Article Date: 8/1/2011

Adding Value to Therapy

Adding Value to Therapy

For Itching Associated With Allergic Conjunctivitis

By Blair Lonsberry, MS, OD, MEd., FAAO

Our allergy season in Oregon is just kicking in and, as I do every year, I'm seeing a lot of unhappy patients demanding fast relief for ocular itching associated with allergic conjunctivitis. Although I've used a variety of prescription antihistamine/mast cell stabilizer eye drops (QD and BID formulations) with good results, I've also recently begun prescribing BEPREVE® (bepotastine besilate ophthalmic solution) 1.5%, [ISTA Pharmaceuticals, Inc.]. Over the past 3 months, I've noticed that BEPREVE helps me add value to allergic conjunctivitis therapy for my patients because it provides the rapid efficacy they're seeking—even for severe ocular itch, dosing that matches their contact lens wear patterns and symptomology, and several options for meeting their economic needs.

The Value of Rapid Relief

Optometric practices see many irritated eyes. My first concern is to determine what's causing the problem and keep the patient out of his contact lenses until I can exclude infection or lens-related issues. There are several ways to confirm that allergic conjunctivitis is the culprit. A history of systemic seasonal allergy includes an ocular component in a majority of cases. Of course, patients who've suffered from ocular symptoms of allergy in the past may tell you what they believe is causing their discomfort. Another important diagnostic clue to—or confirmation of—suspected allergic conjunctivitis is persistent ocular itching with patients reporting an urge to rub or “scratch” their eyes. For obvious reasons, this is a particular problem for contact lens wearers, and because contact lenses can trap allergens and heighten irritation, we must act quickly to relieve the itching. In Oregon, we have two peak allergy seasons, one in the spring associated with grass and tree pollens, and the other in the fall, when we see more mold and a spike in suffering for perennial allergy patients. It's usually during these two periods that my patients experience problems that are severe enough to bring them into my office. Many patients who do well for most of the year have trouble wearing their lenses in the spring.

By the time patients come into my office, the vast majority have already tried a variety of over-the-counter remedies, including oral medications, with limited success. They may even complain of added ocular surface dryness, as well as continued ocular itch. My recent experience prescribing BEPREVE mirrors the results of clinical trials with the product. It relieves itch rapidly, often within minutes, and is very comfortable on instillation.1,2 Even patients with severe itch can get to “no itch” in that timeframe. In the clinical studies, 68% of eyes with severe itching achieved complete relief in 3 minutes, compared to only 3% given placebo drops.1 This rapid relief provides therapeutic value that my patients can appreciate.

The Value of BID Dosing

For contact lens wearers with allergic conjunctivitis who don't want to go without wearing their lenses for an entire season, BEPREVE is a good fit for both their ocular itch symptoms and their lens care regimen. Of course, if their eyes are red, I advise them not to wear their lenses until the redness is resolved. However, if itching is their primary complaint, I recommend they use a drop of BEPREVE in the morning—at least 10 minutes before inserting their lenses. Then, when they get home at night, I instruct them to remove their lenses and instill another drop before bedtime. For these patients, and especially those who have extended wear lenses, twice-a-day dosing with BEPREVE works well. In addition to convenience, BID dosing provides consistent relief for the patient, particularly during the night. If patients take a medication twice a day, in the morning and the evening, they should maintain inhibition of the allergic cascade and, therefore, good itch control throughout their day. Again, BEPREVE should not be used to treat contact lens-related irritation, so we must exclude that as a cause during the initial diagnosis.

The Value of Economic Flexibility

The majority of my patients are uninsured because I practice in a school setting. In an insured environment, I would prescribe a 10 ml bottle of BEPREVE, which is more economical because it provides 2 months of therapy for one copay. Since the copay doesn't come into play with my patients who pay out-of-pocket, I need to offer an affordable option, so I prescribe a 5 ml bottle. I think it's a benefit for them to have a larger bottle, so if I can convince them to get the larger bottle, I certainly do. However, the most important thing is that they get the medication that will provide rapid, sustained relief of their ocular itch and having two options facilitates this.

Fortunately, ISTA also provides a point-of-sale coupon and an online coupon that provide additional economic benefits for my patients. I don't want them to have to wait for a rebate check. Instant savings are more appealing and may encourage them to fill the prescription I've written.

Indications and Usage

BEPREVE is a histamine H1 receptor antagonist indicated for the treatment of itching associated with allergic conjunctivitis.

Dosage and Administration

Instill one drop into the affected eye(s) twice a day (BID).

Warnings and Precautions

• To minimize the risk of contamination, do not touch dropper tip to any surface. Keep bottle tightly closed when not in use.
• Patients should be advised not to wear a contact lens if their eye is red
• BEPREVE should not be used to treat contact lens-related irritation.
• Patients should remove contact lenses prior to instillation of BEPREVE. Lenses may be reinserted after 10 minutes following administration of BEPREVE.

Adverse Reactions

The most common adverse reaction occurring in approximately 25% of patients was a mild taste following instillation. Other adverse reactions which occurred in 2-5% of subjects were eye irritation, headache, and nasopharyngitis.



1. Clark JC, Williams JI, Gow JA, Abelson MB, McNamara TR; Bepotastine Besilate Ophthalmic Solutions Clinical Study Group. Bepotastine besilate ophthalmic solution 1.5% rapidly eliminates ocular itching in more severely allergic subjects in the conjunctival allergen challenge model of allergic conjunctivitis. Poster presented at: Eastern Allergy Conference; May 6-9, 2010; Palm Beach, Fla.
2. Williams JI, Ackerman SL, Dao JT, Reddy TA, McNamara TR, Gow JA. The ocular comfort of bepotastine besilate ophthalmic solution 1.5% in a safety clinical trial. Poster presented at the 88th Annual Meeting of the American Academy of Optometry. San Francisco, Calif.: November 17-20, 2010.

Dr. Lonsberry is a paid consultant of ISTA Pharmaceuticals, Inc.

Optometric Management, Issue: August 2011