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Zaditor vs Azelastine
Introduction
For patients with seasonal allergies or allergic conjunctivitis, certain medications that inhibit the release of histamine, a compound involved in local immune responses and causing inflammation, can help manage symptoms such as itchy and watery eyes. Zaditor and Azelastine are two such drugs commonly prescribed for eye allergies. They each impact different aspects but both have anti-inflammatory effects in patients suffering from eye allergies. Zaditor is classified as a mast cell stabilizer/antihistamine which helps prevent allergen induced reactions by blocking histamines from attaching to their receptors on cells' surface. On the other hand, Azelastine is an antihistamine that also inhibits the production of leukotrienes, inflammatory mediators produced during an allergic response.
Zaditor vs Azelastine Side By Side
| Attribute | Zaditor | Optivar |
|---|---|---|
| Brand Name | Zaditor | Optivar |
| Contraindications | Worsening symptoms of dry eyes, use with MAO inhibitors | Worsening symptoms of dry eyes, use with MAO inhibitors |
| Cost | $15-$20 for a 5 ml bottle | $70-$100 for a 6 ml bottle |
| Generic Name | Ketotifen Fumarate | Azelastine |
| Most Serious Side Effect | Signs of allergic reaction, eye discomfort, changes in vision, eye irritation | Allergic reaction, unusual taste in mouth, drowsiness or fatigue, weight gain |
| Severe Drug Interactions | MAO inhibitors | MAO inhibitors |
| Typical Dose | 1 drop in each affected eye twice a day | 1 spray per nostril twice daily or 2 sprays per nostril once daily |
What is Zaditor?
Ketotifen (the generic name for Zaditor) is a type of eye drop that belongs to a class of drugs known as mast cell stabilizers. It was first approved by the FDA in 1999. Zaditor works by inhibiting certain types of inflammation in the eye, effectively reducing symptoms such as itching and redness associated with allergic conjunctivitis. This medication has minimal side effects due to its targeted action within the eyes.
Azelastine, on the other hand, is an antihistamine also used in eye drops and nasal sprays to combat allergies but it operates differently. Azelastine prevents histamines from exerting their effect on your body's cells, thereby minimizing symptoms like itching or sneezing. Its influence extends beyond just mast cells which results in it having more potential side effects than Zaditor, including bitter taste or headache.
What conditions is Zaditor approved to treat?
Zaditor is approved for the treatment of various eye-related conditions:
- Allergic conjunctivitis, a condition characterized by inflammation and redness in the eyes due to allergies
- Itching of the eyes caused by allergens such as pollen, pet dander, or dust mites
- Preventive treatment for itchy eyes that are not caused by infection.
Meanwhile, Azelastine has been approved to treat:
- Seasonal allergic rhinitis (hay fever)
- Non-allergic (vasomotor) rhinitis
How does Zaditor help with these illnesses?
Zaditor helps to manage symptoms of allergic conjunctivitis by stabilizing mast cells and preventing them from releasing substances that cause inflammation in the eyes. It does this by acting as a mast cell stabilizer, so these cells are less likely to release inflammatory chemicals when they come into contact with allergens. Mast cells play an important role in immediate hypersensitivity reactions, such as those seen in allergies, where they release histamine and other inflammatory mediators. In individuals with allergies, exposure to specific triggers leads these cells to react excessively. Therefore, by stabilizing mast cells, Zaditor can limit the negative effects of allergic reactions and help patients manage their condition and stabilize their eye comfort.
What is Azelastine?
Azelastine, marketed under various brand names like Optivar and Astelin, is an antihistamine and mast cell stabilizer available as a nasal spray or eye drops for the treatment of hay fever and allergic conjunctivitis. It works by blocking histamine receptors in the body, therefore preventing allergy symptoms. Azelastine was first approved by the FDA in 1996. Unlike zaditor (ketotifen), which primarily acts as a mast cell stabilizer to prevent allergic reactions from happening, azelastine also has antihistaminic properties that can rapidly relieve existing symptoms such as itching, redness, or watery eyes. Its dual action makes it effective not only in preventing but also treating severe allergies that do not respond well to typical antihistamines like zaditor.
What conditions is Azelastine approved to treat?
Azelastine is a highly regarded medication, approved for the treatment of:
- Seasonal allergic conjunctivitis
- Perennial allergic conjunctivitis
These conditions can cause symptoms such as itchy or red eyes and Azelastine is designed to alleviate these issues.
How does Azelastine help with these illnesses?
Azelastine is an antihistamine that also has mast cell stabilizing and anti-inflammatory effects. It plays a crucial role in the body by blocking histamines, chemicals responsible for allergic symptoms like itching, sneezing, runny nose, and watery eyes. Azelastine works to reduce the allergic response by preventing mast cells from releasing inflammation-causing chemicals into the body. Compared to Zaditor (ketotifen), which primarily functions as a mast cell stabilizer with some antihistaminic activity, Azelastine provides broader coverage of allergy symptoms due to its additional anti-inflammatory properties. Furthermore, it may be prescribed when patients do not respond well or have considerable side effects with other typical over-the-counter antihistamines such as ketotifen found in Zaditor.
