1. Introduction
Montelukast is a leukotriene receptor antagonist (LTRA) used to treat and prevent asthma, exercise-induced bronchoconstriction, and allergic rhinitis. It works by blocking leukotrienes, inflammatory chemicals that cause airway constriction, mucus production, and swelling in asthma and allergic conditions.
2. Indications
- Chronic asthma management and prevention
- Prevention of exercise-induced bronchoconstriction
- Allergic rhinitis (seasonal and perennial)
3. Dosage
Adults (≥15 years):
- Asthma and/or allergic rhinitis: 10 mg once daily in the evening.
- Exercise-induced bronchoconstriction: 10 mg at least 2 hours before exercise.
Children:
- 6 months to 5 years: 4 mg chewable tablet or granules once daily in the evening.
- 6 to 14 years: 5 mg chewable tablet once daily in the evening.
- ≥15 years: 10 mg tablet once daily in the evening.
Elderly:
- No dosage adjustment required.
4. Administration
- Montelukast can be taken with or without food.
- Granules can be administered directly into the mouth, mixed with a spoonful of soft food (e.g., applesauce), or dissolved in a small amount of liquid. Use immediately after preparation.
5. Forms Available
- Tablets: 10 mg
- Chewable tablets: 4 mg, 5 mg
- Oral granules: 4 mg
6. Side Effects
6.1 Common Side Effects:
- Headache
- Abdominal pain
- Cough
- Fatigue
6.2 Less Common Side Effects:
- Diarrhoea
- Dizziness
- Skin rash
6.3 Rare but Serious Side Effects:
- Neuropsychiatric symptoms (e.g., agitation, depression, suicidal thoughts)
- Churg-Strauss syndrome (rare vasculitis associated with asthma)
- Severe allergic reactions (e.g., angioedema, anaphylaxis)
7. Warnings
- Neuropsychiatric Events: Montelukast has been associated with agitation, mood changes, and suicidal thoughts. Patients and caregivers should be advised to monitor for these symptoms and report them immediately.
- Acute Asthma Attacks: Montelukast is not a rescue medication and should not be used for acute bronchospasm.
- Churg-Strauss Syndrome: Rarely reported; symptoms such as worsening asthma, eosinophilia, and vasculitic rash should be evaluated.
8. Precautions
- Use cautiously in patients with a history of depression or other psychiatric disorders.
- Inform patients to continue other asthma medications unless advised otherwise by a healthcare provider.
- Granules should not be stored for future use after being mixed with food or liquid.
9. Interactions
- Phenytoin and Phenobarbital: May reduce Montelukast levels due to CYP3A4 induction.
- Rifampin: Decreases Montelukast plasma levels, reducing effectiveness.
10. Monitoring Parameters
- Monitor asthma control and symptom relief.
- Assess for any neuropsychiatric symptoms, particularly in children and adolescents.
- Monitor for signs of hypersensitivity or vasculitis.
11. Use in Children
- Approved for use in children as young as 6 months for allergic rhinitis and asthma.
- Use the appropriate formulation (granules or chewable tablets) based on the child’s age and weight.
12. Use in Pregnancy
- Classified as Category B (no evidence of risk in animal studies; no adequate human studies).
- Should be used during pregnancy only if clearly needed and the potential benefit outweighs the risk.
13. Use in Elderly
- No specific dose adjustments are required. Montelukast is well tolerated in older adults.
14. Use in Kidney Disease
- No dose adjustment required, as Montelukast is not renally excreted.
15. Use in Liver Disease
- Use cautiously in patients with severe hepatic impairment. Montelukast is primarily metabolised in the liver.
16. Patient Counselling Points
- Take Montelukast at the same time each day, preferably in the evening.
- Do not use Montelukast as a rescue medication for sudden asthma attacks; carry a short-acting bronchodilator (e.g., salbutamol) for emergencies.
- Inform your doctor immediately if you experience mood changes, agitation, or suicidal thoughts.
- Store the medication in a cool, dry place, away from moisture and heat.
- For granules, use immediately after opening the sachet or mixing with food or liquid.
17. Table of Brand Names, Manufacturer, and Prices in USD
Brand Name | Manufacturer | Strength/Dosage Form | Price (USD) |
---|---|---|---|
Singulair | Merck | 10 mg Tablet | $150 (30 tablets) |
Montair | Cipla | 4 mg Chewable Tablet | $50 (30 tablets) |
Generic Montelukast | Various | 10 mg Tablet | $30 (30 tablets) |
18. 15 FAQs (Frequently Asked Questions)
1. What is Montelukast used for?
Montelukast is used to treat and prevent asthma, exercise-induced bronchoconstriction, and allergic rhinitis.
2. How does Montelukast work?
It blocks leukotrienes, which are inflammatory chemicals involved in airway constriction and swelling.
3. What is the usual dose of Montelukast?
The typical adult dose is 10 mg once daily in the evening.
4. Is Montelukast safe for children?
Yes, it is approved for use in children as young as 6 months.
5. Can Montelukast be taken during pregnancy?
It is generally considered safe (Category B), but consult your doctor before use.
6. How long does it take for Montelukast to work?
It may take a few days to see improvement, but maximum benefits may take weeks.
7. Can Montelukast cause mood changes?
Yes, it has been associated with mood changes, agitation, and suicidal thoughts in some patients.
8. Can Montelukast be used as a rescue medication?
No, it is not a rescue medication and cannot treat acute asthma attacks.
9. What are the common side effects of Montelukast?
Common side effects include headache, abdominal pain, and fatigue.
10. Can Montelukast be taken with food?
Yes, Montelukast can be taken with or without food.
11. Can Montelukast be taken with other asthma medications?
Yes, it is often used alongside inhaled corticosteroids or bronchodilators.
12. How should Montelukast be stored?
Store at room temperature, away from light and moisture.
13. What should I do if I miss a dose of Montelukast?
Take the missed dose as soon as you remember, but skip it if it is close to the next scheduled dose.
14. Can Montelukast cause allergic reactions?
Yes, rare cases of severe allergic reactions, such as angioedema, have been reported.
15. Do I need a prescription for Montelukast?
Yes, Montelukast is a prescription-only medication.