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Montelukast: Uses, Dosage & Side Effects

Montelukast is a prescription medication used to treat asthma and allergic rhinitis. It works by blocking leukotrienes, thereby reducing airway inflammation and bronchoconstriction.

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Things worth knowing about "Montelukast"

Montelukast is a prescription medication used to treat asthma and allergic rhinitis. It works by blocking leukotrienes, thereby reducing airway inflammation and bronchoconstriction.

What is Montelukast?

Montelukast is a leukotriene receptor antagonist (LTRA) used in the long-term management of asthma and allergic rhinitis (hay fever). It is marketed under the brand name Singulair and is available as film-coated tablets, chewable tablets, and oral granules. Montelukast is taken once daily and is approved for use in both adults and children as young as 6 months (for asthma).

Mechanism of Action

Leukotrienes are inflammatory mediators released by immune cells such as mast cells and eosinophils during allergic reactions and asthma attacks. They cause:

Narrowing of the airways (bronchoconstriction)
Increased mucus secretion in the bronchi
Inflammation of the nasal mucosa
Swelling of airway tissue

Montelukast selectively blocks the cysteinyl leukotriene receptor 1 (CysLT1), preventing these effects. This results in reduced airway inflammation, less mucus production, and improved breathing.

Indications

Montelukast is approved for the treatment of:

Asthma bronchiale (long-term prophylactic treatment, from 6 months of age)
Exercise-induced bronchoconstriction
Seasonal and perennial allergic rhinitis (from 2 years of age)

It is often used as an add-on therapy to inhaled corticosteroids (ICS) when ICS alone do not provide sufficient symptom control.

Dosage

Recommended dosages by age group:

Adults and adolescents 15 years and older: 10 mg film-coated tablet once daily in the evening
Children 6 to 14 years: 5 mg chewable tablet once daily in the evening
Children 2 to 5 years: 4 mg chewable tablet or granules once daily
Infants 6 to 23 months (asthma only): 4 mg oral granules once daily

Montelukast can be taken with or without food. For allergic rhinitis, it may be taken at any time of day.

Side Effects

Montelukast is generally well tolerated. Known side effects include:

Common Side Effects

Headache
Abdominal pain
Increased thirst
Upper respiratory tract infections

Serious but Less Common Side Effects

Neuropsychiatric effects: Sleep disturbances, nightmares, depression, anxiety, behavioral changes, and in rare cases suicidal thoughts. The U.S. FDA has issued a boxed (black box) warning regarding these risks.
Allergic reactions including rash and urticaria
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome, very rare)

Patients and caregivers should monitor for changes in mood or behavior and seek medical advice immediately if any such changes are noticed.

Contraindications and Interactions

Montelukast should not be used in patients with known hypersensitivity to the active substance. Relevant drug interactions include:

CYP3A4 inducers such as rifampicin or phenobarbital, which may reduce plasma levels of montelukast
Gemfibrozil, which inhibits montelukast metabolism and may increase its plasma concentration

Montelukast is not a rescue medication and does not replace fast-acting bronchodilators (e.g., salbutamol) for acute asthma attacks.

References

European Medicines Agency (EMA) - Summary of Product Characteristics: Singulair (montelukast), EMA/H/C/000232 (current approved label)
Global Initiative for Asthma (GINA) - Global Strategy for Asthma Management and Prevention, 2023 Update. Available at: ginasthma.org
U.S. Food and Drug Administration (FDA) - Drug Safety Communication: FDA requires a boxed warning about serious mental health side effects for asthma and allergy drug montelukast (Singulair), 2020. Available at: fda.gov

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