Bepreve (bepotastine 1.5%)
Bausch + Lomb's antihistamine for itching from allergic conjunctivitis, one drop twice daily, ages 2 and up.
LabelMedical Eye Care · Prescription
Allergy and Anti-Inflammatory Rx Drops When over-the-counter relief is not enough.
A minority of allergy patients need more than an OTC drop. Prescription antihistamines and a soft steroid labeled for seasonal allergic conjunctivitis cover most of them, with steroid safety monitoring built into the plan.
1.5%bepotastine besilate in Bepreve
0.24%cetirizine in Zerviate, dosed twice daily
0.2%loteprednol etabonate in Alrex
14 daysafter which steroid renewal needs a slit lamp exam
Options
Three prescription paths
Prescription antihistamines extend the OTC approach; a soft steroid adds anti-inflammatory control for short courses during severe seasons.
Zerviate (cetirizine 0.24%)
A topical form of cetirizine for ocular itching, one drop twice daily about 8 hours apart, ages 2 and up.
LabelAlrex (loteprednol 0.2%)
A soft steroid suspension indicated for temporary relief of seasonal allergic conjunctivitis, four times daily.
LabelOther anti-inflammatories
For severe chronic allergic disease such as vernal conjunctivitis, cyclosporine drops are among the options described by MedlinePlus.
MedlinePlusChoosing and monitoring
Pick the least intensive drug that controls symptoms, and set a check-in when a steroid is involved.
- Antihistamine first
- Steroid for short severe flares
- Pressure check on longer steroid courses
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Most common side effects
Bepreve: mild taste after instillation in about 25%. Zerviate: hyperemia, instillation site pain and reduced acuity in about 1% to 7%, similar to vehicle.
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Steroid cautions
Prolonged corticosteroid use can raise pressure, cause posterior subcapsular cataract and mask or worsen infection.
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Monitoring
Alrex labeling calls for pressure monitoring if used 10 days or longer, and re-evaluation if symptoms do not improve after two days.
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Contraindications
Loteprednol is contraindicated in most viral diseases of the cornea and conjunctiva, including epithelial herpes simplex keratitis, and in fungal and mycobacterial infection.
Prescribing
A stepwise plan
Most patients never need the last step.
Step up from OTC
Switch to a prescription antihistamine when a once-daily OTC drop is not enough.
Short steroid course
For a severe flare, add a soft steroid for a limited period and examine with the slit lamp before renewing beyond 14 days.
Follow up
Check pressure on longer courses and taper back to the antihistamine once the flare settles.
Label details
Prescription allergy drops
| Bepreve (bepotastine besilate 1.5%) | Itching with allergic conjunctivitis; twice daily; ages 2+ |
|---|---|
| Zerviate (cetirizine 0.24%) | Ocular itching with allergic conjunctivitis; twice daily about 8 hours apart; ages 2+ |
| Alrex (loteprednol etabonate 0.2%) | Seasonal allergic conjunctivitis; four times daily; contains BAK 0.01% |
Corticosteroid warnings (Alrex label)
- Prolonged use may cause glaucoma with optic nerve damage
- Posterior subcapsular cataract with prolonged use
- Secondary ocular infection and masking of infection
- Initial prescription and renewal beyond 14 days after examination with magnification
Sourcing note
Branded allergy prescriptions are filled by the patient's pharmacy. Practices can order generic ophthalmic prescriptions for in-office use from the Vision Rescue Rx catalog. Prescription orders do not earn the RescueLink participation credit.
Questions about Rx allergy drops
When should I prescribe instead of recommending OTC?
When a once-daily OTC antihistamine has not controlled itching, or when signs are severe enough to need anti-inflammatory control.
Is a steroid safe for allergy?
A soft steroid such as loteprednol 0.2% is labeled for seasonal allergic conjunctivitis, but it carries the class warnings for pressure, cataract and infection, so monitor appropriately.
How long can a patient use Alrex?
The label requires a slit lamp examination before the initial prescription and any renewal beyond 14 days, and pressure monitoring if used 10 days or longer.
Which Rx antihistamines are approved for children?
Bepreve and Zerviate are both labeled for patients two years and older.
What is the most common side effect of Bepreve?
A mild taste after instillation, reported in about 25% of patients.
Does Vision Rescue sell these brands?
Branded allergy prescriptions go to the patient's pharmacy. Vision Rescue supplies OTC allergy products and generic in-office prescriptions.
References
- Bepreve (bepotastine besilate) Prescribing Information, Bausch + Lomb. Label
- Zerviate (cetirizine ophthalmic solution) Prescribing Information, 2017. FDA label
- Alrex (loteprednol etabonate 0.2%) Prescribing Information, Bausch + Lomb. Label
- MedlinePlus. Vernal conjunctivitis. MedlinePlus
Escalate allergy care with confidence
Use OTC drops first, step up to prescriptions when needed, and keep allergy products stocked for the season.
Written for licensed eye care professionals. Review the full Prescribing Information before prescribing. Brand names are trademarks of their owners. Prescription orders are excluded from the RescueLink participation credit.