Second-generation antihistamine
Updated · Methodology
First line
First-line for allergic rhinitis under ARIA 2020 alongside other second-generation antihistamines. Standard dose 10 mg once daily; 20 mg is acceptable for severe symptoms. Onset 1–3 hours after intake, with effect lasting at least 24 hours.
Sources
ICD-10: J30.9 · ICD-11: CA08.0
First line
First-line for chronic spontaneous urticaria. Per 2022, up-dosing to 40 mg/day is acceptable when the standard dose is insufficient.
Sources
ICD-10: L50.1 · ICD-11: EB00.1
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Ebastine is a second-generation antihistamine. It is prescribed for seasonal and perennial allergic rhinitis and urticaria ( 2024, AEMPS Ficha Técnica). Ebastine is used in seasonal colds and viral congestion as a universal anti-allergic agent. 2024 and the Cochrane review by De Sutter 2015 did not confirm significant benefit of antihistamines in the common cold. If ebastine was prescribed for a cold without confirmed allergic rhinitis, consider seeking a second opinion.
Selective peripheral H1-antagonist. CYP3A4 metabolizes it in the liver to the active metabolite carebastine (half-life 15–19 hours), allowing once-daily dosing. Minimal blood-brain barrier penetration. Developed by Spain's Almirall and widely used in Spain under the brand Ebastel.
Limited data. The manufacturer advises against use in T1. Loratadine or cetirizine are preferred when antihistamine therapy is needed in pregnancy.
Compatible. Hale L3 (limited data). RID about 1.4%. Widely used in EU for allergic rhinitis and urticaria.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Verbatim lines from the interaction sections, in the language of the label
«Administrar con precaución en pacientes con riesgo cardíaco conocido tales como pacientes con prolongación del intervalo QT, hipocaliemia, tratamiento concomitante con fármacos que incrementen el…»AEMPS, section 4.4 · Open on CIMA
«Se ha estudiado la interacción de ebastina en combinación con ketoconazol o eritromicina (ambos compuestos producen un incremento del intervalo QTc). Con ambas combinaciones se ha observado una…»AEMPS, section 4.5 · Open on CIMA
«Se ha estudiado la interacción de ebastina en combinación con ketoconazol o eritromicina (ambos compuestos producen un incremento del intervalo QTc). Con ambas combinaciones se ha observado una…»AEMPS, section 4.5 · Open on CIMA
«Se ha estudiado la interacción de ebastina en combinación con ketoconazol o eritromicina (ambos compuestos producen un incremento del intervalo QTc). Con ambas combinaciones se ha observado una…»AEMPS, section 4.5 · Open on CIMA
«Se ha estudiado la interacción de ebastina en combinación con ketoconazol o eritromicina (ambos compuestos producen un incremento del intervalo QTc). Con ambas combinaciones se ha observado una…»AEMPS, section 4.5 · Open on CIMA
«No se han descrito interacciones entre ebastina y teofilina, warfarina, cimetidina, diazepam y alcohol.»AEMPS, section 4.5 · Open on CIMA
«Se han observado interacciones farmacocinéticas al administrar ebastina con rifampicina. Estas interacciones pueden dar luegar a una disminución de las concentraciones plasmáticas y a una reducción…»AEMPS, section 4.5 · Open on CIMA
«No se han descrito interacciones entre ebastina y teofilina, warfarina, cimetidina, diazepam y alcohol.»AEMPS, section 4.5 · Open on CIMA
«No se han descrito interacciones entre ebastina y teofilina, warfarina, cimetidina, diazepam y alcohol.»AEMPS, section 4.5 · Open on CIMA
«Antihistamínicos para uso sist émico: Ebastina 20 mg»AEMPS, section 4.5 · Open on CIMA
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Ebastine is evaluated for the following indications with varying evidence strength: Chronic urticaria (evidence tier A), Allergic rhinitis (evidence tier A), Immune support and respiratory infection care (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Ebastine (≥ 1 in 100): Headache, Drowsiness (~3%, placebo-level), Dry mouth. See the Safety section for uncommon and serious reactions.
Limited data. The manufacturer advises against use in T1. Loratadine or cetirizine are preferred when antihistamine therapy is needed in pregnancy.
Compatible. Hale L3 (limited data). RID about 1.4%. Widely used in EU for allergic rhinitis and urticaria.
Ebastine is contraindicated in: Ebastine hypersensitivity; Age under 12 (for 20 mg dose); Severe hepatic impairment. Full list in the Safety section.
Direct links to regulator labels. Open in a new tab.
Fexofenadine, Ketotifen, Levocetirizine, Loratadine, Rupatadine, Chloropyramine, Dexchlorpheniramine, Promethazine