Ebastine

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Ebastine
Clinical data
AHFS/Drugs.com	International Drug Names
Routes of; administration	Oral
ATC code	R06AX22 (WHO) ;
Pharmacokinetic data
Protein binding	Greater than 95%
Metabolism	Hepatic (CYP3A4-mediated), to carebastine
Elimination half-life	15 to 19 hours (carebastine)
Identifiers
	IUPAC name 4-(4-benzhydryloxy-1-piperidyl)-1-(4-tert-butylphenyl)butan-1-one;
CAS Number	90729-43-4 ;
PubChem CID	3191;
ChemSpider	3079 ;
UNII	TQD7Q784P1;
ChEMBL	ChEMBL305660 ;
E number	{{#property:P628}}
ECHA InfoCard	{{#property:P2566}}Lua error in Module:EditAtWikidata at line 36: attempt to index field 'wikibase' (a nil value).
Chemical and physical data
Formula	C32H39NO2
Molar mass	469.658 g/mol
3D model (JSmol)	Interactive image;
	SMILES O=C(c1ccc(cc1)C(C)(C)C)CCCN4CCC(OC(c2ccccc2)c3ccccc3)CC4;
	InChI InChI=1S/C32H39NO2/c1-32(2,3)28-18-16-25(17-19-28)30(34)15-10-22-33-23-20-29(21-24-33)35-31(26-11-6-4-7-12-26)27-13-8-5-9-14-27/h4-9,11-14,16-19,29,31H,10,15,20-24H2,1-3H3 ; Key:MJJALKDDGIKVBE-UHFFFAOYSA-N ;
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Ebastine (trade names Evastin, Kestine, Ebastel, Aleva, Ebatrol) is a H₁ antihistamine with low potential for causing drowsiness.

It does not penetrate the blood–brain barrier to a significant amount and thus combines an effective block of the H₁ receptor in peripheral tissue with a low incidence of central side effects, i.e. seldom causing sedation or drowsiness.^[1]^[2]^[3]

The patent in which the structure of ebastine is first mentioned is Template:Patent in Europe and Template:Patent in the US. The substance is often provided in micronised form due to poor water solubility.

Uses and availability

Ebastine is a second-generation H1 receptor antagonist that is indicated mainly for allergic rhinitis and chronic idiopathic urticaria.^[4] It is available in 10 and 20 mg tablets^[5] and as fast-dissolving tablets,^[6] as well as in pediatric syrup. It has a recommended flexible daily dose of 10 or 20 mg, depending on disease severity.

Ebastine is available in different formulations (tablets, fast dissolving tablets and syrup) and commercialized under different brand names around the world, Ebet, Ebastel FLAS, Kestine, KestineLIO, KestinLYO, EstivanLYO, Evastel Z, Ebatrol, etc.

Pharmacokinetic profile

After oral administration, ebastine undergoes extensive first-pass metabolism by hepatic cytochrome P450 3A4 into its active carboxylic acid metabolite, carebastine. This conversion is practically complete.

Efficacy

Data from over 8,000 patients in more than 40 clinical trials^{[not in citation given]} and studies^[3]^[4]^[5]^[7]^[8]^[9] suggest efficacy of ebastine in the treatment of intermittent allergic rhinitis, persistent allergic rhinitis and other indications.

Safety

Ebastine has shown overall safety and tolerability profile with no cognitive/psychomotor impairment^[5] and no sedation^[5] worse than placebo,^[2] and cardiac safety, that is, no QT prolongation.^[5] The incidence of most commonly reported adverse events was comparable between the ebastine and placebo groups, which confirms that ebastine has a favourable safety profile.

While experiments in pregnant animals showed no risk for the unborn, no such data are available in humans. It is not known whether ebastine passes into the breast milk.^[2]

