Brimonidine (alphagan), a clonidine derivative and a2 agonist, is administered topically to lower intraocular pressure in patients with ocular hypertension or open-angle glaucoma; brimonidine both decreases aqueous humor production and increases outflow (see Chapter 63). Unlike apraclonidine, brimonidine crosses the blood—brain barrier and can produce hypotension and sedation, although these effects are slight compared to those of clonidine.

Dexmedetomidine (precedex), a relatively selective a2 agonist with sedative properties, produces preoperative sedation and anxiolysis, drying of secretions, and analgesia; the drug is used as an anesthetic adjunct.

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