1)Levocetrizine’s Usual Dose :
Standard recommended dose for adults and children >12 yrs = 5 mg once daily.
It’s the active enantiomer of cetirizine, hence potent even at low doses.
2)When would a doctor consider 10 mg (off-label / higher dose)?
Severe or refractory allergic rhinitis where 5 mg is inadequate for controlling nasal blockage, sneezing, or rhinorrhea.
Chronic spontaneous urticaria (CSU) international guidelines (EAACI/GA²LEN/EDF/WAO) recommend up-dosing of second-generation antihistamines up to 4× the standard dose if symptoms persist.
So, levocetirizine 10 mg (sometimes even 20 mg/day, divided) may be used for resistant urticaria.
Patients with high allergen exposure (seasonal peaks, occupational exposure).

3. Higher dose gives better relief
   Yes, but selectively.
   In urticaria, higher doses can improve itch relief and wheal reduction.
   In allergic rhinitis, benefit is modest often doctors add montelukast or switch to intranasal corticosteroids instead of just doubling levocetirizine.
   Limitation: Beyond 5 mg, chances of sedation, drowsiness, and dry mouth rise, though still safer than first-generation antihistamines.
4. Montelukast + Levocetirizine combo
   Used especially in allergic rhinitis with concomitant asthma or in patients not fully relieved by antihistamine alone.
   Montelukast targets leukotriene pathway (nasal blockage, night symptoms), while levocetirizine blocks histamine pathway.

Therefore the SOP is as given .
a) 5mg OD is standard dose, effective for most patients.
b)10 mg OD (off-label) may be used in chronic urticaria or severe, uncontrolled allergy symptoms where 5 mg is insufficient.
Sometimes higher dose gives better relief especially in urticaria, but not always dramatically better in rhinitis.

Before doubling the dose, doctors may prefer adding montelukast or switching to combination therapy.
This is for knowledge only . Do consult doctor for the treatment.
Regards,
JAKSTAR PHARMA