Prescription Drugs

CLINICAL PHARMACOLOGY Mechanism Of Action Olopatadine is a mast cell stabilizer and a histamine H antagonist. Decreased chemotaxis and inhibition of eosinophil activation has also been demonstrated. Pharmacokinetics In healthy subjects, topical ocular dosing of 1 drop of PAZEO once daily for 7 days into both eyes resulted in mean ± SD (range) steady state plasma olopatadine Cmax and AUC0-12 of 1.6 ± 0.9 ng/mL (0.6 to 4.5 ng/mL) and 9.7 ± 4.4 ng*h/mL (3.7 to 21.2 ng*h/mL), respectively. The olopatadine Cmax and AUC0-12 after the first dose were similar to those measured on day 7 in these subjects, suggesting that there was no systemic accumulation of olopatadine after repeated topical ocular dosing with PAZEO. The median (range) time to achieve peak olopatadine concentrations (Tmax) was 2.0 hours (0.25 to 4 hours). The mean ± SD (range) elimination half life of olopatadine was 3.4 ± 1.2 hours (2 to 8 hours). N-oxide olopatadine (M3) was detected during the first 4 hours after bilateral topical ocular dosing of PAZEO in approximately half of the subjects and in less than 10% of the total plasma samples collected, at concentrations not exceeding 0.121 ng/mL on day 1 and 0.174 ng/mL on day 7. None of the plasma samples from these subjects had mono-desmethyl olopatadine (M1) concentrations that were above the lower limit of quantitation (0.05 ng/mL) of the PK assay. Clinical Studies The efficacy of PAZEO was established in two randomized, double-masked, placebo-controlled, conjunctival allergen challenge (CAC) clinical studies in patients with a history of allergic conjunctivitis (Studies 1 and 2). In Study 1, patients were randomized to receive one of the following study treatments: PAZEO, PATADAY, or vehicle ophthalmic solutions. In Study 2, patients were randomized to receive one of the following study treatments: PAZEO, PATADAY, PATANOL, or vehicle ophthalmic solutions. Patients were evaluated with an ocular itching severity score ranging from 0 (no itching) to 4 (incapacitating itch) at several time points after CAC administration. Table 1 displays the mean ocular itching severity scores after ocular administration of a specific antigen using the CAC model in Studies 1 and 2, respectively. A one unit difference compared to vehicle is considered a clinically meaningful change in the ocular itching severity score. PAZEO demonstrated statistically significantly improved relief of ocular itching compared to vehicle at 30-34 minutes, 16 hours, and 24 hours after study treatment. PAZEO demonstrated statistically significantly improved relief of ocular itching compared to PATADAY at 24 hours after study treatment, but not at 30-34 minutes after study treatment. Table 1: Itching Scores by Treatment Group and Treatment Difference* in Mean Itching Study 1 Time Point PAZEO (Olopatadine, 0.7%) (N = 66) PATADAY (Olopatadine, 0.2%) (N = 68) Vehicle (N = 68) Mean Mean Difference (95% CI) Mean Difference (95% CI) Onset 3 mins 0.36 0.39 -0.02 (-0.31, 0.26) 1.90 -1.54 (-1.82, -1.25) 5 mins 0.53 0.61 -0.08 (-0.39, 0.22) 2.06 -1.53 (-1.84, -1.22) 7 mins 0.48 0.61 -0.13 (-0.44, 0.17) 1.97 -1.49 (-1.80, -1.18) 16h 3 mins 0.70 0.87 -0.17 (-0.44, 0.11) 2.20 -1.50 (-1.77, -1.23) 5 mins 0.79 1.04 -0.24 (-0.55, 0.07) 2.27 -1.48 (-1.79, -1.16) 7 mins 0.75 0.98 -0.23 (-0.54, 0.08) 2.13 -1.38 (-1.69, -1.07) 24h 3 mins 0.93 1.41 -0.48 (-0.76, -0.20) 2.54 -1.61 (-1.88, -1.33) 5 mins 1.10 1.52 -0.42 (-0.72,-0.12) 2.62 -1.51 (-1.81, -1.21) 7 mins 1.09 1.50 -0.41 (-0.72, -0.10) 2.50 -1.41 (-1.72, -1.11) Study 2 (N = 98) (N = 99) (N = 49) Onset 3 mins 0.38 0.47 -0.09 (-0.28, 0.09) 1.91 -1.53 (-1.76, -1.30) 5 mins 0.53 0.61 -0.08 (-0.29, 0.12) 1.99 -1.46 (-1.71, -1.22) 7 mins 0.65 0.61 0.04 (-0.18, 0.26) 1.82 -1.17 (-1.45, -0.90) 24h 3 mins 1.01 1.33 -0.31 (-0.57, -0.06) 2.30 -1.29 (-1.60, -0.97) 5 mins 1.22 1.48 -0.26 (-0.51, -0.01) 2.37 -1.15 (-1.46, -0.84) 7 mins 1.25 1.41 -0.16 (-0.42, 0.11) 2.14 -0.89 (-1.22, -0.57) *Mean score estimates, treatment differences and corresponding 95% confidence intervals (CIs) were based on analysis of repeated measures using a mixed model with itching scores from each eye (left or right) as the dependent variable and fixed effect terms for investigator, treatment, eye-type (left or right), time, and treatment-by-time interaction; The ocular itching score range is 0-4, where 0 is none and 4 is incapacitating itch.

