Livostin

Livostin™ 0.05% (levocabastine hydrochloride ophthalmic suspension) is a selective histamine H1-receptor antagonist for topical ophthalmic use. Each mL contains 0.54 mg levocabastine hydrochloride equivalent to 0.5 mg levocabastine; 0.15 mg benzalkonium chloride; propylene glycol; polysorbate 80; dibasic sodium phosphate, anhydrous; monobasic sodium phosphate, monohydrate; disodium edetate; hydroxypropyl methylcellulose; and purified water. It has a pH of 6.0 to 8.0.

The chemical name for levocabastine hydrochloride is (–)-trans-1-[cis-4-Cyano-4- (p-fluorophenyl)cyclohexyl]-3-methyl-4-phenylisonipecotic acid monohydrochloride, and is represented by the following chemical structure:

Levocabastine is a potent, selective histamine H1-antagonist.

Antigen challenge studies performed two and four hours after initial drug instillation indicated activity was maintained for at least two hours.

In an environmental study, Livostin™ 0.05% (levocabastine hydrochloride ophthalmic suspension) instilled four times daily was shown to be significantly more effective than its vehicle in reducing ocular itching associated with seasonal allergic conjunctivitis.

After instillation in the eye, levocabastine is systemically absorbed. However, the amount of systemically absorbed levocabastine after therapeutic ocular doses is low (mean plasma concentrations in the range of 1-2 ng/mL).

For topical use only. Not for injection.

The most frequent adverse experiences reported with the use of Livostin™ 0.05% (levocabastine hydrochloride ophthalmic suspension) were mild, transient stinging and burning (29%) and headache (5%).

Other adverse experiences reported in approximately 1-3% of patients treated with Livostin™ were visual disturbances, dry mouth, fatigue, pharyngitis, eye pain/dryness, somnolence, red eyes, lacrimation/discharge, cough, nausea, rash/erythema, eyelid edema, and dyspnea.

Levocabastine has been assigned to pregnancy category C by the FDA. Animal studies at doses 16,500 to 66,000 times the maximum recommended human ocular dose have demonstrated teratogenicity. There are no controlled data in human pregnancy. Levocabastine should only be given during pregnancy when benefit outweighs risk.

Levocabastine is excreted into human milk. In one nursing woman, the daily dose in the infant after maternal ophthalmic instillation was approximately 0.5 mcg. Adverse effects in the infant are unlikely.

Summary of Use during Lactation

Because absorption from the eye is limited, levocabastine would not be expected to cause any adverse effects in breastfed infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.

Drug Levels

Maternal Levels. There are no published reports of the excretion of levocabastine into breastmilk. The manufacturer reports that levocabastine was found in breast milk of one nursing woman after ophthalmic administration of the drug (dose and duration not stated). The daily dosage of levocabastine that the infant would receive was calculated to be about 0.5 mcg.[1]

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Relevant published information on levocabastine was not found as of the revision date. In one telephone follow-up study, mothers reported irritability and colicky symptoms in 10% of infants exposed to various antihistamines and drowsiness was reported in 1.6% of infants. None of the reactions required medical attention.[2]

Effects on Lactation and Breastmilk

Antihistamines in relatively high doses given by injection can decrease basal serum prolactin in nonlactating women and in early postpartum women.[3][4] However, suckling-induced prolactin secretion is not affected by antihistamine pretreatment of postpartum mothers.[3] Whether lower oral doses of antihistamines have the same effect on serum prolactin or whether the effects on prolactin have any consequences on breastfeeding success have not been studied. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.

References

1. Livostin package insert. Novartis Opthalmics. Duluth GA. January 2006

2. Ito S, Blajchman A, Stephenson M et al. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993;168:1393-9. PMID: 8498418

3. Messinis IE, Souvatzoglou A, Fais N et al. Histamine H1 receptor participation in the control of prolactin secretion in postpartum. J Endocrinol Invest. 1985;8:143-6. PMID: 3928731

4. Pontiroli AE, De Castro e Silva E, Mazzoleni F et al. The effect of histamine and H1 and H2 receptors on prolactin and luteinizing hormone release in humans: sex differences and the role of stress. J Clin Endocrinol Metab. 1981;52:924-8. PMID: 7228996

LactMed Record Number

156

Last Revision Date

20140116

Disclaimer

Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.