What is Accolate (aka Zafirlukast)?
In 1996 the FDA approved the use of zafirlukast (Accolate; AstraZeneca Pharmaceuticals, Wilmington, DE), a leukotriene receptor antagonist (LTRA), for the treatment of asthma. This class of drugs has the unique ability to prevent asthma symptoms rather than treating an attack once it occurs.
Laboratory studies have shown that Accolate inhibits the eosinophilic influx and contractile activity of smooth muscle in all 3 leukotrienes compounds (compounds involved in the inflammatory process) in both humans and laboratory animals. Zafirlukast 20 mg administered by mouth 2 times daily is indicated for the preventative and long-term treatment of asthma in adults and children 12 years of age or older. Generally, it is well tolerated, although reported side effects may include headache (12.9%) and nausea (3.1%).12-14
How did an asthma medication become associated with Capsular Contracture?
A few select patients who were prescribed Zafilukast for the management of their asthma symptoms noted that they were experiencing improvement in the thickness and texture of their hypertrophic scars. Zafilukast was then given to a patient with a Baker Grade 3 capsular contracture following breast augmentation surgery. This particular patient experienced a softening and improvement of the severity of her capsular contracture.
What is the Dose of Accolate?
Accolate (Zafirlukast) taken twice a day for 90 days has been shown to result in a softening of the scar tissue around the implants in approximately 50% of cases. In a study of women with capsular contracture, forty randomly chosen patients were given zafirlukast (Accolate) and experienced dramatic softening of the breasts over 3-6 months. In another study, thirty patients with capsular contractures used Accolate for 12 months and 50% experienced softening of the breasts. Accolate has also been shown to decrease the recurrence of capsular contracture in patients who require surgical capsulectomy. If you develop capsular contracture, your best best is to start a trial of Accolate immediately. Accolate is less effective at treating capsular contracture that has been longstanding. In preparation for your surgery, Dr. Brenner may prescribe a short course of Accolate pre- and post-operatively.
Suggested dose: 20mg Zafirlukast twice daily for 3 months. The same dose is used for preventive treatment 2 weeks prior to surgery.
Risks: Allergic rashes; Hepatotoxicity (chemical hepatitis, etc.). Long term effects are unknown as Zafirlukast has only been available in the US since 1999.
Other benefits: Zafirlukast is also used for chronic rhinitis, so patients may notice improved breathing and decreased snoring.