Rockville Center, NY-Nedocromil sodium is the mainstay of therapy for patients who need chronic medication because it offers continued relief without the development of tolerance.
Rockville Center, NY-Nedocromil sodium 2% ophthalmic solution (Alocril, Allergan) is a perfect choice for managing chronic ocular allergy, said Eric D. Donnenfeld, MD.
"Nedocromil sodium is a second-generation mast cell stabilizer that, compared with first-generation agents, such as cromolyn [Crolom, Bausch & Lomb], offers greater efficacy due to a second mode of action-inhibition of eosinophil chemotaxis and activation," said Dr. Donnenfeld, who is associate professor of ophthalmology, New York University, New York, and a partner in Ophthalmic Consultants of Long Island.
"Compared with other classes of anti-allergy agents, nedocromil sodium is distinguished by the fact that its efficacy improves with increasing duration of use and is maintained over the longer term without the development of tolerance.
Multiple studies have demonstrated the efficacy of nedocromil sodium 2% as a treatment for ocular allergy, and Dr. Donnenfeld considers it as the foundation of management for his patients who tend to suffer for weeks to months, including those with allergic conjunctivitis, vernal conjunctivitis, and seasonal allergic conjunctivitis. The drug is administered twice daily and can be combined with a mild corticosteroid or an antihistamine to control severe flare-ups.
"Nedocromil sodium is the mainstay of therapy for patients who need chronic medication as it offers continued relief without the development of tolerance," Dr. Donnenfeld said. "However, it can also be used with other agents that act via different mechanisms of action in order to gain increased symptomatic control as needed."
When treating patients with vernal conjunctivitis who develop giant papillary conjunctival changes that last for months begin- ning in the spring and continuing until the first frost, Dr. Donnenfeld initiates nedocromil in March, prior to the onset of the allergy season, and continues treatment until the season ends.
"Pretreating patients in this way is much more helpful for controlling their disease than introducing therapy once signs and symptoms have developed," Dr. Donnenfeld said. "My patients are very attuned to this prophylactic approach and routinely come into the office each year to get their prescription."
As another benefit for a medication that will be used on a chronic basis, nedocromil sodium is also extremely well-tolerated and associated with minimal side effects. Unlike antihistamines, nedocromil sodium does not cause ocular dryness, and it is a much safer choice for prolonged use than a corticosteroid that would otherwise be needed to treat severe ocular allergy, like vernal conjunctivitis.
Nedocromil sodium is also a good choice for pediatric use because it has been shown to be safe and effective in children 3 years of age and older.
Due to its effect on mast cells, nedocromil sodium does provide immediate relief upon initial instillation. Nevertheless, Dr. Donnenfeld does not consider it as a first-line choice for patients with sporadic allergic conjunctivitis who periodically develop itchy eyes as a result of intermittent antigen exposure.