CLINICAL PHARMACOLOGY Mechanism of Action Olopatadine is a mast cellstabilizer and a histamine H1 antagonist. Decreased chemotaxis and inhibition of eosinophil activation has also been demonstrated. Pharmacokinetics Systemic bioavailability data upon topical ocular administration of PATADAY™ (olopatadine hydrochloride ophthalmic solution) solution are not available. Following topical ocular administration of olopatadine 0.15% ophthalmic solution in man, olopatadine was shown to have a low systemic exposure. Two studies in normal volunteers (totaling 24 subjects) dosed bilaterally with olopatadine 0.15% ophthalmic solution once every 12 hours for 2 weeks demonstrated plasma concentrations to be generally below the quantitation limit of the assay ( < 0.5 ng/mL). Samples in which olopatadine was quantifiable were typically found within 2 hours of dosing and ranged from 0.5 to 1.3 ng/mL. The elimination half-life in plasma following oral dosing was 8 to 12 hours, and elimination was predominantly through renal excretion. Approximately 60 - 70% of the dose was recovered in the urine as parent drug. Two metabolites, the mono-desmethyl and the N-oxide, were detected at low concentrations in the urine. Clinical Studies Results from clinical studies of up to 12 weeks duration demonstrate that PATADAY™ (olopatadine hydrochloride ophthalmic solution) solution when dosed once a day is effective in the treatment of ocular itching associated with allergic conjunctivitis.

Find Lowest Prices on PAZEO (olopatadine hydrochloride) Ophthalmic Solution DESCRIPTION PAZEO is a sterile ophthalmic solution containing olopatadine, which is a mast cell stabilizer, for topical administration to the eyes. Olopatadine hydrochloride is a white, crystalline, water soluble powder with a molecular weight of 373.88 and a molecular formula of C21H23NO3•HCl. The chemical structure is presented below: Chemical Name: 11-[(Z)-3(dimethylamino) propylidene]-6-11dihydrodibenz[b,e] oxepin-2-acetic acid, hydrochloride. Each mL of PAZEO solution contains an active ingredient [7.76 mg of olopatadine hydrochloride (7 mg olopatadine)] and the following inactive ingredients: povidone; hydroxypropyl-gamma-cyclodextrin; polyethylene glycol 400; hypromellose; boric acid; mannitol; benzalkonium chloride 0.015% (preservative); hydrochloric acid/sodium hydroxide (to adjust pH); and purified water. PAZEO solution has a pH of approximately 7.2 and an osmolality of approximately 300 mOsm/kg.

