- What is Pazeo?
- Important Information
- Before taking this medicine
- How should I use Pazeo?
- What happens if I miss a dose?
- What happens if I overdose?
- What should I avoid while using olopatadine ophthalmic?
- Pazeo side effects
- What other drugs will affect Pazeo?
- Further information
- More about Pazeo (olopatadine ophthalmic)
- Related Content
Generic Name: olopatadine ophthalmic (OH loe PAT a deen)
Brand Name: Pataday, Patanol, Pazeo
Medically reviewed by Drugs.com on Feb 25, 2019 – Written by Cerner Multum
- Side Effects
What is Pazeo?
Olopatadine is an antihistamine that reduces the natural chemical histamine in the body. Histamine can produce symptoms of itching or watery eyes.
Pazeo (for the eye) is used to treat itching, burning, redness, watering, and other eye symptoms caused by allergic conditions.
Pazeo may also be used for purposes not listed in this medication guide.
Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.
Before taking this medicine
You should not use Pazeo if you are allergic to it.
To make sure Pazeo is safe for you, tell your doctor if you have any type of infection in your eye.
It is not known whether Pazeo will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
It is not known whether olopatadine ophthalmic passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.
Do not give this medicine to a child without medical advice.
How should I use Pazeo?
Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.
Wash your hands before using the eye drops.
To apply the eye drops:
Tilt your head back slightly and pull down your lower eyelid to create a small pocket. Hold the dropper above the eye with the tip down. Look up and away from the dropper and squeeze out a drop.
Close your eyes for 2 or 3 minutes with your head tipped down, without blinking or squinting. Gently press your finger to the inside corner of the eye for about 1 minute, to keep the liquid from draining into your tear duct.
Use only the number of drops your doctor has prescribed.
Wait at least 10 minutes before using any other eye drops your doctor has prescribed.
Do not touch the tip of the eye dropper or place it directly on your eye. A contaminated dropper can infect your eye, which could lead to serious vision problems.
Do not use the eye drops if the liquid has changed colors or has particles in it. Call your pharmacist for new medicine.
Store at room temperature away from moisture and heat. Do not freeze. Keep the bottle tightly closed when not in use.
What happens if I miss a dose?
Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.
What happens if I overdose?
An overdose of Pazeo is not expected to be dangerous. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222 if anyone has accidentally swallowed the medication.
What should I avoid while using olopatadine ophthalmic?
Do not use Pazeo while wearing contact lenses. Pazeo may contain a preservative that can discolor soft contact lenses. Wait at least 15 minutes after using this medicine before putting in your contact lenses.
Avoid wearing contact lenses while your eyes are red or irritated.
Avoid using other eye medications not prescribed by your doctor.
Pazeo side effects
Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Stop using this medicine and call your doctor at once if you have:
severe burning, stinging, or irritation after using this medicine; or
eye swelling, redness, severe discomfort, crusting or drainage (may be signs of infection).
Common side effects may include:
mild eye irritation;
feeling like something is in your eye;
puffy eyelids; or
unusual or unpleasant taste in your mouth.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What other drugs will affect Pazeo?
It is not likely that other drugs you take orally or inject will have an effect on olopatadine used in the eyes. But many drugs can interact with each other. Tell each of your healthcare providers about all medicines you use, including prescription and over-the-counter medicines, vitamins, and herbal products.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Copyright 1996-2018 Cerner Multum, Inc. Version: 4.04.
More about Pazeo (olopatadine ophthalmic)
- Side Effects
- During Pregnancy or Breastfeeding
- Dosage Information
- Pricing & Coupons
- En Español
- 15 Reviews
- Drug class: ophthalmic antihistamines and decongestants
- FDA Approval History
- Pazeo (Advanced Reading)
Other brands: Patanol, Pataday
- Pazeo (FDA)
- … +1 more
Related treatment guides
- Seasonal Allergic Conjunctivitis
Medical Editor: John P. Cunha, DO, FACOEP
Last reviewed on RxList 6/17/2019
Pazeo (olopatadine hydrochloride) Ophthalmic Solution is a mast cell stabilizer used to treat ocular (eye) itching associated with allergic conjunctivitis. Common side effects of Pazeo include:
- blurred vision,
- dry eye,
- watery eyes,
- superficial inflammation of the cornea,
- distorted or bitter sense of taste,
- sore throat,
- stinging or burning in the eye,
- abnormal sensation in the eye,
- eye sensitivity to bright light, or
- bloodshot eyes.
The recommended dosage of Pazeo is to instill one drop in each affected eye once a day. Pazeo may interact with other drugs. Tell your doctor all medications and supplements you use. During pregnancy, Pazeo should be used only if prescribed. It is unknown if this drug passes into breast milk when used in the eye. Consult your doctor before breastfeeding.
Our Pazeo (olopatadine hydrochloride) Ophthalmic Solution Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
While some enjoy the blooming flora and warm sun of spring, others only see elevated pollen levels and a rise in temperature as the dreaded start of allergy season. Their noses will stuff, their throats will itch and their eyes will become itchy and red. Sadly, many patients mismanage ocular allergy by employing over-the-counter (OTC) red eye solutions that neither address the problem nor relieve the symptoms. When it becomes too much, many of these patients will land in our offices seeking relief.
