Wal-Zyr (ketotifen fumarate)

Dosage of ketotifen fumarate is expressed in terms of ketotifen.

The recommended dosage of ketotifen for the temporary relief of ocular itching associated with allergic conjunctivitis in adults and pediatric patients 3 years of age and older is 1 drop of a 0.025% solution in the affected eye(s) twice daily at an interval of 8-12 hours. The drug should not be administered more frequently than twice daily.

Ketotifen fumarate is applied topically to the eye as an ophthalmic solution. Care should be taken to avoid contamination of the solution container.

Ketotifen fumarate ophthalmic solution should not be used for the symptomatic management of contact lens-related irritation. Patients should be advised to remove their contact lenses prior to administration of each dose of ketotifen fumarate ophthalmic solution because the solution contains benzalkonium chloride, which may be absorbed by some soft contact lenses. Patients may reinsert contact lenses 10 minutes following administration of the ophthalmic solution.

Store ketotifen fumarate 0.025% ophthalmic solution between 4-25degreesC.

There is no enhanced messaging for this drug.

There are no contraindication interactions for this drug.

Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

Agents That Affect Iodide/Radioactive Iodide

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Many compounds can affect iodide protein binding and alter iodide pharmacokinetics and pharmacodynamics.(1)

CLINICAL EFFECTS: Compounds that affect iodide pharmacokinetics and pharmacodynamics may impact the effectiveness of radioactive iodide.(1)

PREDISPOSING FACTORS: Compounds that affect iodide pharmacokinetics and pharmacodynamics are expected to have the most impact during therapy using radioactive iodide. Diagnostic procedures would be expected to be impacted less.

PATIENT MANAGEMENT: Discuss the use of agents that affect iodide pharmacokinetics and pharmacodynamics with the patient's oncologist.(1) Because indocyanine green contains sodium iodide, the iodine-binding capacity of thyroid tissue may be reduced for at least one week following administration. Do not perform radioactive iodine uptake studies for at least one week following administration of indocyanine green.(2) The manufacturer of iopamidol states administration may interfere with thyroid uptake of radioactive iodine and decrease therapeutic and diagnostic efficacy. Avoid thyroid therapy or testing for up to 6 weeks post administration of iopamidol.(3)

DISCUSSION: Many agents interact with radioactive iodine. The average duration of effect is: anticoagulants - 1 week antihistamines - 1 week anti-thyroid drugs, e.g: carbimazole, methimazole, propylthiouracil - 3-5 days corticosteroids - 1 week iodide-containing medications, e.g: amiodarone - 1-6 months expectorants - 2 weeks Lugol solution - 3 weeks saturated solution of potassium iodine - 3 weeks vitamins - 10-14 days iodide-containing X-ray contrast agents - up to 1 year lithium - 4 weeks phenylbutazone - 1-2 weeks sulfonamides - 1 week thyroid hormones (natural or synthetic), e.g.: thyroxine - 4 weeks tri-iodothyronine - 2 weeks tolbutamide - 1 week topical iodide - 1-9 months (1)

Agents That Affect Iodide/Sodium Iodide I 131

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Many compounds can affect iodide protein binding and alter iodide pharmacokinetics and pharmacodynamics.(1,2)

CLINICAL EFFECTS: Compounds that affect iodide pharmacokinetics and pharmacodynamics may impact the effectiveness of radioactive iodide.(1,2)

PREDISPOSING FACTORS: Compounds that affect iodide pharmacokinetics and pharmacodynamics are expected to have the most impact during therapy using radioactive iodide. Diagnostic procedures would be expected to be impacted less.