Find Lowest Prices on PATADAY™ (olopatadine hydrochlorideophthalmic) Solution DESCRIPTION PATADAY™ (olopatadine hydrochloride ophthalmic solution) 0.2% is a sterile ophthalmic solution containing olopatadine for topical administration to the eyes. Olopatadine hydrochloride is a white, crystalline, water-soluble powder with a molecular weight of 373.88 and a molecular formula of C21H23NO3 • HCl. The chemical structure is presented below: Chemical Name: 11-[(Z)-3(Dimethylamino) propylidene]-6-11dihydrodibenz[b,e] oxepin-2-acetic acid, hydrochloride Each mL of PATADAY™ (olopatadine hydrochloride ophthalmic solution) solution contains: Active: 2.22 mg olopatadine hydrochloride equivalent to 2 mg olopatadine. Inactives: povidone; dibasic sodium phosphate; sodium chloride; edentate disodium; benzalkonium chloride 0.01% (preservative); hydrochloric acid/sodium hydroxide (adjust pH); and purified water. It has a pH of approximately 7and an osmolality of approximately 300 mOsm/kg.

INDICATIONS PAZEO is indicated for the treatment of ocular itching associated with allergic conjunctivitis. DOSAGE AND ADMINISTRATION The recommended dosage of PAZEO is to instill one drop in each affected eye once a day. HOW SUPPLIED Dosage Forms And Strengths Ophthalmic solution: 7.76 mg of olopatadine hydrochloride in one mL solution (0.7%) in a 4 mL bottle. Storage And Handling PAZEO (olopatadine hydrochloride ophthalmic solution) 0.7% is supplied in a white, oval, low density polyethylene DROP-TAINER* dispenser with a natural low density polyethylene dispensing plug and a white polypropylene cap. Tamper evidence is provided with a shrink band around the closure and neck area of the package. PAZEO is supplied in a 4 mL bottle that contains 2.5 mL of olopatadine hydrochloride ophthalmic solution [7.76 mg of olopatadine hydrochloride in one mL of solution (0.7%)]. NDC 0065-4273-25 Storage Store at 2°C to 25°C (36°F to 77°F). Keep bottle tightly closed when not in use. Alcon Laboratories, Inc., Fort Worth, Texas 76134 USA. Revised: Apr 2017

INDICATIONS PATADAY™ (olopatadine hydrochloride ophthalmic solution) solution is indicated for the treatment of ocular itching associated with allergic conjunctivitis. DOSAGE AND ADMINISTRATION The recommended dose is one drop in each affected eye once a day. HOW SUPPLIED Dosage Forms And Strengths Ophthalmic solution 0.2%: each ml contains 2.22 mg of olopatadine hydrochloride. Storage And Handling PATADAY™ (olopatadine hydrochloride ophthalmic solution) 0.2% is supplied in a white, oval, low density polyethylene DROP-TAINER® dispenser with a natural low density polyethylene dispensing plug and a white polypropylene cap. Tamper evidence is provided with a shrink band around the closure and neck area of the package. 2.5 mL fill in 4 mL bottle (NDC 0065-027225) Storage Store at 2°C to 25°C (36°F to 77°F) Manufacturer details: n/a. Revised: 8/2010

PATIENT INFORMATION Risk of Contamination Advise patients to not touch dropper tip to eyelids or surrounding areas, as this may contaminate the dropper tip and ophthalmic solution. Concomitant Use of Contact Lenses Advise patients not to wear contact lenses if their eyes are red. Advise patients that PAZEO should not be used to treat contact lens related irritation. Advise patients to remove contact lenses prior to instillation of PAZEO. The preservative in PAZEO solution, benzalkonium chloride, may be absorbed by soft contact lenses. Lenses may be reinserted 5 minutes following administration of PAZEO. U.S. Pat.:www.alconpatents.com

PATIENT INFORMATION Topical Ophthalmic Use Only For topical ophthalmic administration only. Sterility of Dropper Tip Patients should be advised to not touch dropper tip to any surface, as this may contaminate the contents. Concomitant Use of Contact Lenses Patients should be advised not to wear a contact lens if their eyes are red. Patients should be advised that PATADAY™ (olopatadine hydrochloride ophthalmic solution) solution should not be use to treat contact lens-related irritation. Patients should also be advised to remove contact lenses prior to instillation of PATADAY™ (olopatadine hydrochloride ophthalmic solution) solution. The preservative in PATADAY™ (olopatadine hydrochloride ophthalmic solution) solution benzalkonium chloride may be absorbed by soft contact lenses. Lenses may be reinserted following administration of PATADAY™ (olopatadine hydrochloride ophthalmic solution) solution.

OVERDOSE No information provided. CONTRAINDICATIONS None.

