Alcaftadine

Alcaftadine, sold under the brand name Lastacaft, is an antihistamine used to help prevent itching of the eyes.^[1] It is an H1 histamine receptor antagonist.^[1] It is given as an drops in the eye.^[1]

Alcaftadine

Clinical data
Trade names	Lastacaft
AHFS/Drugs.com	Monograph
MedlinePlus	a611022
License data	US DailyMed: Alcaftadine
Routes of administration	Eye drops
ATC code	S01GX11 (WHO)
Legal status
Legal status	US: OTC[1][2]
Pharmacokinetic data
Elimination half-life	~2 hrs
Identifiers
IUPAC name 2-(1-Methylpiperidin-4-ylidene)-4,7-diazatricyclo[8.4.0.0(3,7)]tetradeca- 1(14),3,5,10,12-pentaene-6-carbaldehyde
CAS Number	147084-10-4 N
PubChem CID	19371515
IUPHAR/BPS	7587
DrugBank	DB06766 Y
ChemSpider	14201635 Y
UNII	7Z8O94ECSX
KEGG	D06552 N
ChEBI	CHEBI:71023 N
ChEMBL	ChEMBL1201747 N
CompTox Dashboard (EPA)	DTXSID80598455
Chemical and physical data
Formula	C19H21N3O
Molar mass	307.397 g·mol−1
3D model (JSmol)	Interactive image
SMILES CN1CCC(=C2c3ccccc3CCn4c(C=O)cnc24)CC1
InChI InChI=1S/C19H21N3O/c1-21-9-6-15(7-10-21)18-17-5-3-2-4-14(17)8-11-22-16(13-23)12-20-19(18)22/h2-5,12-13H,6-11H2,1H3 Y Key:MWTBKTRZPHJQLH-UHFFFAOYSA-N Y
NY (what is this?)  (verify)

It was approved for medical use in the United States in July 2010.^[3] It is available as a generic medication and as an over-the-counter medication.^[4]

Medical uses

Alcaftadine is indicated for the prevention of itching associated with allergic conjunctivitis.^[1]

Pharmacology

Alcaftadine is an antagonist of histamine receptor 1.^[1] By blocking the receptor, alcaftadine has been shown to reduce itching and redness of the eyes, and to reduce recruitment of eosinophils after exposure to an allergen.^[5] Alcaftadine reduces the number of eosinophils compared to olopatadine 0.1%, and in animal models, alcaftadine 0.25% decreased the expression of the epithelial protein E-cadhedrin-1 compared to placebo. Reducing E-cadherin decreases junctions that lead to the progression of allergic conjunctivitis.^[6]

Adverse effects

In studies comparing the effectiveness of olopatadine to alcaftadine, there was not a dose-response increase of adverse effects as alcaftadine doses increases for 0.05% to 0.1% to 0.25%. The most common seen side effect of alcaftadine administration was irritation or a stinging sensation at the administration site.^[5]

Pharmacokinetics

Because alcaftadine is administered at low concentrations and at a local site (the eye), it appears to have minimal systemic effects, and the low absorption of alcaftadine results in minimal systemic accumulation.^[7]

History

When alcaftadine was tested against placebo and olopatadine, only alcaftadine 0.25% showed a clinically significant reduction in conjunctival redness scores 7 and 15 minutes after administration. Alcaftadine 0.05%, 0.1%, and 0.25% all reduced lid swelling, conjunctival redness, and ocular itching/tearing compared to placebo.^[5]

Society and culture

Economics

Allergan, Inc. began selling alcaftadine under the trade name Lastacaft after it was approved by the US Food and Drug Administration in July 2010.^[8] By March 2012, 139,000 prescriptions had been written for 104,000 unique patients, and alcaftadine exceeded the sales of epinastine (Elestat).^[9]

Legal status

Alcaftadine was approved for medical use in the United States in July 2010.^[1][3]