Livostin provides relief for allergy eyes

Issue: April 1997

ByBobby Christensen, OD FAAO

This is the second in a series to spotlight specific ophthalmic medications. Each month, a different drug from "My Top 15 Ophthalmic Medications" will be reviewed. I will explain when to prescribe these medications, the possible side effects and treatment plans based on a specific diagnosis.

Operation Optometry Prescribe Allergy season brings patients to our offices with complaints of itchy, red eyes. Depending on the weather and pollinating vegetation, these patients fight seasonal battles with their allergies. Those with chronic seasonal allergies complain of chronic itching, stringy matter and sometimes swollen eyes. The acute reactions will involve intense itching and swollen lids and conjunctiva. These patients are often frightened by how quickly their eyes react. Our task is to provide them with rapid, safe relief.

Livostin 0.05% (levocabastine HCl, Ciba Vision) is a medical option now available to help bring relief to these patients. This ophthalmic suspension is a selective H₁ antagonist. Livostin is preserved with 0.15 mg benzalkonium chloride and is supplied in 2.5-, 5- and 10-mL bottles.

Livostin is a powerful antihistamine that relieves itch and irritation quickly. It has been my experience that patients report reduced itching within the hour after the first instillation. Because Livostin does not contain a decongestant, the medication is safer for patients with hypertension or potential narrow-angle glaucoma, as compared to combination ophthalmic allergy drugs.

Diagnosis, treatment plans

Type 4 chronic allergy
(itch, stringy matter, moderate injection)
Treatment plan: Prescribe Livostin suspension drops to use in both eyes four times per day for 7 days and then use twice per day for an additional 7 to 21 days. I would also recommend a nonpreservative saline rinse (Softwear (Ciba Vision) or Unisol (Alcon))] before the drops are instilled in the morning and evening. Cold compresses are recommended for 10 minutes two to four times per day depending on the frequency and intensity of the itch.
Type 1 acute allergy
(intense itch, stringy matter, moderate injection, conjunctival edema, lid edema)
Treatment plan: Prescribe Livostin every 2 hours until the patient has relief from the itch, matter and injection. This usually takes 12 to 24 hours. An over-the-counter oral decongestant and antihistamine, such as Chlor Trimeton (chlorpheniramine maleate, phenylpropanolamine HCl, Schering-Plough), can be prescribed for healthy adults with instructions to use as directed on the package. Saline rinses (Softwear or Unisol) should be used every 1 to 2 hours to remove the stringy matter. Cold compresses should be applied every 2 hours for 10-minute intervals to also help relieve itch and edema.
Giant pupillary conjunctivitis (GPC)
(itch, matter, coated lenses, papilla)
Treatment plan: Prescribe Livostin four times per day for 1 week to help relieve itch and irritation. Taper the drops to two times per day for the second week. Also, prescribe either Alomide 0.1% (lodoxamide tromethamine, Alcon) or Crolom 4% (cromolyn sodium, Bausch & Lomb) four times per day for 2 weeks for the affected eye(s). Saline rinse should be used in the morning and evening before drops are instilled. Prescribe new lenses after the inflammation subsides.
Eyelid myokymia
(lid twitch)
Treatment plan: Prescribe Livostin four times per day for 5 to 7 days in affected eye. Also, recommend warm compresses two to four times per day for 10-minute intervals for 3 to 5 days. If the patient is working long hours with limited sleep, recommend rest.

Considerations

Shake before instillation of drop.
Wait 5 minutes before inserting contact lenses.
Safety has not been established for children younger than 12.
Mild stinging and burning is noted with about 15% of patients.
Livostin has been approved as an "as needed eye drop."

I use Livostin as my drug of choice for patients with ocular itch. This is one of the few medications I prescribe for an initial treatment plan and then let the patient use the drops twice daily as needed.

For Your Information:
Bobby Christensen, OD, is in private practice in Midwest City, Okla. He lectures widely on therapeutic pharmaceutical agents. He can be reached at Heritage Park Vision Source, 6912 E. Reno, Suite 101, Midwest City, OK 73110; (405) 732-2277; fax: (405) 737-4776. He has no financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned above.