Elestat vs. Patanol

[DrG]

In an article in the December issue of Eye & Contact Lens here, the authors concluded that topical epinastine (Elestat) inhibited tear secretion in mice signficantly less than topical olapatadine (Patanol). Elestat and Patanol are both used to control symptoms of allergic conjunctivitis.

[kakinda]

Thanks,
Dr G (or anyone): is there a PF version of epinastine (Elestat) in the US? do both contain benzalkonium?
Thanks
K

[DrG]

Thanks,
Dr G (or anyone): is there a PF version of epinastine (Elestat) in the US? do both contain benzalkonium?
Thanks
K

Both have 0.01% BAK as the preservative, as do most prescription eyedrops AFAIK.

[Maria1972]

That's interesting. I use Patanol sometimes and my ophtalmologist prescribed me Elestat because he said it was supposed to be less drying. I tried Elestat and I felt that it dried me more.
So I continue using Patanol when I have allergy related itchiness.

I'll definitely try Elestat again. Maybe the dryness I had when I first tried was not related to Elestat.

[DrG]

I hope nobody thinks that I am endorsing Elestat. I have no interest in either product. I am just passing on some information I thought was interesting. One of the authors of the study was Dr. Pflugfelder, who has received endorsements from several people in this forum.

As with anything medical "your mileage may vary."

Also, I do not personally believe that wearing contact lenses leads to dry eye.

[kakinda]

Bak

HI Dr G,
Thanks for the info, I'm sure you're not endorsing any of the two drugs!
It's not so surprising to have BAK again in both drugs considering the lack of common sense of pharmas currently. We all know the toxic effects of BAK (some more and longer than others such as Neil and myself), the inflammatory aspect of BAK (meaning that if the active substance is likely to help, the preservative is there to do just the opposite - induce more inflammation), check this excellent post by Scout on allergy drugs containing BAK:


click me

which is a study involving Dr Baudouin (most likely the world's top specialist on BAK)....
So we already heard about those effects, but sometimes we forget the basics: BAK is a surfactant detergent, exactly the type of thing one would use to dissolve and remove an oily substance on one's clothes for instance (a sort of more sofisticated soap). What you may want to do to your clothes, you may not want to do to your eyes. May I remind that there's this thing called the lipid layer in our eyes...
I'll let you think by yourselves, but the existence of the lipid layer barrier or lack thereof is something that concerns many people here, I think... right?
And doesn't seem to concern pharmas that much.
I have a study on this additional reason not to use BAK but unfortunately it's in French. I could scan it & send to those of you interested.
As for Elestat and Opatanol, maybe there's a difference just related to the active substance in terms of inducing dryness (since they have similar BAK concentrations), however, it's obvious that both could improve their results by avoiding adding BAK to it.

I'm certain that olopatidine without BAK could be useful in our type of inflammatory disease. I actually had to use last year (for work), and really I felt better for 6 days... then as always I had yet another erosion and couldn't work for more than a month.

I had warned the doctor this would happen that it would be better to prescribe me a leave for work altogether. "NO your epithelium is currently fine despite the scar but you need to control allergy" he said. Six or 7 days later, I left will an absence leave and an ulcer diagnostic. Needless to say, I have left my docs in Lyon, my job ... and will not use BAK again even if it means loosing a job over a "simple" allergy (which actually last more than six months a year in my case)!

I've been wearing sclerals for 2 years, no ulcers unless when using BAK (removing the lenses for 15 minutes), just minor KPS... especially during allergies.
of course, allergies bother me a lot (I'm stuck at home) but I've been able to avoid ulcers (sometimes I've had to use some oral steroids) this way. Hoping for some PF effective anti-histaminic drops...
Take care
K

[DrG]

I've not ever prescribed Elestat. But, I do have one or two patients who find Optivar less drying than Patanol.

[kakinda]

Hello,
That's the one with BAK 0.125mg or is there a preservative free version?
Take care
K

[DrG]

Hello,
That's the one with BAK 0.125mg or is there a preservative free version?
Take care
K

Yes, that's the one with 0.125 mg of BAK per 1000 mg of solution.

I don't know why there aren't more unit dose PF ophthalmic preparations available. Maybe Rebecca can shed some light on that for you.