The good news is that allergy medication is more targeted than ever, and with the right background optometrists can bring patients the relief they’re seeking. Gone are the days when ODs simply threw a combination antihistamine and mast-cell stabilizer drop at anything that itches.
Over the last decade, an explosion of research has focused on the ocular surface, increasing our understanding of how our environment, and its offending allergens, impacts the anterior segment.
This article provides an update on the state of ocular allergy therapies and how optometrists can use that knowledge to bolster their roles in treatment.
This patient displays nasal inferior papillary conjunctivitis in the right eye. Click image to enlarge.
Before delving into ocular allergy management, get familiar with your comorbidities. In many cases, managing them can reduce the need for directly treating the allergic reaction. Some of my most successful cases have started with first managing the coexisting conditions that were exacerbating the allergy.
Demodex: Ask if the patient’s itch is directed toward the conjunctiva or the eyelid. If it’s the former, it’s likely the result of an allergy; if it’s the latter, you should suspect Demodex.1 Look closely at the base of the lash follicles for protruding tails. If you’re still unsure, try using forceps to gently twirl a lash within its follicle to draw out the mite.2 Patients with Demodex blepharitis alone will find no relief from topical allergy medications, so eradicating the mites via mechanical debridement and chemical eradication (e.g., ophthalmic-grade tea tree oil or hypocholorous acid 0.01%) is necessary to relieve itchy eyelids.3
Both patients suffering from allergy and Demodex should be advised to wash their linens weekly and to replace makeup containers to reduce exposure to offending agents. If patients are compliant with your Demodex treatment regimen and a papillary reaction is still present after several weeks (the life cycle of Demodex mites is approximately 14 days) adjunctive topical allergy medications are indicated.4
If a patient describes the itch as being toward the eyelid, there’s a chance they’re dealing with a Demodex infection, like the patient in this photograph.
Dry eye disease. If Demodex is ruled out, consider whether the patient has exacerbated allergies due to a poor tear film—due to either meibomian gland dysfunction or aqueous deficiency.
Is their ocular itch directed toward the caruncle, where stagnant tears—loaded with allergens and allergic mediators—have collected?5 A 2016 study in China shows an alarmingly high incidence of dry eye (98%) in young children with allergic conjunctivitis.6 More times than not, if I have a patient with both signs of dry eye disease and allergy and I lead with dry eye treatment, it reduces or, in some cases, eliminates the need for allergy treatment. With new dry eye treatments rapidly being made available, one common principle persists: if you decrease inflammation on the ocular surface and improve meibomian gland function, the tear production of most dry eye patients will improve.7 More tears means less concentration of allergens and allergic mediators on the eye, often serving as an effective treatment for the ocular allergy, which is the exact reason OTC artificial tears provide relief as well. However, they only provide temporary relief and should be used as adjunctive, not primary, treatment.
Avoid punctal plugs in patients with a history of allergy, to allow blinking to naturally flush irritants away through the punctum.
OCULAR ALLERGY DIAGNOSIS
Percentage of patients with a specific ocular allergy diagnosis: Seasonal allergic conjunctivitis (SAC), perennial allergic conjunctivitis (PAC), vernal keratoconjunctivitis (VKC), atopic keratoconjunctivitis (AKC), contact blepharoconjunctivitis (CBC) and giant papillary conjunctivitis (GPC).3
Getting a History
During the patient’s workup, investigate what symptoms related to allergies the patient has. Do they have both ocular and systemic symptoms? Patients may inadvertently take OTC allergy medications for allergy-related ocular itch, not realizing that they can actually worsen the situation. Oral antihistamines reduce aqueous and mucus production due to their anticholinergic activity, which decreases the eye’s ability to dilute allergens on the ocular surface.8 Counsel those patients about the differences and switch to a targeted ocular-allergy approach. If the patient experiences allergy-related rhinitis and other systemic symptoms, recommend OTC allergy orals, emphasizing the benefits of second-generation histamine H1 antagonists over their more ocular surface-drying first-generation counterparts.
The first rule of allergic conjunctivitis management is to identify and avoid the allergen whenever possible. While some patients know their specific triggers, the majority do not. Some clinics reported up to 80% of their allergic conjunctivitis patients had never had an allergy test before.4 In-office testing for tear osmolarity, adenovirus and MMP-9 inflammatory biomarkers have been invaluable in our viral conjunctivitis and dry eye management, as their instant results to guide our treatments. Now, there’s in-office testing to add to your ocular allergy evaluation. The Doctor’s Rx Allergy Formula (Bausch + Lomb) takes three minutes to prepare and collect patient samples without use of a needle. In less than 15 minutes, practitioners will receive the patient’s sensitivity results against 58 common allergens. In addition to these, there is also one positive and one negative control.5 If patients test negative across all allergens tested or do not show minimal response to the histamine control, they are unlikely to benefit from antihistamines or mast-cell stabilizers that inhibit histamine release.4 These patients may warrant referral to an allergist for longer-term management.