References

↑ Tagawa, M; Kano, M; Okamura, N (2001). "Neuroimaging of histamine H1-receptor occupancy in human brain by positron emission tomography (PET): a comparative study of ebastine, a second-generation antihistamine, and (+)-clorphrniramine, a classical antihistamine". Br J Clin Pharmacol. 52 (5): 501–509. doi:10.1046/j.1365-2125.2001.01471.x. PMC 2014616. PMID 11736858.
↑ ^2.0 ^2.1 ^2.2 Dinnendahl, V, Fricke, U, ed. (2010). Arzneistoff-Profile (in German). 4 (23 ed.). Eschborn, Germany: Govi Pharmazeutischer Verlag. ISBN 978-3-7741-98-46-3.
↑ ^3.0 ^3.1 Bousquet, J; Gaudaño, EM; Palama Carlos, AG (1999). "A 12-week, placebo-controlled study of the efficacy and safety of ebastine, 10 and 20 mg once daily, in the treatment of perennial allergic rhinitis". Allergy. 54 (6): 562–568. doi:10.1034/j.1398-9995.1999.00984.x. PMID 10435469.
↑ ^4.0 ^4.1 Van Cauwenberge, P; de Belder, T; Sys, L (2004). "A review of the second-generation antihistamine ebastine for the treatment of allergic disorders". Exp Rew Pharmacother. 5 (8): 1807–13. doi:10.1517/14656566.5.8.1807. PMID 15264995.
↑ ^5.0 ^5.1 ^5.2 ^5.3 ^5.4 Sastre, J (2008). "Ebastine in allergic rhinitis and chronic idiopathic urticaria". Allergy. 63 (Suppl 89): 1–20. doi:10.1111/j.1398-9995.2008.01897.x. PMID 19032340.
↑ Antonijoan, R; García-Gea, C; Puntes, M (2007). "Comparison of inhibition of cutaneous histamine reaction of ebastine fast-dissolving tablet (20 mg) versus desloratadine capsules (5 mg): a randomized, double-blind, double-dummy, placebo-controlled, three period crossover study in healthy, nonatopic adults". Clin Ther. 29 (5): 814–22. doi:10.1016/j.clinthera.2007.05.001. PMID 17697901.
↑ Ratner, P; Falqués, M; Chuecos, F (2005). "Meta-analysis of the efficacy of ebastine 20 mg compared to loratadine 10 mg and placebo in the symptomatic treatment of seasonal allergic rhinitis". Int Arch Allergy Immunol. 138 (4): 312–8. doi:10.1159/000088869. PMID 16224195.
↑ Antonijoan, RM; García-Gea, C; Puntes, M (2007). "A comparison of ebastine 10 mg fast-dissolving tablet with oral desloratadine and placebo in inhibiting the cutaneous reaction to histamine in healthy adults". Clin Drug Invest. 27 (7): 453–61. doi:10.2165/00044011-200727070-00002. PMID 17563125.
↑ Gehanno, P; Bremard-Oury, C; Zeisser, P (1996). "Comparison of ebastine to cetirizine in seasonal allergic rhinitis in adults". Annals of Allergy, Asthma and Immunol. 76 (6): 507–12. doi:10.1016/S1081-1206(10)63269-3. PMID 8673684.

External links

"KESTINE Package Insert". South African Electronic Package Inserts. 1997-10-24. Retrieved 2007-04-01.

[Tagawa_2001-1] Tagawa, M; Kano, M; Okamura, N (2001). "Neuroimaging of histamine H1-receptor occupancy in human brain by positron emission tomography (PET): a comparative study of ebastine, a second-generation antihistamine, and (+)-clorphrniramine, a classical antihistamine". Br J Clin Pharmacol. 52 (5): 501–509. doi:10.1046/j.1365-2125.2001.01471.x. PMC 2014616. PMID 11736858.

[Arzneistoff-Profile-2] 2.0 ^2.1 ^2.2 Dinnendahl, V, Fricke, U, ed. (2010). Arzneistoff-Profile (in German). 4 (23 ed.). Eschborn, Germany: Govi Pharmazeutischer Verlag. ISBN 978-3-7741-98-46-3.

[Bousquet_1999-3] 3.0 ^3.1 Bousquet, J; Gaudaño, EM; Palama Carlos, AG (1999). "A 12-week, placebo-controlled study of the efficacy and safety of ebastine, 10 and 20 mg once daily, in the treatment of perennial allergic rhinitis". Allergy. 54 (6): 562–568. doi:10.1034/j.1398-9995.1999.00984.x. PMID 10435469.

[Van_Cauwenberge_2004-4] 4.0 ^4.1 Van Cauwenberge, P; de Belder, T; Sys, L (2004). "A review of the second-generation antihistamine ebastine for the treatment of allergic disorders". Exp Rew Pharmacother. 5 (8): 1807–13. doi:10.1517/14656566.5.8.1807. PMID 15264995.

[Sastre_2008-5] 5.0 ^5.1 ^5.2 ^5.3 ^5.4 Sastre, J (2008). "Ebastine in allergic rhinitis and chronic idiopathic urticaria". Allergy. 63 (Suppl 89): 1–20. doi:10.1111/j.1398-9995.2008.01897.x. PMID 19032340.

[pmid_17697901-6] Antonijoan, R; García-Gea, C; Puntes, M (2007). "Comparison of inhibition of cutaneous histamine reaction of ebastine fast-dissolving tablet (20 mg) versus desloratadine capsules (5 mg): a randomized, double-blind, double-dummy, placebo-controlled, three period crossover study in healthy, nonatopic adults". Clin Ther. 29 (5): 814–22. doi:10.1016/j.clinthera.2007.05.001. PMID 17697901.

