What is the recommended dosage and treatment protocol for Bilastine (Bilastine) in patients with allergic rhinitis and urticaria?

Bilastine Dosage and Treatment Protocol for Allergic Rhinitis and Urticaria

The recommended dosage of bilastine for allergic rhinitis and urticaria is 20 mg once daily for adults and adolescents aged 12 years and older, and 10 mg once daily for children aged 6 to <12 years. Bilastine should be taken on an empty stomach, at least one hour before or two hours after meals, to avoid interference with absorption.

Pharmacological Properties and Efficacy

Bilastine is a second-generation, non-sedating H1-antihistamine with several advantageous properties:

• Rapid onset of action and prolonged duration (14-hour elimination half-life) 1
• Highly selective for H1 histamine receptors 2
• No significant metabolism in humans and minimal drug-drug interaction potential 1
• No dosage adjustment required for patients with renal or hepatic impairment 3
• No cardiotoxic effects at therapeutic doses 4
• Minimal sedative properties compared to other second-generation antihistamines 2

Efficacy in Allergic Rhinitis

Clinical studies have demonstrated that bilastine 20 mg once daily is effective for:

• Reducing nasal symptoms (congestion, rhinorrhea, itching, sneezing) 5
• Improving non-nasal symptoms (ocular itching, tearing, redness) 5
• Enhancing quality of life in patients with both seasonal and perennial allergic rhinitis 1

In comparative studies, bilastine showed:

• Similar efficacy to desloratadine 5 mg in seasonal allergic rhinitis 5
• Similar efficacy to cetirizine in perennial allergic rhinitis 1
• Potentially longer duration of action than fexofenadine 1

Efficacy in Urticaria

For chronic urticaria, bilastine:

• Effectively reduces itching and wheal development from the second day of treatment 4
• Shows similar efficacy to levocetirizine 1
• Can be safely used at doses up to 80 mg once daily (fourfold higher than standard) for refractory cases 1

Treatment Algorithm for Allergic Rhinitis

1. First-line therapy:

   • Bilastine 20 mg once daily for adults and adolescents ≥12 years
   • Bilastine 10 mg once daily for children 6 to <12 years
   • Take on an empty stomach for optimal absorption 4

2. For inadequate response:

   • Consider combination therapy with intranasal corticosteroids, which is more effective than monotherapy for moderate to severe allergic rhinitis 6
   • Intranasal corticosteroids are the most effective medication class for controlling nasal symptoms 6

3. For persistent symptoms:

   • Evaluate for comorbid conditions such as asthma, atopic dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, and otitis media 6
   • Consider allergen immunotherapy for patients with inadequate response to pharmacologic therapy 6

Treatment Algorithm for Urticaria

1. First-line therapy:

   • Bilastine 20 mg once daily for adults and adolescents ≥12 years
   • Take on an empty stomach

2. For inadequate response:

   • Increase bilastine dose up to 80 mg once daily (off-label but supported by safety data) 1
   • This higher dosing is consistent with international guidelines for second-line treatment of urticaria 1

3. For refractory cases:

   • Consider adding an H2 antihistamine, which may provide better control than H1 antihistamine alone 6
   • Consider referral for additional therapies if symptoms persist

Important Clinical Considerations

• Administration timing: Bilastine should not be taken with food to avoid interference with absorption 4

• Drug interactions: Bilastine has minimal potential for drug-drug interactions as it does not interact with cytochrome P450 system 1

• Safety in special populations:

  • No dosage adjustment needed in renal or hepatic impairment 3
  • Not recommended for children under 6 years
  • Safe for elderly patients without dosage adjustment 3

• Common side effects: Headache is the most frequently reported adverse effect 4

• Advantages over other antihistamines:

  • Less sedating potential than many second-generation antihistamines 2
  • No cardiotoxicity concerns at therapeutic doses 4
  • No anticholinergic effects 2

Bilastine represents an effective option for managing allergic rhinitis and urticaria with a favorable safety profile and once-daily dosing convenience that can improve patient adherence and quality of life.