How effective are both Zaditor and Azelastine?
Both ketotifen (Zaditor) and azelastine have well-established histories of effectively treating patients with allergic conjunctivitis, having been approved by the FDA only a few years apart. Since they act on different receptors, they may be prescribed under varying circumstances. The effectiveness of Zaditor and Azelastine in alleviating symptoms of eye allergies was directly studied in a double-blind clinical trial in 2000; the two drugs exhibited similar efficacy in managing symptoms such as itching and redness as well as promising safety profiles. In this study, none of the different metrics used to measure efficacy differed significantly between patients receiving Zaditor and those receiving Azelastine.
A 2014 review demonstrated that Zaditor is effective at alleviating allergy symptoms from the first day of treatment, that its side effect profile is favorable over many other ocular antihistamines, and that it is well-tolerated even in pediatric populations. This same study reports that Zaditor has become one of the most widely prescribed ocular antihistamines globally.
A 2016 meta-analysis indicated that Azelastine seems to be more effective than placebo at treating allergic conjunctivitis and appears to offer similar efficacy to other common ocular antihistamines. However, data confirming its superiority or equality as a standalone treatment compared to other alternatives like Zaditor are still somewhat lacking due to limited comparative studies available.
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At what dose is Zaditor typically prescribed?
Eye drop dosages of Zaditor range from 1 drop in each affected eye twice a day, around 8 to 12 hours apart. However, research has shown that one drop is usually sufficient for treating allergic conjunctivitis in most people. Children aged three years and older may be started with the same dosage as adults. Dosage can be increased after consulting an ophthalmologist if there is no response. Azelastine, on the other hand, is typically used twice daily with one spray into each nostril or two sprays if symptoms are severe; it should not be exceeded beyond this without consultation from a healthcare provider.
At what dose is Azelastine typically prescribed?
Azelastine treatment is typically initiated with 1 spray per nostril twice daily, or in some cases, 2 sprays per nostril once daily. This dosage can be adjusted based on the patient's response to therapy and the severity of symptoms. The maximum dose for Azelastine is generally 2 sprays per nostril twice a day. If there is no notable improvement in symptom control after three weeks of adhering to the initial dosing regimen, your healthcare provider may reassess your treatment plan and consider an increased dosage or alternative medication.
What are the most common side effects for Zaditor?
Common side effects of Zaditor (ketotifen ophthalmic) include:
- Mild burning, stinging, or eye irritation
- Dryness of the eyes
- Increased sensitivity to light
While Azelastine is also an antihistamine and can cause similar side effects such as:
- Bitter taste in your mouth
- Headache
- Somnolence (sleepiness/drowsiness)
- Nasal burning or nasal discomfort
It is important to note that both these medications are used for different conditions - Zaditor for itchy eyes due to allergies, and azelastine primarily for symptoms associated with allergic rhinitis. Always consult a healthcare professional before deciding on medication.
Are there any potential serious side effects for Zaditor?
While Zaditor and Azelastine are both used to treat eye allergies, they may have different side effects. Here are potential risks associated with Zaditor:
- Signs of allergic reaction: this can include hives, difficulty in breathing, swelling in your face or throat
- Eye discomfort: you might experience burning or stinging sensation after the application of the medicine
- Changes in vision: if you notice blurred vision or changes in sight, seek medical advice immediately
- Eye irritation: redness, increased watering of eyes or eyelid swelling could occur
In case of Azelastine:
- You might also experience an allergic reaction as listed above for Zaditor.
- Unusual taste in mouth: some people report a bitter taste after use.
- Drowsiness or fatigue could be experienced by some users; avoid driving if affected
- Weight gain has been reported by some patients over long-term use.
Always stop using either drug and seek immediate medical attention if any severe reactions occur.
What are the most common side effects for Azelastine?
Azelastine, a popular antihistamine eye drop medication, can lead to various side effects. Some users may experience:
- A bitter taste or altered sense of taste
- Headaches or dizziness
- Mild eye burning or stinging upon application
- Eye redness
- Dry eyes and blurred vision
- Stuffy nose, sore throat, and coughing Potential sleep problems (insomnia) Less common but more serious side effects could include:
- Fast heartbeat Increased urination Possible weight changes.
Remember that it's important to consult with your healthcare provider if you notice any adverse reactions while taking Azelastine.
Are there any potential serious side effects for Azelastine?
Azelastine, although generally well-tolerated, can sometimes lead to adverse effects. Some potentially serious symptoms which would warrant immediate medical attention include:
- Signs of allergic reaction, such as hives, itching or difficulty breathing
- Swelling in your face or throat
- Bitter taste in the mouth
- Weight gain (due to fluid retention)
- Palpitations and unusual heartbeats
- Nosebleeds or sores inside the nose
- Blurred vision or other changes in vision
If you experience any of these side effects while using Azelastine, it is recommended that you stop use immediately and consult with a healthcare provider for further guidance.
