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  • Originally posted by Starlite View Post
    I am very serious. "Ischemia" is simply the descriptor for loss of proper circulation to tissue causing a shortage of oxygen and glucose needed for cellular metabolism. It is not a word used to describe the cause of the circulation loss. Your study link is very interesting in that brimonodine was used in small doses to prevent the the damage clearly described "as reperfusion injury" on the optic nerve after circulation returned. It is only the abstract though. I would love to see the whole study.

    No one is describing "allergy" like symptoms here on this forum but what they do describe does fit symptoms of frost bite like injuries or other ischemic like injuries. They report cold sensations, extreme blanching of the treated areas, and "rebound" flushing. The worst cases even report a sloughing off of dead tissue as they recovered from the use of the medication. The Mirvaso is intended to affect the redness of the skin. If it is achieving this goal by shutting down vascular supply to the face, it will cause damage.

    If applying Benadryl helps this issue it maybe because as described, "The restored blood flow also exaggerates the inflammation response of damaged tissues, causing white blood cells to destroy damaged cells that may otherwise still be viable." This is also found in an allergic reaction. As you and wiry both mentioned, it would not be wise to cover up those symptoms because it may just be hiding damage that is occurring.

    So to me the big question is, does Mirvaso work by shutting down vascular supply to the skin it is applied to?

    No Mirvaso does not work in that manner because if it did it would not be approved and alphagan would cause Ischemia. Alphagan has been used consistently for years without any signs of it causing Ischemia and again Alphagan caused allergic reactions to up to 20 % of the patients wich is in line with what I said. Ischaemia is reduction to the point that tissue begans to die, Brimonidine does not cause that.

    Comment


    • Originally posted by Makron View Post
      No Mirvaso does not work in that manner because if it did it would not be approved and alphagan would cause Ischemia. Alphagan has been used consistently for years without any signs of it causing Ischemia and again Alphagan caused allergic reactions to up to 20 % of the patients wich is in line with what I said. Ischaemia is reduction to the point that tissue begans to die, Brimonidine does not cause that.
      ?????????????????? Alphagan IS brimonidine.

      Comment


      • Originally posted by Makron View Post
        Are you serious. Ischemia is caused by trauma or by a blood cloth and sometimes by inherited disese and under no circumstances does Brimonidine cause Ischemia. If it did it would probably not have been approved and also Alphagan would have caused Ischemia. Im not even going to discuss frostbite. Why did you even bring up frostbite

        Brimonidine is even used to combat Ischemia: http://www.ncbi.nlm.nih.gov/pubmed/11950228

        25 % in the brimonodine study reported allergic reactions. People using Mirvaso where reporting flushing far more then the trials suggested. The trials did not involve people that where allergic so its safe to assume that the general population will have more problems then the people involved in the trials due to allergy. This is why I claimed that allergy was a plausable reason for the many negative reports. The allergy claim is based on sound reasoning. It is the best and simplest explanation for the difference in user reports and the FDA trials.
        Makron,

        That was my initial simple logical conclusion as well. However, there is a difference between an allergic reaction and the rebound effect. For example, cocaine constricts vessels so that when a cocaine addict is withdrawing from the drug the eyes will become red in a 'rebound' effect of the drug. You can see clearly why a cocaine addict is in a mess without the drug (obviously red eyes are only one 'rebound' side effect).

        What is happening with Mirvaso 'victims' is rebound, which technically isn't an allergic reaction, but a side effect of brimonidine withdrawal. That is my understanding of this issue, at this point.

        The signs and symptoms of allergy are hives, rash, difficulty breathing, etc.

        We had this discussion way back in this thread. And I know there is a gray line between differentiating an allergic reaction to rebound but that is why they have a different word (rebound) describing what is happening to these 'victims' or patients who have accepted this treatment.
        Last edited by Brady Barrows; 26 November 2013, 09:27 PM.
        Brady Barrows
        Blog - Join the RRDi


        Comment


        • Difference Between an Allergic Reaction and Rebound

          To understand the difference between an allergic reaction and rebound, Husein Husein El-Ahmed, M.D., RRDi MAC Member, explains;

          "Allergic reaction is a immune-mediated process which requires a previous contact of antigen presenting cells to the drug. This first contact shows no symptoms in the person, and it is known as sensibilization. Once one person is sensibilized, the second contact to the drug leads to a rapid reaction including rash, itchy eyes, swollen tongue, and even, anaphylactic reaction.Rebound is a NON-immune-mediated process in which the symptoms are caused for the effect or the lack of effect (discontinuation) of a drug. This reaction is rather quickly, but no immune cells are implicated, in overall terms."

