Toti is a medication containing Ketotifen Fumarate. It is available in tablet and syrup forms and is manufactured by Eskayef Pharmaceuticals Ltd. in Bangladesh.

Indications

Toti (Ketotifen) is an anti-allergic substance with mast cell stabilizing and antihistamine properties. It is primarily used for the prophylactic (preventive) treatment of:

• Bronchial Asthma: It helps reduce the frequency, severity, and duration of asthma attacks. Important: Toti does not relieve an asthma attack once it has already started.
• Allergic Conditions: Symptomatic treatment of various allergic manifestations, including:
  • Allergic Rhinitis (hay fever, runny nose, sneezing)
  • Allergic Conjunctivitis (itchy, watery eyes)
  • Allergic skin reactions (like urticaria/hives)
  • Alleviating complications of itching, pain, and tenderness associated with neurofibroma.

Pharmacology

Ketotifen works by blocking histamine H1 receptors, which are involved in allergic reactions. It also stabilizes mast cells, preventing them from releasing inflammatory mediators like histamine, leukotrienes, and prostaglandins that cause allergic symptoms. Its prophylactic activity in asthma may take several weeks to become fully established.

Dosage and Administration

Toti is administered orally with food.

• Adults: 1 mg twice daily. In severe cases, the dose may be increased to 2 mg twice daily.
• Children above 3 years: 1 mg twice daily with food.
• Patients prone to sedation: May start with 0.5 to 1 mg at night for the first few days.
• Elderly: Same as adult dose or as advised by a physician.

It is important to continue any previous asthma treatment (especially corticosteroids) for at least two weeks after starting Toti to prevent asthma exacerbation.

Side Effects

Side effects are uncommon and usually mild, often resolving spontaneously after a few days of treatment:

• Common: Drowsiness, dry mouth, slight dizziness.
• Rare: Excitation, irritability, sleep disturbance (insomnia), nervousness, weight gain, a reversible fall in platelet count (if used with oral antidiabetic medications).

Contraindications

• Known hypersensitivity to Ketotifen or any component of the formulation.
• Concurrent use with oral antidiabetic medications, as a reversible decrease in platelet count has been observed.
• Generally not recommended during pregnancy or breastfeeding due to limited data, although there's no evidence of teratogenic effects.

Precautions and Warnings

• Not for Acute Attacks: Toti will not stop an acute asthma attack. Patients should continue using their rescue inhalers for acute symptoms.
• Withdrawal of other medications: It is important to gradually reduce or withdraw other asthma medications (especially systemic corticosteroids) only under medical supervision.
• Sedation: During the first few days of treatment, reactions may be impaired. Patients should be cautious when driving or operating machinery until they know how Toti affects them.
• Alcohol: Patients should avoid alcoholic drinks as Toti may potentiate the effects of alcohol and other CNS depressants (sedatives, hypnotics, other antihistamines).
• Intercurrent Infection: If an infection occurs, Toti treatment must be supplemented with appropriate antimicrobial therapy.

Pregnancy and Lactation

• Pregnancy: Although no evidence of teratogenic effects, it's generally not recommended during pregnancy. Consult your doctor.
• Lactation: Ketotifen is excreted in breast milk. Use is generally not recommended; consult your doctor to weigh benefits and risks.

Drug Interactions

• CNS Depressants: Toti may potentiate the effects of sedatives, hypnotics, other antihistamines, and alcohol.
• Oral Antidiabetics: A reversible decrease in platelet count has been reported with concomitant use, so this combination should generally be avoided.

Storage Conditions

Store below 30°C, protected from light and moisture. Keep out of the reach of children.