[Ratner_2005-7] Ratner, P; Falqués, M; Chuecos, F (2005). "Meta-analysis of the efficacy of ebastine 20 mg compared to loratadine 10 mg and placebo in the symptomatic treatment of seasonal allergic rhinitis". Int Arch Allergy Immunol. 138 (4): 312–8. doi:10.1159/000088869. PMID 16224195.

[pmid_17563125-8] Antonijoan, RM; García-Gea, C; Puntes, M (2007). "A comparison of ebastine 10 mg fast-dissolving tablet with oral desloratadine and placebo in inhibiting the cutaneous reaction to histamine in healthy adults". Clin Drug Invest. 27 (7): 453–61. doi:10.2165/00044011-200727070-00002. PMID 17563125.

[Gehanno_1996-9] Gehanno, P; Bremard-Oury, C; Zeisser, P (1996). "Comparison of ebastine to cetirizine in seasonal allergic rhinitis in adults". Annals of Allergy, Asthma and Immunol. 76 (6): 507–12. doi:10.1016/S1081-1206(10)63269-3. PMID 8673684.

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v t e Antihistamines (R06)
Aminoalkyl ethers	Bromazine/Bromodiphenhydramine • Carbinoxamine • Clemastine • Chlorphenoxamine • Diphenylpyraline • Diphenhydramine • Doxylamine • Orphenadrine • Phenyltoloxamine
Substituted alkylamines	Brompheniramine • Chlorphenamine • Dexbrompheniramine • Dexchlorpheniramine • Dimetindene • Pheniramine • Talastine
Substituted ethylenediamines	Chloropyramine • Histapyrrodine • Mepyramine • Methapyrilene • Tripelennamine (Pyribenzamine)
Phenothiazine derivatives	Alimemazine • Hydroxyethylpromethazine • Isothipendyl • Mequitazine • Methdilazine • Oxomemazine • Promethazine
Piperazine derivatives	Buclizine • Cetirizine • Chlorcyclizine • Cinnarizine • Cyclizine • Hydroxyzine • Levocetirizine • Meclizine • Niaprazine • Oxatomide
Others for systemic use	Antazoline • Azatadine • Bamipine • Cyproheptadine • Deptropine • Dimebon • Ebastine • Epinastine • Ketotifen • Mebhydrolin • Mizolastine • Phenindamine • Pimethixene • Pyrrobutamine • Rupatadine • Triprolidine • selective (Acrivastine • Astemizole • Azelastine • Desloratadine • Fexofenadine • Loratadine • Terfenadine)
For topical use	Bamipine • Chloropyramine • Chlorphenoxamine • Clemastine • Dimetindene • Diphenhydramine • Isothipendyl • Mepyramine • Promethazine • Thenalidine
Antiallergic agents excluding corticosteroids	Antazoline • Azelastine
Other antiallergics	Emedastine • Epinastine • Ketotifen • Montelukast • Olopatadine

