Ketotifen / Hydroquinone / Niacinamide Gel in WO6®

Ketotifen / Hydroquinone / Niacinamide Gel in WO6® is a compounded topical preparation that carries three active ingredients in an anhydrous base. WO6® holds almost no water. Hydroquinone degrades quickly in water based formulas, so an anhydrous base is what makes this combination practical to dispense.

How it works

1. The pharmacist blends the three actives into the WO6® anhydrous gel at the strengths the prescriber orders.
2. Hydroquinone is a depigmenting agent and niacinamide is a form of vitamin B3.
3. Ketotifen is a mast cell stabilizer and an H1 antihistamine.
4. WO6® has a water activity below 0.6, which is what classifies it as an anhydrous base.
5. Low water content limits the oxidation that shortens shelf life in hydroquinone preparations.

When prescribers choose it

• Dermatologists ordering a pigment preparation in a combination not sold commercially
• Aesthetic and med spa practices working under a supervising prescriber
• OB GYN practices whose patients develop facial pigment changes during or after pregnancy
• Family medicine and integrative practices that manage pigment concerns
• Prescribers who specifically want ketotifen included, since no commercial pigment product contains it

Dosage forms and strengths

• Hydroquinone 4%, ketotifen 0.05%, and niacinamide at the prescriber's chosen strength
• Actives added, removed, or adjusted at the prescriber's direction
• Gel or cream consistency
• Fragrance free and dye free

How Mixwell prepares it

Mixwell compounds this preparation in Chino, California under USP 795 standards for non sterile compounding. Beyond use dating and batch documentation follow USP requirements. The low water activity of the base is one reason this preparation can carry a longer beyond use date than a water based equivalent. Finished preparations ship across California.

References

• Dias JAF, Lima PB, Cassiano DP, Espósito ACC, Bagatin E, Miot LDB, et al. Oral ketotifen associated with famotidine for the treatment of facial melasma: a randomized, double blind, placebo controlled trial. Journal of the European Academy of Dermatology and Venereology. 2022. https://doi.org/10.1111/jdv.17692
  Note: this trial studied ketotifen taken by mouth. It does not evaluate ketotifen applied to the skin.
• Yoshida M, Takahashi Y, Inoue S. Histamine induces melanogenesis and morphologic changes by protein kinase A activation via H2 receptors in human normal melanocytes. Journal of Investigative Dermatology. 2000;114:334 to 342.
• Melasma. StatPearls [Internet]. National Library of Medicine, NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK459271/

Patients should talk with their own healthcare professional about their circumstances before taking any medication.

Reviewed by Linda Pungpravat, Compounding Pharmacist, RPh, Mixwell Compounding Pharmacy, Chino, CA.