Can Pataday Be Used in the Third Trimester of Pregnancy?
Yes, Pataday (olopatadine ophthalmic solution) can be used in the third trimester of pregnancy when the benefits outweigh the risks, though it should be used with caution as there is limited human pregnancy data.
Understanding the Safety Profile
Pataday contains olopatadine, an antihistamine used for allergic conjunctivitis. The available evidence regarding antihistamine use in pregnancy provides the following guidance:
General Antihistamine Safety in Pregnancy
It is best to avoid all antihistamines in pregnancy, especially during the first trimester, although none has been shown to be teratogenic in humans 1.
Loratadine and cetirizine (oral antihistamines in the same class) are classified as U.S. Food and Drug Administration Pregnancy Category B drugs, implying there is no evidence of harm to the fetus during pregnancy, although well-controlled studies in humans are not available 1.
Intranasal antihistamines should be avoided during pregnancy 2, though this recommendation specifically addresses nasal formulations rather than ophthalmic preparations.
Third Trimester Considerations
The third trimester carries lower teratogenic risk compared to the first trimester, as organogenesis is complete 1.
The risk-benefit calculation shifts favorably in later pregnancy, particularly when maternal symptoms significantly impact quality of life 3.
Clinical Decision-Making Algorithm
When considering Pataday in the third trimester:
Assess symptom severity: If allergic conjunctivitis is mild, start with non-pharmacologic measures first 3.
Try safer alternatives first:
- Saline eye rinses have zero systemic absorption and no fetal risk 3
- Cold compresses for symptomatic relief
- Avoidance of allergen triggers when possible
If pharmacologic treatment is necessary:
- Topical ophthalmic medications have minimal systemic absorption, making them inherently lower risk than oral antihistamines 4
- A recent study of topical ophthalmic corticosteroids in pregnant women with allergic conjunctivitis found no association with congenital anomalies, preterm birth, or low birthweight 4
- Olopatadine ophthalmic solution has been shown to effectively control ocular symptoms of allergic conjunctivitis with good tolerability 5
Use the lowest effective dose for the shortest duration 1.
Important Clinical Caveats
Inadequately controlled symptoms may pose greater risk to maternal well-being than appropriate medication use 3.
The ophthalmic route of administration results in significantly less systemic absorption compared to oral antihistamines, reducing theoretical fetal exposure 4.
Document the clinical rationale clearly: severe ocular symptoms affecting daily function, failure of conservative measures, and discussion of risks versus benefits with the patient.
Monitor for any unusual symptoms and maintain close follow-up 3.
Common Pitfall to Avoid
Do not withhold necessary treatment due to pregnancy concerns when maternal quality of life is significantly impaired 3. The third trimester represents a lower-risk period for medication use compared to the first trimester, and topical ophthalmic preparations have minimal systemic absorption 4.