Fexofenadine Dosing Recommendations
For adults and children ≥12 years with seasonal allergic rhinitis or chronic idiopathic urticaria, the recommended dose is 60 mg twice daily or 180 mg once daily; for children 6-11 years, use 30 mg twice daily. 1
Standard Dosing by Indication and Age
Seasonal Allergic Rhinitis
Adults and children ≥12 years:
- 60 mg twice daily OR 180 mg once daily with water 1
- Both regimens provide equivalent 24-hour symptom control 2
- Clinical trials demonstrate superiority over placebo with maintained efficacy throughout the entire dosing interval 2
Children 6-11 years:
- 30 mg twice daily with water 1
- This dose is safe and well-tolerated in large pediatric populations, with adverse event rates similar to placebo 3
Chronic Idiopathic Urticaria
Adults and children ≥12 years:
- 60 mg twice daily OR 180 mg once daily with water 1
- The 60 mg twice daily regimen provides 95% improvement rates with rapid clinical response 4
- Effective for up to 6 weeks of continuous treatment 5
Children 6-11 years:
- 30 mg twice daily with water 1
Renal Impairment Dosing
Adults with decreased renal function:
- Start with 60 mg once daily (rather than twice daily or 180 mg once daily) 1
Children 6-11 years with decreased renal function:
- Start with 30 mg once daily (rather than twice daily) 1
Key Clinical Advantages
Non-sedating profile:
- Fexofenadine, loratadine, and desloratadine do not cause sedation at recommended doses 6
- Even at doses exceeding FDA-approved levels (up to 240 mg/day), fexofenadine demonstrates no sedative properties 6, 5
- This distinguishes it from cetirizine, which causes drowsiness in 9% of patients versus 4% with fexofenadine 2
Cardiac safety:
- No QT interval prolongation or cardiac K+ channel inhibition 5, 7
- Safe when combined with erythromycin or ketoconazole 5
Rapid onset:
- Symptom relief begins within ≤2 hours of administration 5
Common Pitfalls to Avoid
- Do not reduce the dose in elderly patients based on age alone—only adjust for documented renal impairment 1
- Avoid first-generation antihistamines in older adults due to increased risk of falls, fractures, cognitive impairment, and anticholinergic effects 6
- Do not assume all second-generation antihistamines are equally non-sedating—cetirizine and intranasal azelastine may cause sedation at recommended doses, unlike fexofenadine 6
Comparative Efficacy
Fexofenadine 120 mg once daily demonstrates equivalent efficacy to cetirizine 10 mg once daily and loratadine 10 mg once daily for seasonal allergic rhinitis 5, 2. However, fexofenadine produces greater quality of life improvements than loratadine to a clinically meaningful extent 5. No single second-generation antihistamine has been conclusively found to achieve superior overall response rates 6.