Montelukast Brand Name– Singulair
What is Montelukast
Montelukast is an oral leukotriene receptor antagonists (LTRA).
Unlike zafirlukast, montelukast does not inhibit CYP2C9 or CYP3A4 and has not been found to affect the hepatic clearance of drugs metabolized by these enzymes.
Montelukast is primarily used for the chronic maintenance treatment of asthma, to prevent exercise-induced bronchoconstriction (EIB), and for the treatment of perennial and seasonal allergic rhinitis.
In general, montelukast is well tolerated; however, serious psychiatric effects (e.g., suicidal behaviors, aggression, depression) have been prevalent in postmarketing reports.
A boxed warning exists in the product label because of serious neuropsychiatric effects.
Montelukast should not be used for mild symptoms of allergic rhinitis, but should be reserved for patients who are not treated effectively with or cannot tolerate other allergy medication.
For asthma maintenance therapy, LTRAs are less effective than inhaled corticosteroids (ICSs); however, they may be of benefit in patients who are unwilling or unable to use ICS, experience intolerable ICS side effects, or have concomitant allergic rhinitis.
LTRAs are add-on therapy for severe asthma in adolescents and adults. In young children with asthma, LTRA therapy reduces symptoms and the need for oral corticosteroids when compared with placebo.
For the prevention of exercise-induced bronchoconstriction (EIB), montelukast may be considered a first-line choice to add as a controller agent to an inhaled short-acting beta-2 agonist (SABA) to control EIB symptoms in patients who cannot be controlled by an inhaled SABA alone.
Expert opinions regard the LTRAs as options in the treatment of allergic rhinitis, particularly when the patient has comorbid asthma.
Montelukast has the most substantial evidence for seasonal and perennial allergies of the LRTAs. However, in patients with allergic rhinitis (seasonal or other) alone, intranasal corticosteroids are generally considered first-line therapy, since treatment results with LTRAs appear to be similar to standard treatments such as antihistamines, and inferior to intranasal corticosteroids.
Montelukast is FDA-approved for use in patients as young as 1 year of age for the maintenance treatment of asthma, as young as 2 years of age for treatment of seasonal allergic rhinitis, and in infants as young as 6 months with perennial allergic rhinitis.
Montelukast is also used for preventing exercise-induced bronchoconstriction (EIB) in patients 6 years and older.
Indications
- allergic rhinitis
- aspirin-induced asthma
- asthma
- atopic dermatitis
- chronic idiopathic urticaria
- exercise-induced bronchospasm prophylaxis
- perennial allergies
- seasonal allergies
- sleep apnea
- urticaria
For the chronic treatment and prevention of the symptoms of asthma, either as monotherapy or as add-on therapy in patients whose persistent mild-moderate asthma is inadequately controlled with inhaled corticosteroids
NOTE: Montelukast is not a rescue medication; it should not be used for the treatment of an acute asthmatic attack or acute bronchospasm. However, montelukast may be continued during the treatment of an acute asthmatic event.
Side Effects
- abdominal pain
- abnormal dreams
- agitation
- anaphylactoid reactions
- angioedema
- anxiety
- arthralgia
- asthenia
- atopic dermatitis
- bleeding
- Churg-Strauss syndrome
- confusion
- conjunctivitis
- cough
- depression
- diarrhea
- dizziness
- drowsiness
- dyspepsia
- dysphemia
- ecchymosis
- edema
- elevated hepatic enzymes
- eosinophilia
- epistaxis
- erythema multiforme
- erythema nodosum
- fatigue
- fever
- gastritis
- hallucinations
- headache
- hepatitis
- hostility
- hypoesthesia
- impulse control symptoms
- infection
- influenza
- insomnia
- irritability
- laryngitis
- memory impairment
- muscle cramps
- myalgia
- myopia
- nasal congestion
- nausea
- nightmares
- palpitations
- pancreatitis
- paresthesias
- pharyngitis
- pruritus
- pyuria
- rash
- restlessness
- rhinitis
- rhinorrhea
- seizures
- sinusitis
- somnambulism
- Stevens-Johnson syndrome
- suicidal ideation
- thrombocytopenia
- toxic epidermal necrolysis
- tremor
- urinary incontinence
- urticaria
- vasculitis
- vomiting
- weight loss
- wheezing
Monitoring Parameters
- laboratory monitoring not necessary
Contraindications
- acute bronchospasm
- alcoholism
- behavioral changes
- breast-feeding
- corticosteroid withdrawal
- depression
- geriatric
- hepatic disease
- hepatitis
- infants
- jaundice
- neonates
- neurologic events
- phenylketonuria
- pregnancy
- psychiatric event
- status asthmaticus
- suicidal ideation
Interactions
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Carbamazepine
- Enzalutamide
- Gemfibrozil
- Hydantoins
- Lumacaftor; Ivacaftor
- Mitotane
- Phenobarbital
- Primidone
- Rifamycins
- St. John’s Wort, Hypericum perforatum
- Warfarin
