Mast Cell Activation Syndrome & Mastocytosis: Compounded Oral Ketotifen or Cromolyn Capsules?

Our accreditations place us in the top 1% of compounding pharmacies

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Ketotifen or Cromolyn Sodium? Town & Country Compounding explores options for compounded mast cell stabilizers

Prescribers often ask us at Town & Country Compounding which mast cell stabilizers can be compounded in an oral form for their patients? The answer is either ketotifen or cromolyn sodium.

Source: NIH

Mast cells are a part of everyone’s immune system, and are located throughout the body. They protect us from infection through the inflammatory process. They also are present in allergic responses, also with inflammatory responses.

Source: The Mast Cell Disease Society

When the body comes in contact with a “trigger” such as an allergen, medication, or trigger ingredient, mast cells in the body “degranulate” and release inflammatory mediators such as histamine, prostaglandins, leukotrienes, and tryptase. These substances can cause a myriad of immediate allergic-type responses which can be quite serious for those who have a mast cell disease or serious allergies.

Ketotifen is currently available in other countries.
An oral antiallergic drug developed in 1970 by Sandoz, ketotifen is approved and prescribed in Canada, Europe, and Mexico. It is often used in patients with mastocytosis, food allergies, asthma, allergic rhinitis, atopic dermatitis, and more.

Source: NCBI

Mast Cell Diseases

can cause much suffering and disability with excessive mast cell mediator release along with symptoms from the accumulation of mast cells in major organ systems.

Source: The Mast Cell Disease Society

The three major forms of mast cell diseases

  • Mast cell activation syndrome (MCAS)
  • Mastocytosis
  • Hereditary Alpha tryptasemia (HAT)

Mast Cell Activation Syndrome

is caused by the inappropriate release of inflammatory mediators, causing persistent allergic-type symptoms, which can be severe, in multiple organs throughout the body.

Mastocytosis

is caused by genetic mutations resulting in the over-activation, proliferation and accumulation of altered mast cells causing persistent and allergic-type reactions in multiple organs throughout the body.

Symptoms of mast cell disease can occur in various organs

  • Itching, hives, flushing
  • Abdominal pain, bloating, nausea, diarrhea, vomiting, reflux (GERD)
  • Blood pressure changes; palpitations, fainting
  • Respiratory: difficulty breathing, congestion
  • Brain fog, cognitive problems, anxiety/depression, headaches
  • Bone pain, bone weakness
  • Anaphylactic reaction

Source: Allergy and Asthma Network

Mast Cell Stabilizers

Orally, Mast Cell Stabilizers have been useful in stomach and bone pain, flushing, headaches, and cognitive functioning. Topically, they have helped with itching and hives.

Source: MastoKids

Compounded Ketotifen

at Town & Country Compounding

Ketotifen is not commercially available as capsules or cream in the US but can be compounded. It is a unique drug in that it is a mast cell stabilizer and also has some antihistamine (H1) activity.

At Town & Country Compounding, we often receive prescriptions for 0.5-mg, 1-mg, and 2-mg capsules, or creams if needed for topical applications.

Ketotifen liquid: available in the UK, Zatiden, contains alcohol, which could be a trigger for sensitive patients. An alcohol-free, concentrated liquid can be compounded for patients by Town & Country Compounding.

“Each 5 mL of strawberry-flavoured syrup, available in the UK, contains ketotifen fumarate 1 mg. Nonmedicinal ingredients: alcohol, citric acid, methyl-p-hydroxybenzoate, propyl-p-hydroxybenzoate, sodium phosphate, sorbitol solution, strawberry flavour, sucrose, and water.”

Our accreditation places us in the top 1% of compounding pharmacies

Compounded Cromolyn Sodium Oral Capsules

This mast cell stabilizer is often prescribed as 100-mg or 200-mg oral capsules and must be compounded since it comes commercially only as a concentrated liquid.

Liquid: If a patient is sensitive to ingredients in the commercially available liquid, we can compound a “trigger-free” version.

Town & Country Compounding for mast cell stabilizers

Whether you are interested in compounded Cromolyn Sodium or Ketotifen, our expert pharmacists are able to assist you or your patients with recommendations and educations.

Call, text, or contact us online today.

References

Town & Country Compounding Pharmacy is located at
Town & Country Compounding Pharmacy is located at 535 East Crescent Ave Ramsey, NJ 07446

Town & Country Compounding provides the most advanced formulations based on the most recent research and peer-reviewed guidelines.

We work with patients and their medical providers to customize solutions that are right for their individual needs when commercially-made medications are not showing results.

Medication is not one-size-fits-all. 

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