MCAS / Allergies

Starting: 0.5-1 mg at bedtime → Target: 1-2 mg twice daily

Asthma prevention

Starting: 1 mg at bedtime → Target: 1-2 mg twice daily

Pediatric

Starting: 0.5 mg at bedtime → Target: 0.5-1 mg twice daily

Titration Tips

1. Start low — drowsiness is common initially and dose-dependent
2. Take at bedtime initially to manage sedation
3. Increase by 0.5-1 mg every 5-7 days as tolerated
4. Allow 2-4 weeks at target dose to assess efficacy

Available Forms

Compounding pharmacies typically prepare ketotifen as capsules (0.5 mg, 1 mg, 2 mg) or oral liquid (1 mg/mL is common). Liquid formulations allow more precise dosing and easier titration, especially for children or those who need very low starting doses.

Common (may improve over time)

• Drowsiness/sedation — most common, usually decreases after 1-2 weeks
• Increased appetite — can lead to weight gain
• Dry mouth
• Dizziness

Less Common

• Headache
• Nausea
• Irritability (more common in children)
• Insomnia (paradoxical)

Managing Side Effects

• For drowsiness: Take dose at bedtime; start with lowest dose; give it 1-2 weeks to improve
• For weight gain: Monitor appetite changes; maintain regular eating schedule
• For dry mouth: Stay hydrated; sugar-free gum can help