PATIENT MANAGEMENT: Discuss the use of agents that affect iodide pharmacokinetics and pharmacodynamics with the patient's oncologist.(1,2) Because indocyanine green contains sodium iodide, the iodine-binding capacity of thyroid tissue may be reduced for at least one week following administration. Do not perform radioactive iodine uptake studies for at least one week following administration of indocyanine green.(3) The manufacturer of iopamidol states administration may interfere with thyroid uptake of radioactive iodine and decrease therapeutic and diagnostic efficacy. Avoid thyroid therapy or testing for up to 6 weeks post administration of iopamidol.(4)

DISCUSSION: Many agents interact with radioactive iodine. The average duration of effect is: anticoagulants - 1 week antihistamines - 1 week anti-thyroid drugs, e.g: carbimazole, methimazole, propylthiouracil - 3-5 days corticosteroids - 1 week iodide-containing medications, e.g: amiodarone - 1-6 months expectorants - 2 weeks Lugol solution - 3 weeks saturated solution of potassium iodine - 3 weeks vitamins - 10-14 days iodide-containing X-ray contrast agents - up to 1 year lithium - 4 weeks phenylbutazone - 1-2 weeks sulfonamides - 1 week thyroid hormones (natural or synthetic), e.g.: thyroxine - 4 weeks tri-iodothyronine - 2 weeks tolbutamide - 1 week topical iodide - 1-9 months (1,2)

There are no moderate interactions for this drug.

*Known hypersensitivity to ketotifen or any ingredient in the formulation.

There are no contraindication contraindications for this drug.

• Chronic kidney disease stage 4 (severe) GFR 15-29 ml/min
• Chronic kidney disease stage 5 (failure) GFr<15 ml/min
• Disease of liver

• No disease contraindications

There is no enhanced messaging for this drug.

More Frequent

• Ocular inflammation
• Ocular redness

Less Frequent

• Conjunctivitis
• Keratitis
• Ocular discharge
• Ocular itching
• Ocular pain
• Pruritus of skin
• Skin rash
• Urticaria

Rare or Very Rare

• Abnormal hepatic function tests
• Acute generalized exanthematous pustulosis
• Anaphylaxis
• Bronchospastic pulmonary disease
• Cardiac arrhythmia
• Cholestasis
• Dehydration
• Edema
• Glomerulonephritis
• Hearing loss
• Hemolytic anemia
• Hepatitis
• Palpitations
• Seizure disorder
• Thrombocytopenic disorder
• Tongue swelling
• Tonic clonic seizure

More Frequent

• Drowsy
• Dry nose
• Dry throat
• Headache disorder
• Rhinitis
• Xerostomia

Less Frequent

• Acute abdominal pain
• Diarrhea
• Epistaxis
• Eye tearing
• Fatigue
• Flu-like symptoms
• Insomnia
• Mydriasis
• Nausea
• Ocular irritation
• Pharyngitis
• Pharyngitis
• Photophobia

Rare or Very Rare

• Acne vulgaris
• Acute cognitive impairment
• Aggressive behavior
• Alopecia
• Anorexia
• Anticholinergic toxicity
• Blurred vision
• Constipation
• Cramps in legs
• Dizziness
• Dysgeusia
• Dyskinesia
• Dyspepsia
• Dysuria
• Eructation
• Euphoria
• Excitement
• Flatulence
• Gastritis
• Hallucinations
• Headache disorder
• Hemorrhoids
• Hyperhidrosis
• Increased appetite
• Memory impairment
• Nervousness
• Nightmares
• Parosmia
• Skin photosensitivity
• Skin rash
• Stomatitis
• Syncope
• Tachycardia
• Tinnitus
• Tongue discoloration
• Tremor
• Unsteady gait
• Urinary retention
• Visual changes
• Vomiting
• Weight gain

No enhanced messaging available.

Safety and efficacy have not been established in pediatric patients younger than 3 years of age. Ketotifen fumarate ophthalmic solution should not be used in pediatric patients younger than 3 years of age unless otherwise directed by a clinician.

Animal reproductive studies showed developmental skeletal abnormalities at a dose 30,000 times the maximum recommended human ocular dose. Because the drug is minimally absorbed following topical administration to the eye, it is not likely to have an effect on reproductive safety.

No enhanced messaging available.

No enhanced messaging available.