v t e Histamine receptor modulators
H₁	Agonists: 2-Pyridylethylamine Betahistine Histamine HTMT L-Histidine UR-AK49 Antagonists: First-generation: 4-Methyldiphenhydramine Alimemazine Antazoline Azatadine Bamipine Benzatropine (benztropine) Bepotastine Bromazine Brompheniramine Buclizine Captodiame Carbinoxamine Chlorcyclizine Chloropyramine Chlorothen Chlorphenamine Chlorphenoxamine Cinnarizine Clemastine Clobenzepam Clocinizine Cloperastine Cyclizine Cyproheptadine Dacemazine Decloxizine Deptropine Dexbrompheniramine Dexchlorpheniramine Dimenhydrinate Dimetindene Diphenhydramine Diphenylpyraline Doxylamine Embramine Etodroxizine Etybenzatropine (ethylbenztropine) Etymemazine Fenethazine Flunarizine Histapyrrodine Homochlorcyclizine Hydroxyethylpromethazine Hydroxyzine Isopromethazine Isothipendyl Meclozine Medrylamine Mepyramine (pyrilamine) Mequitazine Methafurylene Methapyrilene Methdilazine Moxastine Orphenadrine Oxatomide Oxomemazine Perlapine Phenindamine Pheniramine Phenyltoloxamine Pimethixene Piperoxan Pipoxizine Promethazine Propiomazine Pyrrobutamine Talastine Thenalidine Thenyldiamine Thiazinamium Thonzylamine Tolpropamine Tripelennamine Triprolidine Second/third-generation: Acrivastine Alinastine Astemizole Azelastine Bamirastine Barmastine Bepiastine Bepotastine Bilastine Cabastinen Carebastine Cetirizine Clemastine Clemizole Clobenztropine Desloratadine Dorastine Ebastine Efletirizine Emedastine Epinastine Fexofenadine Flezelastine Ketotifen Latrepirdine Levocabastine Levocetirizine Linetastine Loratadine Mapinastine Mebhydrolin Mizolastine Moxastine Noberastine Octastine Olopatadine Perastine Pibaxizine Piclopastine Quifenadine (phencarol) Rocastine Rupatadine Setastine Sequifenadine (bicarphen) Talastine Temelastine Terfenadine Vapitadine Zepastine Others: Atypical antipsychotics (e.g., aripiprazole, asenapine, brexpiprazole, clozapine, iloperidone, olanzapine, paliperidone, quetiapine, risperidone, RP-5063, ziprasidone, zotepine) Phenylpiperazine antidepressants (e.g., hydroxynefazodone, nefazodone, trazodone, triazoledione) Tetracyclic antidepressants (e.g., amoxapine, loxapine, maprotiline, mianserin, mirtazapine, oxaprotiline) Tricyclic antidepressants (e.g., amitriptyline, butriptyline, clomipramine, desipramine, dosulepin (dothiepin), doxepin, imipramine, iprindole, lofepramine, nortriptyline, protriptyline, trimipramine) Typical antipsychotics (e.g., chlorpromazine, flupenthixol, fluphenazine, loxapine, perphenazine, prochlorperazine, thioridazine, thiothixene) Unknown/unsorted: Azanator Belarizine Elbanizine Flotrenizine GSK1004723 Napactadine Tagorizine Trelnarizine Trenizine
H₂	Agonists: Amthamine Betazole Dimaprit Histamine HTMT Impromidine L-Histidine UR-AK49 Antagonists: Bisfentidine Burimamide Cimetidine Dalcotidine Donetidine Ebrotidine Etintidine Famotidine Isolamtidine Lafutidine Lamtidine Lavoltidine (loxtidine) Lupitidine Metiamide Mifentidine Niperotidine Nizatidine Osutidine Oxmetidine Pibutidine Quisultazine (quisultidine) Ramixotidine Ranitidine Roxatidine Sufotidine Tiotidine Tuvatidine Venritidine Xaltidine Zolantidine
H₃	Agonists: α-Methylhistamine Cipralisant Histamine Imetit Immepip Immethridine L-Histidine Methimepip Proxyfan Antagonists: A-349,821 A-423,579 ABT-239 ABT-652 AZD5213 Bavisant Betahistine Burimamide Ciproxifan Clobenpropit Conessine Enerisant GSK-189,254 Impentamine Iodophenpropit Irdabisant JNJ-5207852 MK-0249 NNC 38-1049 PF-03654746 Pitolisant SCH-79687 Thioperamide VUF-5681
H₄	Agonists: 4-Methylhistamine α-Methylhistamine Histamine L-Histidine OUP-16 VUF-8430 Antagonists: JNJ-7777120 Mianserin Seliforant Thioperamide Toreforant VUF-6002
See also: Receptor/signaling modulators • Monoamine metabolism modulators • Monoamine reuptake inhibitors

Clinical data

AHFS/Drugs.com	International Drug Names
Routes of administration	Oral
ATC code	R06AX22 (WHO)
Pharmacokinetic data
Protein binding	Greater than 95%
Metabolism	Hepatic (CYP3A4-mediated), to carebastine
Elimination half-life	15 to 19 hours (carebastine)
Identifiers
IUPAC name 4-(4-benzhydryloxy-1-piperidyl)-1-(4-tert-butylphenyl)butan-1-one
CAS Number	90729-43-4^Y
PubChem CID	3191
ChemSpider	3079^Y
UNII	TQD7Q784P1
ChEMBL	ChEMBL305660^Y
E number	{{#property:P628}}
ECHA InfoCard	{{#property:P2566}}Lua error in Module:EditAtWikidata at line 36: attempt to index field 'wikibase' (a nil value).
Chemical and physical data
Formula	C₃₂H₃₉NO₂
Molar mass	469.658 g/mol
3D model (JSmol)	Interactive image
SMILES O=C(c1ccc(cc1)C(C)(C)C)CCCN4CCC(OC(c2ccccc2)c3ccccc3)CC4
InChI InChI=1S/C32H39NO2/c1-32(2,3)28-18-16-25(17-19-28)30(34)15-10-22-33-23-20-29(21-24-33)35-31(26-11-6-4-7-12-26)27-13-8-5-9-14-27/h4-9,11-14,16-19,29,31H,10,15,20-24H2,1-3H3^Y Key:MJJALKDDGIKVBE-UHFFFAOYSA-N^Y
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