SIDE EFFECTS Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. In a randomized, double-masked, vehicle-controlled trial, patients at risk for developing allergic conjunctivitis received one drop of either PAZEO (N=330) or vehicle (N=169) in both eyes for 6 weeks. The mean age of the population was 32 years (range 2 to 74 years). Thirty-five percent were male. Fifty-three percent had brown iris color and 23% had blue iris color. The most commonly reported adverse reactions occurred in 2-5% of patients treated with either PAZEO or vehicle. These events were blurred vision, dry eye, superficial punctate keratitis, dysgeusia and abnormal sensation in eye. DRUG INTERACTIONS No information provided.

SIDE EFFECTS Symptoms similar to cold syndrome and pharyngitis were reported at an incidence of approximately 10%. The following adverse experiences have been reported in 5% or less of patients: Ocular: blurred vision, burning or stinging, conjunctivitis, dry eye, foreign body sensation, hyperemia, hypersensitivity, keratitis, lid edema, pain and ocular pruritus. Non-ocular: asthenia, back pain, flu syndrome, headache, increased cough, infection, nausea, rhinitis, sinusitis and taste perversion. Some of these events were similar to the underlying disease being studied. DRUG INTERACTIONS No information provided.

WARNINGS Included as part of the PRECAUTIONS section. PRECAUTIONS Contamination Of Tip And Solution As with any eye drop, care should be taken not to touch the eyelids or surrounding areas with the dropper tip of the bottle to prevent contaminating the tip and solution. Keep bottle tightly closed when not in use. Contact Lens Use Patients should not wear a contact lens if their eye is red. The preservative in PAZEO solution, benzalkonium chloride, may be absorbed by soft contact lenses. Patients who wear soft contact lenses and whose eyes are not red, should be instructed to wait at least five minutes after instilling PAZEO before they insert their contact lenses. Nonclinical Toxicology Carcinogenesis, Mutagenesis, Impairment Of Fertility Carcinogenicity Olopatadine administered orally was not carcinogenic in mice and rats in doses up to 500 mg/kg/day and 200 mg/kg/day, respectively. Based on a 35 μL drop size and a 60 kg person, these doses are approximately 4,500 and 3,600 times the MRHOD, on a mg/m² basis. Mutagenesis No mutagenic potential was observed when olopatadine was tested in an in vitro bacterial reverse mutation (Ames) test, an in vitro mammalian chromosome aberration assay or an in vivo mouse micronucleus test. Impairment Of fertility Olopatadine administered at an oral dose of 400 mg/kg/day (approximately 7,200 times the MRHOD) produced toxicity in male and female rats, and resulted in a decrease in the fertility index and reduced implantation rate. No effects on reproductive function were observed at 50 mg/kg/day (approximately 900 times the MRHOD). Use In Specific Populations Pregnancy Risk Summary There are no adequate or well-controlled studies with PAZEO in pregnant women. Olopatadine caused maternal toxicity and embryofetal toxicity in rats at levels 1,080 to 14,400 times the maximum recommended human ophthalmic dose (MRHOD). There was no toxicity in rat offspring at exposures estimated to be 45 to 150 times that at MRHOD. Olopatadine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Animal Data In a rabbit embryofetal study, rabbits treated orally at 400 mg/kg/day during organogenesis showed a decrease in live fetuses. This dose is 14,400 times the MRHOD, on a mg/m² basis. An oral dose of 600 mg/kg/day olopatadine (10,800 times the MRHOD) was shown to be maternally toxic in rats, producing death and reduced maternal body weight gain. When administered to rats throughout organogenesis, olopatadine produced cleft palate at 60 mg/kg/day (1080 times the MRHOD) and decreased embryofetal viability and reduced fetal weight in rats at 600 mg/kg/day. When administered to rats during late gestation and throughout the lactation period, olopatadine produced decreased neonatal survival at 60 mg/kg/day and reduced body weight gain in offspring at 4 mg/kg/day. A dose of 2 mg/kg/day olopatadine produced no toxicity in rat offspring. An oral dose of 1 mg/kg olopatadine in rats resulted in a range of systemic plasma area under the curve (AUC) levels that were 45 to 150 times higher than the observed human exposure [9.7 ng·hr/mL] following administration of the recommended human ophthalmic dose. Nursing Mothers Olopatadine has been identified in the milk of nursing rats following oral administration. Oral administration of olopatadine doses at or above 4 mg/kg/day throughout the lactation period produced decreased body weight gain in rat offspring; a dose of 2 mg/kg/day olopatadine produced no toxicity. An oral dose of 1 mg/kg olopatadine in rats resulted in a range of systemic plasma area under the curve (AUC) levels that were 45 to 150 times higher than the observed human exposure [9.7 ng·hr/mL] following administration of the recommended human ophthalmic dose. It is not known whether topical ocular administration could result in sufficient systemic absorption to produce detectable quantities in the human breast milk. Nevertheless, caution should be exercised when PAZEO is administered to a nursing mother. Pediatric Use The safety and effectiveness of PAZEO have been established in pediatric patients two years of age and older. Use of PAZEO in these pediatric patients is supported by evidence from adequate and wellcontrolled studies of PAZEO in adults and an adequate and well controlled study evaluating the safety of PAZEO in pediatric and adult patients. Geriatric Use No overall differences in safety and effectiveness have been observed between elderly and younger patients.