          Mirvaso Post #9

          You can now see why having the RRDi MAC is worth all the effort I have been doing for almost ten years. We can ask questions and hopefully get some answers.
          Brady Barrows
          Blog - Join the RRDi


          Comment


          • Only negative reviewers post?

            The question has come up as to why there are so many negative reviews. Some claim it is because there is a tendency for negative reviews to post, while positive reviews are not posted.

            In general, I do not agree that this would be the case. We see many people excited to post positive reviews on this forum (across the different sub forums). We also see that for products in general.

            Now lets be more specific. When Mirvaso was first introduced, there were several people who went from (a) talking about getting it (b) seeing their doctor (c) then using it. Each of these people had no particular bias at that point (aside from that they were all forum members). But none of them knew if it would work for them. They were simply going to report their results. And they did. And the results were consistently poor.

            Now lets look at the other aspect. If there were many users on this forum that had success, they would be even more inclined to post. The would want to help offset the negative reviews and share their positive experience. That is simply not happening. There is very little that is positive to be said about Mirvaso. Yes, there are some very positive studies. But the real world experience, by any measure, is very negative.

            Comment


            • Originally posted by Makron View Post
              No Mirvaso does not work in that manner because if it did it would not be approved and alphagan would cause Ischemia. Alphagan has been used consistently for years without any signs of it causing Ischemia and again Alphagan caused allergic reactions to up to 20 % of the patients wich is in line with what I said. Ischaemia is reduction to the point that tissue begans to die, Brimonidine does not cause that.
              Alphagan eye drops (brimonidine)

              How does it work? - Alphagan eye drops contain the active ingredient brimonidine, which is a type of medicine called an alpha agonist. It works by stimulating alpha receptors found on blood vessels in the eye. <snip> Brimonidine stimulates alpha receptors found on the blood vessels that supply the ciliary body. This causes the blood vessels to constrict, and reduces the amount of watery fluid that filters out of the blood vessels to form aqueous humour.<snip>

              Use with caution in -
              * Disease involving the heart and blood vessels (cardiovascular disease).
              * Decreased blood supply to the heart (coronary insufficiency), eg people with angina.
              * Decreased blood supply to the brain (cerebral insufficiency), eg people who have had a stroke or mini-stroke (transient ischaemic attack).
              * People who experience drops in blood pressure when moving from lying down to sitting or standing, that result in dizziness and light-headedness (postural hypotension).
              * Narrowing of the blood vessels in the hands, causing numb and painful fingers (Raynaud's phenomenon).
              * Progressive disease involving narrowing of the blood vessels in the legs (thromboangiitis obliterans).
              * Depression.
              * Decreased kidney function.
              * Decreased liver function.
              Brimonidine - Mechanism of action

              Peripheral alpha 2 agonist activity results in vasoconstriction of blood vessels
              It seems you have misunderstood what an allergic reaction is, what ischemia is, and how brimonidine works. I can understand so badly wanting this medication to work out well. So many people are suffering with redness and flushing and it has a profound impact on their lives. Of course you want this to work. But you have to be realistic about how this is turning out and it's not looking like it's the magic we have been waiting for.

              Originally posted by Brady Barrows View Post
              <snip>
              We had this discussion way back in this thread. And I know there is a gray line between differentiating an allergic reaction to rebound but that is why they have a different word (rebound) describing what is happening to these 'victims' or patients who have accepted this treatment.
              "We had this discussion way back in this thread. And I know there is a gray line between differentiating an allergic reaction to rebound but that is why they have a different word (rebound) describing what is happening to these patients who have had an adverse reaction after trusting their Doctor, pharmaceutical company, and the FDA"

              There, fixed.

              Originally posted by Brady Barrows View Post
              To understand the difference between an allergic reaction and rebound, Husein Husein El-Ahmed, M.D., RRDi MAC Member, explains;

              "Allergic reaction is a immune-mediated process which requires a previous contact of antigen presenting cells to the drug. This first contact shows no symptoms in the person, and it is known as sensibilization. Once one person is sensibilized, the second contact to the drug leads to a rapid reaction including rash, itchy eyes, swollen tongue, and even, anaphylactic reaction.Rebound is a NON-immune-mediated process in which the symptoms are caused for the effect or the lack of effect (discontinuation) of a drug. This reaction is rather quickly, but no immune cells are implicated, in overall terms."

