ALOMIDE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ALOMIDE (ALOMIDE).
Lodoxamide stabilizes mast cells by preventing antigen-induced release of histamine and other inflammatory mediators (e.g., SRS-A) from the mast cell, possibly by inhibiting calcium influx.
| Metabolism | Lodoxamide is not significantly metabolized; it is excreted largely unchanged in the urine. |
| Excretion | Primarily renal excretion; approximately 50-60% of the dose is excreted unchanged in urine within 24 hours. Fecal elimination accounts for less than 10%. Minor biliary excretion. |
| Half-life | Terminal elimination half-life is approximately 1.5-2 hours. Clinically, this short half-life supports frequent dosing for sustained ocular effects. |
| Protein binding | Approximately 60-70% bound to plasma proteins, primarily albumin. |
| Volume of Distribution | Approximately 2.5-4 L/kg, indicating extensive distribution into tissues. Clinically, this suggests that the drug is widely distributed beyond the plasma compartment. |
| Bioavailability | Ophthalmic: Systemic bioavailability following topical ocular administration is less than 10% due to limited absorption and extensive first-pass metabolism in the nasolacrimal system. |
| Onset of Action | Ophthalmic: Onset of clinical effect (reduction in ocular itching) occurs within 30 minutes to 2 hours after instillation. |
| Duration of Action | Ophthalmic: Duration of action is approximately 4-6 hours, requiring administration 4 times daily for continuous symptom control. |
1 to 2 drops in each affected eye four times daily (every 6 hours).
| Dosage form | SOLUTION/DROPS |
| Renal impairment | No dosage adjustment required; not systemically absorbed to a significant extent. |
| Liver impairment | No dosage adjustment required; not systemically absorbed to a significant extent. |
| Pediatric use | Children ≥2 years: same as adult dose (1-2 drops per eye four times daily). |
| Geriatric use | No specific dose adjustment; use same as adult dose with caution for increased ocular sensitivity. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for ALOMIDE (ALOMIDE).
| Breastfeeding | Unknown if excreted in human breast milk. Caution in breastfeeding women. M/P ratio not available. |
| Teratogenic Risk | Pregnancy Category B. Animal studies have not demonstrated fetal risk, but no adequate human studies in pregnant women. Use only if clearly needed. First trimester: no known teratogenic effects. Second/third trimester: no specific risks identified. |
| Fetal Monitoring |
■ FDA Black Box Warning
None
| Serious Effects |
["Hypersensitivity to lodoxamide or any component of the formulation"]
| Precautions | ["May cause transient burning, stinging, or discomfort upon instillation","Patients should not wear contact lenses during treatment","Use with caution in patients with known hypersensitivity to lodoxamide or any component of the formulation"] |
| Food/Dietary | No clinically significant food interactions reported. |
| Clinical Pearls | ALOMIDE (lodoxamide tromethamine) is a mast cell stabilizer indicated for vernal keratoconjunctivitis (VKC), but not for simple allergic conjunctivitis. Onset of action is delayed; therapeutic effect may take up to 2 weeks. Requires 4-6 times daily dosing. Do not use while wearing soft contact lenses; can be used 10 minutes after lens removal. Store at room temperature, avoid freezing. |
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| No specific monitoring required beyond routine prenatal care. |
| Fertility Effects | No known effects on fertility in animal studies. |
| Patient Advice | Instill 1-2 drops in each affected eye 4 times daily at regular intervals. · Do not touch the dropper tip to any surface, including your eye, to avoid contamination. · Wait at least 10 minutes after insertion of soft contact lenses before using the drops. · Temporary mild stinging or burning may occur upon instillation. · Store the bottle upright at room temperature, do not freeze. · Do not use the solution if it discolors or becomes cloudy. · Full benefit may not be seen for up to 2 weeks of regular use. |