WARNINGS Included as part of the PRECAUTIONS section. PRECAUTIONS For topical ocular use only. Not for injection or oral use. Contamination of Tip and Solution As with any eye drop, to prevent contaminating the dropper tip and solution, care should be taken not to touch the eyelids or surrounding areas with the dropper tip of the bottle. Keep bottle tightly closed when not in use. Contact Lens Use Patients should be advised not to wear a contact lens if their eye is red. PATADAY™ (olopatadine hydrochloride ophthalmic solution) 0.2% should not be used to treat contact lens related irritation. The preservative in PATADAY™ (olopatadine hydrochloride ophthalmic solution) solution, benzalkonium chloride, may be absorbed by soft contact lenses. Patients who wear soft contact lenses and whose eyes are not red, should be instructed to wait at least ten minutes after instilling PATADAY™ olopatadine hydrochloride ophthalmic solution) 0.2% before they insert their contact lenses. Nonclinical Toxicology Carcinogenesis, Mutagenesis, Impairment of Fertility Olopatadine administered orally was not carcinogenic in mice and rats in doses up to 500 mg/kg/day and 200 mg/kg/day, respectively. Based on a 40 μL drop size and a 50 kg person, these doses were approximately 150,000 and 50,000 times higher than the maximum recommended ocular human dose (MROHD). No mutagenic potential was observed when olopatadine was tested in an in vitro bacterial reverse mutation (Ames) test, an in vitro mammalian chromosome aberration assay or an in vivo mouse micronucleus test. Olopatadine administered to male and female rats at oral doses of approximately 100,000 times MROHD level resulted in a slight decrease in the fertility index and reduced implantation rate; no effects on reproductive function were observed at doses of approximately 15,000 times the MROHD level. Use In Specific Populations Pregnancy Teratogenic effects: Pregnancy Category C Olopatadine was found not to be teratogenic in rats and rabbits. However, rats treated at 600 mg/kg/day, or 150,000 times the MROHD and rabbits treated at 400 mg/kg/day, or approximately 100,000 times the MROHD, during organogenesis showed a decrease in live fetuses. In addition, rats treated with 600 mg/kg/day of olopatadine during organogenesis showed a decrease in fetal weight. Further, rats treated with 600 mg/kg/day of olopatadine during late gestation through the lactation period showed a decrease in neonatal survival and body weight. There are, however, no adequate and well- controlled studies in pregnant women. Because animal studies are not always predictive of human responses, this drug should be used in pregnant women only if the potential benefit to the mother justifies the potential risk to the embryo or fetus. Nursing Mothers Olopatadine has been identified in the milk of nursing rats following oral administration. It is not known whether topical ocular administration could result in sufficient systemic absorption to produce detectable quantities in the human breast milk. Nevertheless, caution should be exercised when PATADAY™ olopatadine hydrochloride ophthalmic solution) 0.2% is administered to a nursing mother. Pediatric Use Safety and effectiveness in pediatric patients below the age of 2 years have not been established. Geriatric Use No overall differences in safety and effectiveness have been observed between elderly and younger patients.