              Mirvaso Post #9

              You can now see why having the RRDi MAC is worth all the effort I have been doing for almost ten years. We can ask questions and hopefully get some answers.
              So what Dr El-Ahmed is purposing is that the redness, flushing, pain, and even tissue sloughing, is a result of the tissue having rapidly adapted to the chemical brimonidine and what people are experiencing is withdrawal (rebound) symptoms... not "reperfusion injury" from an extended period of ischemia? I disagree. It happens to fast to be accounted for by the adaption/tolerance process, and then the need for more of the chemical to maintain baseline. Considering all the symptoms of first use; sensations of cold, color blanching, and then when the blood supply returns, extreme redness, pain, some reports of swelling, and even tissue sloughing. This is sounding like ischemia and reperfusion injury. Especially sense the mode of action for brimonidine is constriction of blood vessels.

              Originally posted by hozer2k View Post
              The question has come up as to why there are so many negative reviews. Some claim it is because there is a tendency for negative reviews to post, while positive reviews are not posted.

              In general, I do not agree that this would be the case. We see many people excited to post positive reviews on this forum (across the different sub forums). We also see that for products in general.

              Now lets be more specific. When Mirvaso was first introduced, there were several people who went from (a) talking about getting it (b) seeing their doctor (c) then using it. Each of these people had no particular bias at that point (aside from that they were all forum members). But none of them knew if it would work for them. They were simply going to report their results. And they did. And the results were consistently poor.

              Now lets look at the other aspect. If there were many users on this forum that had success, they would be even more inclined to post. The would want to help offset the negative reviews and share their positive experience. That is simply not happening. There is very little that is positive to be said about Mirvaso. Yes, there are some very positive studies. But the real world experience, by any measure, is very negative.
              I'm beginning to agree with your assessment Hozer2k.

              Comment


              • I had a bad rxn to Mirvaso

                Hi there- I wish I found this forum before I decided to try Mirvaso, but I only tried it once and things are much better now. I have pretty mild rosacea and flush occasionally and mildly just round my nose, normally I just take metrogel and it clears it up (the bumps) fine. I was talking with my dermatologist on Friday though, and she recommended this new drug mirvaso to help with the flushing. I asked her about side effects, she told me that they were worried about rebound as being one of them, but that the clinical trials proved it wasn't a side effect. So I took the medicine at about 4pm, she gave me a sample, I used a pea sized amount. After about 30 minutes, my face turned extremely pale, so pale, it looked like I was dead. I went to sleep at about 10pm, woke up,face still a little pale but a bit of color returning. By about noon, or roughly 20 hours later after I took the med, my face started to burn and flush terribly. Huge red triangles appeared on my cheeks. In patches, on my cheeks, my nose, it would be red in one area and then move to another area and then get red in the same area again. This went on for about 72 hours, in the middle of work I broke down and went home because of the horrible flushing and burning. I tried benadryl, and some expired steroid cream, it did nothing. The only thing that sort of worked was a cold rag compress to ease the angry blood vessels. I contacted my dermatologist who told me that it sounded like an allergic rxn, she rxed me a steroid cream. I put it on and about 5 hours later, combined with cold compresses, my face started to go down. When I woke up today, it had gone down a lot. I applied more steroid cream and went to work, the whole day, no flushing, no reactions, no burning. So I am torn- On one hand, my skin seemed to rebound from the medication- I got very flushed when I didn't put it on after the first treatment, and it would appear in different places, it didn't necessarily stay in one place like other skin rashes of mine have. But on the other hand, when I took the nonexpired steroid cream, the redness was mostly gone by the morning. I am a little nervous about discontinuing the steroids, because I am afraid the flushing might return, but I will cross that bridge when I get there I guess. Or maybe it was rebound and coincidentally wore off at the same time I began the steroids? I have been reading these forums and I know a lot of you who haven't tried this drug are seriously considering trying it- If you do, only try it on a very small area of your body first, and monitor it for a few days. I really wish I would have done that, and now I am very worried I may have damaged my flush response. But that being said, my response to the steroids has been very positive. I will never try Mirvaso again, my skin went from very mild flushing to fire siren red flushing and extreme pain, I have never experienced anything like it and I can't see how, given all of the similar complaints I have read online, this drug could continue on the market in the state it exists today, it just seems too dangerous, not to mention psychologically damaging to those of us who are already sensitive to our flushing. Best of luck to all of you, thanks for sharing your stories, it really helped me get through the worst of it.

                Comment


                • Ween yourself off the steroid cream. Long term use is bad. Your skin will probably settle back down. Don't mess with it too much! That is how I ended up in a bad state.

