Questions about using Alphagen P (brimonidine preserved with Purite)

[KnowItAll7]

I have been prescribed Alphagen P for open angle glaucoma that in left eye that also has a cateract which is part of the problem and I have been put on a waiting list for cataract surgery. I havent used the drops yet. I did some more research on Alphagen P and cant find answers. Im hoping you can help. I have been taking Citicholine, Pine Bark, Ginko Biloba to increase blood flow to my optic nerve and lower eye pressure which they have. I have gone from 32 and 31 in my eyes to 22 and 21 using these and changing my diet to a low carbohydrate one and adding exercise. The supplements have also lowered my blood pressure to  a resting rate usually varying between 98/65 to 112/75. This morning it was only 86/63 and I got concerned thinking if I started using the Alphagen P drops would they lower my blood pressure too low and cause the perfusion level to be too low and my optic nerve not be getting the blood flow enough with oxygen and nutrients which would cause worse damage to the optic nerve. So do you think I should cut out my supplements or maybe just take only one of them a day instead of all three each day and see what that does to my blood pressure before I start the drops?  Another concern is I already naturally have very small pupil size and I read that Alphagen P can cause miosis. Will that make my vision even worse since less light will get into my eyes? Also if I was using those drops and stopped using them will my eyes have a rebound effect where the pupils get larger because of not having the drug keeping the muscles not as active? If so would that worsen my vision also?
Also the insert says use caution in people with circulation problems. I have had one instance of Reynauds where my palm turned blue and I get tingling alot in my hands and feet and sometimes wake with an arm or hand numb which may be from sleeping wrong on it. Also I get skipped heart beats sometimes. The pharmacist seemed to think these drops have a very mild side effect profile and the only thing you must worry about is if you are allergic to it. How will you know if you are allergic if you already have dry red sore eyes, low blood pressure and not the best circulation?

[John C Hagan III, MD, FACS, FAAO]

I rarely use Alphagan-P anymore. It is usually expensive and latanoprost is a much better choice for most people. It is inexpensive and once per day dose. The rest of you statement/questions I can't answer. There is no scientific evidence that those supplements lower IOP. Remember IOP changes from hour to hour and varies 6-12 pts/day. You will need to direct these to your ophthalmologist