Prevalence and Characteristics of Ocular Allergy
In the United States, ocular allergies affect up to 40% of the population. While itching is reported in 90% of cases, the other most common symptoms—hyperemia (84.6%) and tearing (76.5%)—are also shared complaints in dry eye and other anterior segment conditions and should be differentiated. Of allergic conjunctivitis cases, 73% are largely environmental, 55% are diagnosed as seasonal allergic conjunctivitis (SAC) and 18% are perennial allergic conjunctivitis (PAC). Allergy testing for these patients is a cornerstone for treatment, as patients can be educated to develop ways to minimize their exposure and receive specific allergen immunotherapy for long-term management. The remaining 27% of ocular allergy sufferers tend to have more severe ocular reactions, from enlargened papillae to lid edema, requiring specific treatment strategies and more likely necessitate adjunctive topical steroids.
1. Leonardi A, Piliego F, Castegnaro A, et al. Allergic conjunctivitis: a cross-sectional study. Clinical and Experimental Allergy. 2015 May;45:1118-25.
Before we discuss therapeutics, minimizing allergen exposure on the eye needs to go one step further. Fitting patients in daily disposable contact lenses is a foundation of our practice, not only due to the improved lens wear experience and convenience, but also decrease in contact lens-related complications. Of our patients fit in soft contact lenses, 90% are currently wearing a daily disposable modality. The thinking is that wearing a new lens daily will minimize allergen buildup, whereas a biweekly or monthly lens leads to buildup of allergens and irritants over time. When switching to a daily disposable is not an option due to the patient’s prescription, switching to a hydrogen peroxide cleaner in conjunction with manual cleaning (none of that “no-rub solution” business for allergy sufferers) optimizes the modality.
While our arsenal of topical allergy medications has remained unchanged since extra-strength Pazeo (olopatadine 0.07%, Alcon) was released three years ago, our management of allergic conjunctivitis can continue to become more nuanced with each passing season. I recommend prescription medications in place of OTC options, as many patients seem to have already tried OTC ketotifen without relief (hence, why they are in your chair in the first place). In fact, when given both ketotifen 0.025% and olopatadine 0.1% to try on a twice-daily dose schedule, 81% preferred olopatadine, citing improved comfort and more reduction in allergy symptoms.7
The mainstays of allergic conjunctivitis therapy are topical combination antihistamine and mast-cell stabilizer eye drops. This dual mechanism provides both short- and long-term relief for its effect on decreasing histamine release. The two primary once-daily dosing topical allergy medications are Lastacaft (alcaftadine, Allergan) and Pazeo, Pataday and Patanol (olopatadine, Alcon). In a head-to-head alcaftadine 0.25% vs. olopatadine 0.2% study of 284 subjects, both topical solutions decreased itching severity within three minutes of instillation and continued to provide itch relief at 16 hours. When comparing the two, alcaftadine provided more relief.6 That said, due to olopatadine’s different available concentrations, you can customize your treatment regimen to the condition severity. Start at lower concentrations and discuss with the patient that, if more frequent dosing provides relief, the stronger formulation may be warranted.
Unfortunately, all the major ocular allergy formulations contain benzalkonium chloride (BAK) as the preservative. If you’ve ever had a patient in your chair with a laundry list of allergies, it’s not uncommon for them to be sensitive or even allergic to BAK.8 The last thing you want is for your patient to develop allergic conjunctivitis secondary to their topical allergy medication, compounding their problem. Palliative ocular allergy therapy includes allergen avoidance, cool compresses, regular linen cleaning, preservative-free artificial tears and, if warranted, short-term fluorometholone 1% ointment (non-BAK preserved).
When patients suffer from ocular inflammation due to allergy, as seen here, education about avoidance of triggers is a vital aspect of treatment. Click image to enlarge.
Depending on your state, prescribing systemic medications such as fluticasone nasal spray and oral loratadine for allergy may be additional treatment options. For patients who can’t tolerate oral antihistamines, montelukasts—while less effective—can also provide relief.9 When topical treatment alone is insufficient, consider fluticasone nasal spray or oral loratadine, but proceed with caution. While oral medications can benefit both systemic and ocular allergy, beware of increased ocular dryness due to the anticholinergic effects. If considering a steroid nasal spray, educate the patient and monitor them more often, as ocular side effects include potential increased intraocular pressure and higher risk of central serous retinopathy.10 However, if a patient’s ocular allergy is so severe that you’re considering those therapies or they’re experiencing severe systemic symptoms, comanaging with an allergist can help provide the best outcome.
Don’t Wait, Educate
Because we often only see patients once a year for their annual comprehensive eye exam (and often not during allergy season), take the opportunity during this visit to ask patients if they have a history of allergy. Begin educating patients about preventative measures and the importance of not rubbing their eyes, which further exacerbates the condition due to mast-cell degranulation and increased histamine release.11
Starting this dialogue early with patients can not only build your medical practice, but also build patient satisfaction as you preemptively take their eye care beyond the exam chair. Manage co-existing conditions, prescribe when indicated, and most importantly, identify the allergen whenever possible so patients can minimize their exposure.
Dr. Young specializes in dry eye and contact lenses at Specialty Eyecare Group in Seattle.