Can the Rupall dose be increased from 10mg to 20mg?

Increasing Rupall (Rupatadine) Dose from 10mg to 20mg

Yes, Rupall (rupatadine) dose can be safely increased from 10mg to 20mg daily in patients who do not achieve adequate symptom control with the standard 10mg dose. This higher dosing is supported by clinical evidence demonstrating both efficacy and safety.

Evidence Supporting Dose Increase

Efficacy at Higher Doses

• Clinical trials have demonstrated that rupatadine 20mg provides greater symptom relief compared to 10mg:
  • In a Japanese study of seasonal allergic rhinitis, rupatadine 20mg showed a greater reduction in nasal symptoms compared to 10mg (least squares mean difference of -1.415 vs -1.085 from placebo) 1
  • For chronic idiopathic urticaria, 20mg dosing achieved 63.3% reduction in mean pruritus score compared to 57.5% with 10mg 2

Long-term Safety at Higher Doses

• A 52-week clinical trial specifically evaluated the safety and efficacy of updosing from 10mg to 20mg in Japanese patients with pruritic conditions 3
  • The study demonstrated persistent therapeutic effect up to Week 52
  • No serious adverse drug reactions were reported at either dose

Clinical Considerations When Increasing Dose

Patient Selection

• Consider dose increase for patients with:
  • Inadequate symptom control on 10mg daily
  • More severe symptoms of allergic rhinitis or urticaria
  • Symptoms that significantly impact quality of life despite standard dosing

Monitoring

• When increasing to 20mg, monitor for:
  • Somnolence (most common adverse effect, reported in 7.0-7.3% of patients) 1
  • Other potential adverse effects, though clinical trials show similar safety profile between 10mg and 20mg doses

Contraindications to Dose Increase

• Avoid 20mg dosing in patients with:
  • Concurrent use of cytochrome P450 inhibitors (e.g., erythromycin, ketoconazole) 4
  • Significant hepatic or renal impairment
  • Previous intolerance to 10mg dose

Implementation

1. Start with standard 10mg daily dose
2. Evaluate symptom control after 2 weeks of therapy
3. If symptoms persist and 10mg is well-tolerated, increase to 20mg daily
4. Reassess efficacy and tolerability after 2-4 weeks on 20mg dose

Practical Considerations

• Rupatadine can be taken once daily regardless of dose due to its long duration of action (>24 hours) 4
• The increased dose maintains the convenience of once-daily dosing
• Long-term studies show compliance rates remain good at higher doses 5

In conclusion, increasing Rupall from 10mg to 20mg is a clinically appropriate strategy for patients with inadequate symptom control at the standard dose, with clinical evidence supporting both the efficacy and safety of this approach.