Mast cell disorder patients have sensitivities to many medications. Tolerance of different main ingredients, brand name vs. generic, colouring, additives,
preservatives, alcohol, flavouring, animal-derived gelcaps etc., is unique to each patient. Also, over time, patients may develop a tolerance to their
main or preferred type of a medication and need to switch.
We have listed medications approved for use and available in Canada. This page will be updated to reflect new treatments as medical advances
are achieved in treating these disorders.
Please see our list of medications etc. to be avoided at Symptom Management & Mast Cell Degranulation Triggers.
First line medical treatments to alleviate symptoms for all patients include:-
H1 Antihistamines - Reactine (Cetirizine) - Preferred as most effective due to it's late phase reaction properties.
Alternatives to Cetirizine - Aerius (Desloratadine), Claritin (Loratidine), Allegra (Fexofenadine)
Addition of different class of H1 Antihistamine - Some patients benefit from taking two different classes of H1 concurrently.
H2 Antihistamines - Ranitidine (Zantac) - Preferred in prescription form as it is most effective based on patient and
Emergency Extra Medication - Benadryl - Children's Allergy Liquid (for all ages of patients), Atarax (Hydroxyzine)
Antidepressant - Doxepin (tricyclic antidepressant) - This drug has powerful antihistamine properties. It crosses
the blood-brain barrier which helps with cognitive impairment & other symptoms.
Eye Lubricant - Tears Plus, Blink, Refresh - Safest to lubricate dry eyes, stop excessive tear production, protect
tear ducts from becoming blocked or permanently closing;
Eye Mast Cell Stabilizers - Opticrom (Cromolyn) eye drops (OTC), Zaditen (Ketotifen) or Alocril eye drops (both
Proton pump inhibitors for acid reflux - Nexium (Esomeprazole) is preferred as it is most effective based on patient
and physician reports.
Alternatives to Nexium - Pantoloc (Pantoprazole), Pariet (Rabeprazole) - reportedly not as effective.
Nausea medication - Gravol (Dimenhydrinate), Ginger Tablets (Gravol brand or plain), Stemetil (Prochlorperazine)
Anxiety & Tachycardia - Low dose of Clonazepam or other benzodiazepines, Remeron (Mirtazapine), Lyrica
Leukotriene blocker for inflammation - Singulair (Montelukast)
Pain medications - Tylenol Extra Strength (OTC) white tablets only (avoid red dyes, capsules),
Tramadol without Acetaminophen, Nubain (Nalbuphine), Lyrica (Pregabalin), Fentanyl;
Epinephrine - EpiPens for anaphylaxis. Emergency use only.
Steroids - For anaphylaxis and stabilization, Skin reactions - Prednisone, Corticosteroid cream
Additional medical treatments as symptoms and illness progress:-
Mast Cell Stabilizers - Ketotifen is preferred as most effective for entire body, Cromolyn mainly targets
Breathing medication - Ventolin (Salbutamol), Xolair (Omalizumab) for persistent breathing difficulties and
stabilization of disease.
Malnutrition/Malabsorption - Total Parenteral Nutrition (TPN) feeding tube, IV Iron infusion, Vitamin B12
Chemotherapy - Cladribine (Leustatin/2-CdA), Interferon-alfa, Hydroxyurea, Tasigna (Nilotinib), Gleevec (Imatinib),
Aspirin - Our medical advisory panel is assessing the value vs. safety of aspirin therapy. It is to be avoided for all mast cell disorder
patients except in a controlled hospital setting. We currently do not advocate aspirin use for patients in Canada.
Antihistamines - Most antihistamines come in various strengths and some forms have a built in decongestant. Mastocytosis patients
need to avoid decongestants.
Antibiotics - These are not well tolerated. However, over the years, masto patients have built a list of antibiotics they've found to be safest (varies per patient - these are not an endorsement, just patient reported):-
Generics vs. Name Brands - Some patients cannot use generics, some have difficulty with name brands. Also, some patients report that they alternately use generic or name brands of their medications, depending
on how bad their symptoms are per day.
Cold Medicines - Generally, these patients cannot tolerate cold or flu medications.
Atarax (Hydroxyzine) - This is a powerful antihistamine has caused heart
palpitations or irregular heartbeats in mastocytosis patients. It has also caused elevated or fluctuating blood sugar levels.
Patients should be advised of these potential complications before prescribing this medication.
We suggest it be used on emergency basis rather than daily if it causes problems.
Antidepressants - Mastocytosis patients have reported adverse reactions to all types of SSRI antidepressants.
They should be avoided.
Benadryl - This is a crucial first line emergency life saving medication. It is also anticholinergic but not as potent as Atarax.
To avoid developing a tolerance to Benadryl, it is not recommended for daily use in any form. We suggest the Children's Allergy Liquid only
as the liquid form works faster than tablets or pills, and it does not have alcohol. The Adult Benadryl Allergy Liquid has alcohol
and a flavouring which has bothered many patients. Many patients report that generic forms of Benadryl do not work as effectively.
Cimetidine - This is a powerful antihistamine we do not suggest. Research has proven that long term use causes permanent vision
Ginger Gravol - Ginger has salicylates, which may not be safe for some patients.
Doxepin - Research has proven (and patients have reported) that this medication may cause heart arrhythmias in some at high doses (over 50mg). We take it in very low dose (eg.5-10mg)
and slowly increase under Physician guidance. This drug is effective for mastocytosis patients in low doses. Histamine and other chemicals are dumped by our mast cells during sleep. Taking Doxepin at bedtime is an effective
antihistamine with the rare ability to cross the blood-brain barrier. It helps with all symptoms.
Steroids - Long term use of Prednisone has caused diabetes in some patients. Long term use of Corticosteroid creams has caused
thinning of skin. Patients should be advised of these potential complications when prescribing these medications.
Tramadol - This medication comes with or without acetaminophen. As the liver is hardest hit by mastocytosis, our physicians recommend the
form of Tramadol *without* Acetaminophen to protect the liver.
- Azithromycin (Z-pak)
- Beconase AQ
- Biaxin (eg. Clarithromycin)