Usage
- Alcaftadine + Ketorolac ophthalmic solution is prescribed for the treatment of the signs and symptoms of allergic conjunctivitis.
- Pharmacological classification: This combination drug includes an antihistamine (Alcaftadine) and a non-steroidal anti-inflammatory drug (NSAID) (Ketorolac).
- Mechanism of action: Alcaftadine works by blocking H1 receptors and stabilizing mast cells, reducing the effects of histamine release. Ketorolac inhibits COX enzymes, reducing prostaglandin production, which leads to decreased inflammation and pain.
Alternate Names
- While the generic name is Alcaftadine + Ketorolac, variations might exist internationally.
- Brand names: A common brand name is Alcarex KT. Lastacaft was a brand name for Alcaftadine, and Acular for Ketorolac.
How It Works
- Pharmacodynamics: Alcaftadine antagonizes H1 receptors and stabilizes mast cells, mitigating the effects of histamine release, therefore reducing itching, redness, and swelling. Ketorolac inhibits COX-1 and COX-2 enzymes, reducing prostaglandin production, which leads to a decrease in inflammation and pain.
- Pharmacokinetics: Alcaftadine has low systemic absorption after topical ophthalmic administration. Ketorolac, when administered ophthalmically, can reach detectable systemic levels, especially with prolonged use.
- Receptor binding/enzyme inhibition: Alcaftadine binds to H1 receptors. Ketorolac inhibits COX-1 and COX-2 enzymes.
- Elimination pathways: Primarily hepatic metabolism and renal excretion for both drugs.
Dosage
Standard Dosage
Adults:
- Instill one drop in each affected eye twice daily.
Children:
- Safety and efficacy have not been established in children under 2 years old.
- Limited information suggests potential use in children 3 years and older but under strict medical supervision and adapted dosing.
Special Cases:
- Elderly Patients: Use with caution; data limited. Do not exceed 60mg/day of Ketorolac component.
- Patients with Renal Impairment: Contraindicated in severe renal impairment. Use with caution in moderate renal impairment, reducing the Ketorolac dose.
- Patients with Hepatic Dysfunction: Use with caution; monitor for liver toxicity. Limited specific guidance for combined formulation exists, primarily for Ketorolac component.
- Patients with Comorbid Conditions: Use cautiously in patients with glaucoma, dry eye syndrome, arthritis, diabetes, or bleeding/blood clotting problems.
Clinical Use Cases
- Alcaftadine + Ketorolac is not indicated for Intubation, Surgical Procedures, Mechanical Ventilation, ICU Use, or Emergency Situations. Its use is specific to allergic conjunctivitis.
Side Effects
Common Side Effects
- Eye irritation
- Burning sensation
- Sore eyes
- Blurred vision (temporary)
- Headache
Rare but Serious Side Effects
- Severe eye pain or swelling
- Sudden vision changes
- Signs of a serious allergic reaction (rash, itching/swelling, severe dizziness, trouble breathing)
Long-Term Effects
- Chronic complications are not typical, as the medication is for short-term use.
Adverse Drug Reactions (ADR)
- Severe ADRs require immediate medical attention. Any signs of a serious allergic reaction or sudden vision changes need prompt evaluation.
Contraindications
- Known hypersensitivity to alcaftadine, ketorolac, or any component of the formulation.
- Hypersensitivity to NSAIDs.
- Severe renal impairment.
- Active peptic ulcer disease or history of GI bleeding.
- Pregnancy (especially later stages).
- Perioperative pain in patients undergoing coronary artery bypass graft (CABG) surgery.
Drug Interactions
- Blood thinners (e.g., warfarin): Increased bleeding risk.
- Other ophthalmic medications: Wait at least 5 minutes between instillations.
Pregnancy and Breastfeeding
- Pregnancy Safety Category: Alcaftadine (Category B); Ketorolac (Category C, shifting to Category D in later trimesters). Use with extreme caution in pregnancy, only if the benefits outweigh the risks.
- Breastfeeding: It is unknown if alcaftadine or ketorolac are excreted in breast milk. Exercise caution. Consider applying pressure over the tear duct for at least 1 minute after instillation.
Drug Profile Summary
- Mechanism of Action: Dual-acting: antihistamine (alcaftadine) and NSAID (ketorolac).
- Side Effects: Eye irritation, burning, blurred vision, headache.
- Contraindications: Hypersensitivity, NSAID allergy, severe renal impairment, active peptic ulcer disease.
- Drug Interactions: Blood thinners, other ophthalmic medications.
- Pregnancy & Breastfeeding: Use with caution; safety not fully established.
- Dosage: One drop in each affected eye twice daily.
- Monitoring Parameters: Observe for allergic reactions, vision changes, or increased intraocular pressure.
Popular Combinations
- Alcaftadine and Ketorolac are typically prescribed together. No other fixed-dose combinations are commonly utilized.
Precautions
- Assess for allergies, existing eye conditions, and systemic diseases. Use with caution in pregnancy/breastfeeding and with renal or hepatic impairment.
- Blurred vision can occur. Advise against driving until it clears.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Alcaftadine + Ketorolac?
A: One drop in each affected eye twice a day.
A: No. Remove contact lenses before instilling the drops and wait at least 10 minutes before reinserting.
Q3: What are the common side effects?
A: Common side effects include eye irritation, burning sensation, blurred vision, and headache.
Q4: Can pregnant or breastfeeding women use this medication?
A: Use with caution during pregnancy and breastfeeding, only if clearly needed and after a risk/benefit assessment.
Q5: How should this medication be stored?
A: Store in a cool, dry place away from direct sunlight.
Q6: What should I do if I miss a dose?
A: Instill the missed dose as soon as you remember, unless it is almost time for the next dose. Do not double the dose.
Q7: Can I use other eye drops with Alcaftadine + Ketorolac?
A: Yes, but wait at least 5 minutes between different eye drops.
Q8: How long can I use Alcaftadine + Ketorolac?
A: Typically for short-term use. Consult a physician if symptoms persist after 3 days or worsen.
Q9: What are the signs of a serious allergic reaction?
A: Rash, itching/swelling, severe dizziness, and trouble breathing. Seek immediate medical attention if any of these occur.
