindication of steroids-cortisone and rosacea skin. I learned the very hard way with IPL that test spots are sensible with crazy skin like ours. I don´t think brimonidine/mirvaso will cause long term worsening after testing it (or it didnt with me at least), but for him to tell people here that its silly to want to do test spots makes no sense. It should be great if people start trying mirvaso and do it the way they feel comfortable, and post about it as much as they want. I think everyone would appreciate it. It can´t be that others here are telling them off for not sticking through with a 2 month long trial period; if you feel its sensible to keep testing it because your skin agrees with it fine, if you feel it reacts to it then no one should be made to feel bad for reporting this and stopping.

[Starlite]

Very well said Starlite. Don´t think anyone can reason with any of that. Wjs was the same who repeatedly advised people here to just add hydrocortisone to the mix in order to prevent rebound flushing, which is really an almost outrageous thing to advice people here given the contraindication of steroids-cortisone and rosacea skin. I learned the very hard way with IPL that test spots are sensible with crazy skin like ours. I don´t think brimonidine/mirvaso will cause long term worsening after testing it (or it didnt with me at least), but for him to tell people here that its silly to want to do test spots makes no sense. It should be great if people start trying mirvaso and do it the way they feel comfortable, and post about it as much as they want. I think everyone would appreciate it. It can´t be that others here are telling them off for not sticking through with a 2 month long trial period; if you feel its sensible to keep testing it because your skin agrees with it fine, if you feel it reacts to it then no one should be made to feel bad for reporting this and stopping.

Ya know Nat, I didn't make the connection that this was the same person recommending the use of hydrocortisone to help mask any rebound flushing. Thank you for connecting the two. That would be a highly unwise course of action indeed.

I also agree with your assessment that no one should be made to feel bad about proceeding with caution, watching out for their own best interests, and sharing their experiences with others. I know I sure appreciate hearing how it is going for everyone.

Kind'a makes me wonder why some people are now calling for this thread to be abandoned, that it's all messed up now etc... Ya think some one might be trying to manage information sharing?

[maskielli]

Kind'a makes me wonder why some people are now calling for this thread to be abandoned, that it's all messed up now etc... Ya think some one might be trying to manage information sharing?

When the last 4 pages have basically only contained posts from people not using the drug, i know im not the only one who thinks a thread dedicated to users experiences with Mirvaso might help with sifting through it all.

edit: in fact basically the entire thread has been that lol, and im as guilty as anyone :P

[nat007]

When the last 4 pages have basically only contained posts from people not using the drug, i know im not the only one who thinks a thread dedicated to users experiences with Mirvaso might help with sifting through it all.

edit: in fact basically the entire thread has been that lol, and im as guilty as anyone :P

True. On the other hand, its a new drug/treatment option and a lot of the theorizing and general talk has been in relation to actual users posting questions about the side effects they think they encountered. New drug equals many questions. But a new thread with only user comments seems a good idea?

[maskielli]

True. On the other hand, its a new drug/treatment option and a lot of the theorizing and general talk has been in relation to actual users posting questions about the side effects they think they encountered. New drug equals many questions. But a new thread with only user comments seems a good idea?

I think it would help, also just having a proper established thread that has some resources on it in the first post so people can find information out themselves such as availability, cost, pictures etc would be good to help avoid duplicate questions.

[wiry]

Here is what I found. If I use the recommended amount (3 total pea sizes - forehead and cheeks) it totally blanches the skin. A couple problems with this:

- looks unnatural (on my face at least)
- may cause rebound flushing (at potentially severe levels).

So here is my approach right now. I use about a half pea size (total) for all three areas. This is just barely enough to get a very thin layer on. This would be about 15% of the manufacturers recommendation. If you are just doing the cheeks, you may want to try just a quarter of a pea size total for both cheeks.

- this tones down redness, but does eliminate it. To me it looks pretty natural and improves my cosmetic look to an acceptable level.
- in theory, this should significantly decrease the rebound side effect.

I think the recommended amount is simply too much and increases the chance of a bad rebound. It totally blanches the skin. This suggests that a smaller amount would also blanch the skin (and hence there is just too much being applied). A smaller amount will just tone down redness (and I don't think there are any other drugs that can really even do this). So instead of going for the home run (totally pale), why not try (and be happy with) a reduction in redness and the hope that you can use it more regularly without bad rebounds. Sure, I could apply 6 times more and get total blanching, but then the risk of side effects go through the roof. It could also be a problem psychologically (a cycle of pale and red skin). I much prefer a more consistent toned down level.

[maskielli]

Here is what I found. If I use the recommended amount (3 total pea sizes - forehead and cheeks) it totally blanches the skin. A couple problems with this:

- looks unnatural (on my face at least)
- may cause rebound flushing (at potentially severe levels).

You didnt experience the rebound yourself did you? I've read your previous posts and didnt find any mention of it, are you just cutting down the amount for cosmetic reasons aswell as a precaution only?

[wiry]

With regard to my personal experience, I did notice something that may have been a slight rebound, but nothing to post about. I was not sure I could directly attribute that to Mirvaso though. So, yes, I am scaling back because:

- for my face, a little pinkness is cosmetically acceptable and in fact preferred (to me). I did not like the look of totally pale skin.
- based on all of the reading, I fear rebound is very possible/probable. Therefore, using a smaller dosage is preventative (in theory at least)
- I did not like going to red to pale to red, etc. It is a gradual transition and therefore it is not predicable how you are going to look at any given moment. I really don't want to revolve my life around timing the peak paleness and return of redness. I didn't want the distress of looking pale one moment and red the next.

So my theory is that a much smaller amount, applied once or twice daily would give cosmetically acceptable results, smooth out the roller coaster of pale/red, and decrease odds of rebounds. In theory at least For now, it seems to be going OK but I will certainly report back as I experiment.

Either way, I think this is a good way to start trying out Mirvaso. You can always gradually increase the amount. I think the key is apply the minimum amount you find acceptable. Anything beyond that has the potential for increased risk of side effects with little value in return.