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.”
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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.