                  Comment


                  • Originally posted by Chime09 View Post
                    Hi there- I wish I found this forum before I decided to try Mirvaso, but I only tried it once and things are much better now. I have pretty mild rosacea and flush occasionally and mildly just round my nose, normally I just take metrogel and it clears it up (the bumps) fine. I was talking with my dermatologist on Friday though, and she recommended this new drug mirvaso to help with the flushing. I asked her about side effects, she told me that they were worried about rebound as being one of them, but that the clinical trials proved it wasn't a side effect. So I took the medicine at about 4pm, she gave me a sample, I used a pea sized amount. After about 30 minutes, my face turned extremely pale, so pale, it looked like I was dead. I went to sleep at about 10pm, woke up,face still a little pale but a bit of color returning. By about noon, or roughly 20 hours later after I took the med, my face started to burn and flush terribly. Huge red triangles appeared on my cheeks. In patches, on my cheeks, my nose, it would be red in one area and then move to another area and then get red in the same area again. This went on for about 72 hours, in the middle of work I broke down and went home because of the horrible flushing and burning. I tried benadryl, and some expired steroid cream, it did nothing. The only thing that sort of worked was a cold rag compress to ease the angry blood vessels. I contacted my dermatologist who told me that it sounded like an allergic rxn, she rxed me a steroid cream. I put it on and about 5 hours later, combined with cold compresses, my face started to go down. When I woke up today, it had gone down a lot. I applied more steroid cream and went to work, the whole day, no flushing, no reactions, no burning. So I am torn- On one hand, my skin seemed to rebound from the medication- I got very flushed when I didn't put it on after the first treatment, and it would appear in different places, it didn't necessarily stay in one place like other skin rashes of mine have. But on the other hand, when I took the nonexpired steroid cream, the redness was mostly gone by the morning. I am a little nervous about discontinuing the steroids, because I am afraid the flushing might return, but I will cross that bridge when I get there I guess. Or maybe it was rebound and coincidentally wore off at the same time I began the steroids? I have been reading these forums and I know a lot of you who haven't tried this drug are seriously considering trying it- If you do, only try it on a very small area of your body first, and monitor it for a few days. I really wish I would have done that, and now I am very worried I may have damaged my flush response. But that being said, my response to the steroids has been very positive. I will never try Mirvaso again, my skin went from very mild flushing to fire siren red flushing and extreme pain, I have never experienced anything like it and I can't see how, given all of the similar complaints I have read online, this drug could continue on the market in the state it exists today, it just seems too dangerous, not to mention psychologically damaging to those of us who are already sensitive to our flushing. Best of luck to all of you, thanks for sharing your stories, it really helped me get through the worst of it.
                    Oh I'm so sorry you went though this. You're going to be ok. You only used it once and you did all the right things after you got an adverse reaction. Like wiry says, long term use of steroids is a bad idea. Search the forum for that info about that. However, as a disruptor of a runaway reaction to something, a steroid cream is an awesome tool. Thank you for reporting this to us.

                    Comment


                    • Thanks Chime09, you made the 31st anecdotal report (Post #1) I have been collecting. Hopefully as Starlite says, you will get your skin under control eventually since you only used it once.

                      Did you wade through all 93 pages of this thread or did you just jump past them all and posted your experience?
                      Brady Barrows
                      Blog - Join the RRDi


                      Comment


                      • Originally posted by Brady Barrows View Post
                        Makron,

                        That was my initial simple logical conclusion as well. However, there is a difference between an allergic reaction and the rebound effect. For example, cocaine constricts vessels so that when a cocaine addict is withdrawing from the drug the eyes will become red in a 'rebound' effect of the drug. You can see clearly why a cocaine addict is in a mess without the drug (obviously red eyes are only one 'rebound' side effect).

                        What is happening with Mirvaso 'victims' is rebound, which technically isn't an allergic reaction, but a side effect of brimonidine withdrawal. That is my understanding of this issue, at this point.

                        The signs and symptoms of allergy are hives, rash, difficulty breathing, etc.

                        We had this discussion way back in this thread. And I know there is a gray line between differentiating an allergic reaction to rebound but that is why they have a different word (rebound) describing what is happening to these 'victims' or patients who have accepted this treatment.