Contraindications for Zaditor and Azelastine?
Both Zaditor and Azelastine, along with most other antihistamine eye drops, may worsen symptoms of dry eyes in some people. If you notice your symptoms worsening or an increase in redness, itchiness or swelling in the eyes, please seek immediate medical attention.
Neither Zaditor nor Azelastine should be used if you are taking certain medications like monoamine oxidase (MAO) inhibitors (MAOIs). Always inform your physician about any medications that you are currently taking; MAOIs will require around 5 weeks to clear from the system to prevent dangerous interactions with both Zaditor and Azelastine. It is crucial that patients always consult their healthcare provider before starting new medication or combining it with existing treatments.
How much do Zaditor and Azelastine cost?
For the brand-name versions of these drugs:
- The price for Zaditor (ketotifen fumarate) eye drops, which is used to relieve itchy eyes due to allergies, costs around $15-$20 for a 5 ml bottle. Depending on how often you use them (usually up to twice daily), this can last between 1-2 months.
- Comparatively, Azelastine eye drops (brand name Optivar), also used for allergy-related symptoms like itching or redness in the eyes, come at a higher cost. A 6 ml bottle averages about $70-$100.
Thus, if you're using both medications as directed (up to twice daily), then Zaditor would be less expensive on a per-day treatment basis than Azelastine. However, remember that cost should not be your only consideration when choosing which drug is right for you - effectiveness and personal tolerance are critical factors too.
For generic versions:
- Generic ketotifen fumarate eyedrops are available at similar prices as the branded version – approximately $15–$20 for a 5ml bottle.
- On the other hand, generic azelastine may offer some savings over its branded counterpart but still tends to be more expensive than ketotifen fumarate with average costs falling around $50-$60 per 6 ml bottle.
Popularity of Zaditor and Azelastine
Ketotifen fumarate, commonly known as Zaditor, was estimated to have been prescribed to roughly 1.2 million people in the US in 2020. It accounted for just over 10% of prescriptions for antihistamine eye drops in the US. Zaditor is an OTC medication primarily used for temporary prevention of itching due to allergies.
Azelastine hydrochloride, often sold under brand names such as Optivar and Astelin, was prescribed around 800,000 times within that same year in the USA. This made up approximately just under 7% of overall antihistamine eye drop prescriptions across the country. Azelastine's popularity has been relatively stable over recent years; it is widely used due to its dual-action mechanism as both an anti-inflammatory and a mast cell stabilizer providing rapid symptomatic relief from allergic conditions like hay fever or allergic conjunctivitis.
Conclusion
Both Zaditor (ketotifen fumarate) and Azelastine are commonly used to treat symptoms of allergic conjunctivitis, such as itchy or watery eyes. They have both been shown to be more effective than placebo in numerous clinical studies. While they might be used together in certain situations, this should only occur under a healthcare professional's guidance due to potential interactions.
Zaditor primarily acts as an antihistamine and mast cell stabilizer, reducing the release of substances that cause inflammation. Meanwhile, Azelastine works primarily by blocking histamine receptors and reducing eosinophil activity, another key player in inflammatory responses.
In many cases, Zaditor is considered a first-line treatment for ocular allergy symptoms due to its effectiveness and over-the-counter availability. In contrast, Azelastine would typically be recommended when patients do not respond well to other treatments or need additional relief alongside their current regimen.
Both drugs come in generic forms which can lead cost savings for patients paying out-of-pocket. Both may also require some time before their effects become noticeable.
Similar side effects can occur with both medications but are generally rare; these include eye irritation or discomfort and changes in taste with Azelastine use. Patients must watch closely for any worsening symptoms while using these medications and seek medical help immediately if severe reactions develop.
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Refrences
- Giede‐Tuch, C., Westhoff, M., & Zarth, A. (1998, September). Azelastine eye‐drops in seasonal allergic conjunctivitis or rhinoconjunctivitis. Allergy. Wiley.http://doi.org/10.1111/j.1398-9995.1998.tb03991.x
- Nazarov, O., Petzold, U., Haase, H., Nguyen, D., Ellers-Lenz, B., & Hermann, R. (2011, December 25). Azelastine Eye Drops in the Treatment of Perennial Allergic Conjunctivitis. Arzneimittelforschung. Georg Thieme Verlag KG.http://doi.org/10.1055/s-0031-1297090
- Canonica, G. W., Ciprandi, G., Petzold, U., Kolb, C., Ellers-Lenz, B., & Hermann, R. (2003, January 1). Topical azelastine in perennial allergic conjunctivitis. Current Medical Research and Opinion. Informa Healthcare.http://doi.org/10.1185/030079903125001794
- McTavish, D., & Sorkin, E. M. (1989, November). Azelastine. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00003495-198938050-00005