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Dual-action ocular allergy drop acts as antihistamine, inhibits inflammation
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I was asked the following question at a pharmaceutical advisory meeting a few years ago: "What new drug would you like to see available for your patients?" My answer was: "A combination antihistamine/mast-cell inhibitor to improve convenience and compliance for my patients now having to use two ophthalmic allergy drops, with each being used four times per day."
Many of these patients wear contact lenses, and they either have to take their lenses out or not wear lenses during the treatment. Patanol (olopatadine hydrochloride 0.1%, Alcon) addresses this issue by acting as an antihistamine and a mast-cell stabilizer. Recommended dosage is two times per day, which improves compliance and makes it possible for contact lens wearers to use the drops before and after contact lens wear. My wish was granted!
Available since April
Patanol was approved by the Food and Drug Administration in December 1996 and has been on the market since April of this year. I usually wait until I have used a pharmaceutical at least 12 months before putting in print my opinions regarding that ocular medication. Patanol is worthy of comment because it adds another dimension to our therapy for allergic conjunctivitis. I still reserve complete judgment until Patanol has been prescribed many times over a longer span of time, but my initial impression and comments from other colleagues have been positive.
Patanol inhibits the release of inflammatory chemicals from the mast cells and is a selective histamine H1 antagonist that inhibits the hypersensitivity reaction caused when histamine is released. It is preserved with benzalkonium chloride 0.01%. Patanol is supplied in 5-mL bottles, and the recommended dosage is one to two drops two times daily. It should be stored at 39° to 86°F. Indicated usage is for prevention of temporary itching and hyperemia due to pollens, molds, airborne irritants and animal dander.
It is approved for children 3 years of age and older. Safety and effectiveness for those younger than 3 years have not been established by clinical testing. Adverse reactions reported during clinical trials included headaches 7%, burning and stinging (less than 5%), dry eyes (less than 5%), and hyperemia (less than 5%). It should be noted that patients being treated during the clinical studies with a placebo reported a headache 13% of the time.
Treatment protocol
Patanol has been effective at treating acute and chronic allergic conjunctivitis. Prescribing the drops twice per day for 2 to 6 weeks with supportive therapy has provided patients with relief from itching and low-grade hyperemia and reduces the stringy matter associated with allergic conjunctivitis.
Supportive therapy typically includes saline rinses, lubricating drops and cold compresses two to four times per day. Contact lens patients with mild itch and mattering can continue to wear their lenses while using the drops before and after contact lens wear.
Patients with grade 1 to grade 2 giant papillary conjunctivitis (GPC) report improvement of the itch with Patanol therapy. The mast-cell stabilizer and antihistamine combine to help lessen the autoimmune response. These patients usually need to discontinue contact lens wear for at least the first week and also incorporate the use of saline rinse and lubricating drops. Patients wearing conventional contact lenses should either have lenses replaced or be refit into disposable lenses.
Extended-wear disposable patients may need to start wearing their lenses on a daily-wear basis. Daily disposable lenses are another option to help overcome the GPC.
The more severe cases of GPC still require cromolyn 4% (Crolom, Bausch & Lomb) four times per day for at least 2 weeks, and either Livostin (levocabastine HCl, Ciba) or Flarex (fluorometholone acetate 0.1%, Alcon) four times per day for the first week. The Livostin or Flarex dosage can then be adjusted according to the severity of that particular case.
Experience helps define efficacy
Patanol is a welcome addition for allergic conjunctivitis. As with any new drug, experience will help define the clinical efficacy of the agent.
I will be more confident prescribing Patanol after extended clinical use helps me establish the required duration of treatment for the immediate inflammatory reaction and the required level of maintenance dosage for chronic allergies.
Experience using Patanol over the next year will make it easier to establish the most effective treatment plan for each patient. Clinical use of Patanol with patient feedback and follow-up examination is the best way to truly understand the benefits, adverse effects and comfort of the medication.
With the above qualification, I conclude that Patanol offers a welcome, simplified clinical solution for treating allergic conjunctivitis. The combination of a twice-per-day dosage and a dual pharmaceutical action for immediate relief of itch and mast-cell stabilization for chronic relief of ocular allergy improves both convenience and compliance for patients.
For Your Information:
- Bobby Christensen, OD, FAAO, in in private practice and lectures widely on therapeutic pharmaceutical agents. He can be reached at Heritage Park Medical Center, 6912 E. Reno, Suite 101, Midwest City, OK 73110; (405) 732-2277; fax: (405) 737-4776. Dr. Christensen has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any company mentioned.
- Patanol is available from Alcon Laboratories, 6201 South Freeway, Fort Worth, TX 76134; (800) 757-9195; fax: (817) 551-8893.