                        Excellent summary Brady! Thanks for me not needing to dish my same posts up from last month
                        My rosacea related blog: http://scarletnat.blogspot.com/2012/...edication.html

                        Comment


                        • Originally posted by Chime09 View Post
                          Hi there- I wish I found this forum before I decided to try Mirvaso, but I only tried it once and things are much better now. I have pretty mild rosacea and flush occasionally and mildly just round my nose, normally I just take metrogel and it clears it up (the bumps) fine. I was talking with my dermatologist on Friday though, and she recommended this new drug mirvaso to help with the flushing. I asked her about side effects, she told me that they were worried about rebound as being one of them, but that the clinical trials proved it wasn't a side effect. So I took the medicine at about 4pm, she gave me a sample, I used a pea sized amount. After about 30 minutes, my face turned extremely pale, so pale, it looked like I was dead. I went to sleep at about 10pm, woke up,face still a little pale but a bit of color returning. By about noon, or roughly 20 hours later after I took the med, my face started to burn and flush terribly. Huge red triangles appeared on my cheeks. In patches, on my cheeks, my nose, it would be red in one area and then move to another area and then get red in the same area again. This went on for about 72 hours, in the middle of work I broke down and went home because of the horrible flushing and burning. I tried benadryl, and some expired steroid cream, it did nothing. The only thing that sort of worked was a cold rag compress to ease the angry blood vessels. I contacted my dermatologist who told me that it sounded like an allergic rxn, she rxed me a steroid cream. I put it on and about 5 hours later, combined with cold compresses, my face started to go down. When I woke up today, it had gone down a lot. I applied more steroid cream and went to work, the whole day, no flushing, no reactions, no burning. So I am torn- On one hand, my skin seemed to rebound from the medication- I got very flushed when I didn't put it on after the first treatment, and it would appear in different places, it didn't necessarily stay in one place like other skin rashes of mine have. But on the other hand, when I took the nonexpired steroid cream, the redness was mostly gone by the morning. I am a little nervous about discontinuing the steroids, because I am afraid the flushing might return, but I will cross that bridge when I get there I guess. Or maybe it was rebound and coincidentally wore off at the same time I began the steroids? I have been reading these forums and I know a lot of you who haven't tried this drug are seriously considering trying it- If you do, only try it on a very small area of your body first, and monitor it for a few days. I really wish I would have done that, and now I am very worried I may have damaged my flush response. But that being said, my response to the steroids has been very positive. I will never try Mirvaso again, my skin went from very mild flushing to fire siren red flushing and extreme pain, I have never experienced anything like it and I can't see how, given all of the similar complaints I have read online, this drug could continue on the market in the state it exists today, it just seems too dangerous, not to mention psychologically damaging to those of us who are already sensitive to our flushing. Best of luck to all of you, thanks for sharing your stories, it really helped me get through the worst of it.
                          Thank you so much for your very detailed description of your experience Chime. Unfortunately your post-Mirvaso flare sounds exactly like the many others we have been reading here. I tried a self made, same consistancy brimonidine mix and had exactly the same reaction as you, including the well described red, badly burning and flushing patches of redness appearing and moving around everywhere and the feeling of having your normal flushing times 50.
                          My rosacea related blog: http://scarletnat.blogspot.com/2012/...edication.html

                          Comment


                          • I asked my derm about Mirvaso again and this is his reply:

                            `Mirvaso is interesting. I think you tried the brimonidine eye drop on the skin N.., and this did cause severe rebound. I have looked through all the trial data and spoken to the American investigators and they all confirmed that no rebound occurred – so not sure what to make of these reports.´
                            My rosacea related blog: http://scarletnat.blogspot.com/2012/...edication.html

                            Comment


                            • Originally posted by nat007 View Post
                              I asked my derm about Mirvaso again and this is his reply:

                              `Mirvaso is interesting. I think you tried the brimonidine eye drop on the skin N.., and this did cause severe rebound. I have looked through all the trial data and spoken to the American investigators and they all confirmed that no rebound occurred – so not sure what to make of these reports.´
                              Whilst this reply is unsatisfying, I can at least sympathise because the published trial data is so different to what we have seen reported online that there is some investigating required to find out why.
                              Get Rosacea News here - https://rosacea-support.org

                              Comment


                              • Originally posted by David Pascoe View Post
                                Whilst this reply is unsatisfying, I can at least sympathise because the published trial data is so different to what we have seen reported online that there is some investigating required to find out why.
                                Yeh for sure David.. Its such a huge discrepancy that I also wonder what is really going on. I guess it takes a lot more time to find out if the published trials were accurate and there is just a disproportionate large group of bad responders here online, or if the trial outcomes were perhaps colored and misrepresenting things.
                                My rosacea related blog: http://scarletnat.blogspot.com/2012/...edication.html

                                Comment

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