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Leukotriene receptor antagonist for asthma/allergy control
Chronic Asthma:
Prophylaxis and maintenance treatment in adults/adolescents ≥15 years.
Allergic Rhinitis:
Seasonal (SAR) and perennial (PAR) allergic rhinitis.
Exercise-Induced Bronchospasm (EIB):
Prophylaxis in patients ≥6 years.
Not for acute asthma attacks or status asthmaticus.
Mechanism: Selective cysteinyl leukotriene (CysLT₁) receptor antagonist.
Action:
Blocks inflammatory effects of leukotrienes (LTC₄, LTD₄, LTE₄).
Reduces eosinophil infiltration, bronchoconstriction, and mucus secretion.
| Indication | Dose | Timing |
|---|---|---|
| Chronic Asthma / SAR / PAR | 10 mg once daily | Evening |
| EIB Prophylaxis | 10 mg single dose | ≥2 hours pre-exercise |
Key Notes:
Do not exceed 10 mg/24 hours.
Swallow tablet whole (do not crush/chew).
Administer with/without food, but consistent timing daily.
| Age | Formulation | Asthma/EIB | Allergic Rhinitis |
|---|---|---|---|
| 6–14 years | Chewable 5 mg | 5 mg daily (evening) | 5 mg daily |
| 2–5 years | Chewable 4 mg or granules | 4 mg daily (evening) | 4 mg daily |
| 6–23 months | Granules 4 mg | 4 mg daily (evening) | 4 mg daily (PAR only) |
EIB in Pediatrics:
≥6 years: 5 mg (chewable) ≥2 hrs pre-exercise.
≥15 years: 10 mg ≥2 hrs pre-exercise.
Hypersensitivity to montelukast or excipients.
Common (≥1%):
Headache • Abdominal pain • Nausea/vomiting • Diarrhea
Serious (Monitor Closely):
Neuropsychiatric: Aggression, depression, suicidal ideation (black box warning).
Allergic Granulomatosis: Churg-Strauss syndrome (eosinophilia, vasculitic rash).
Hepatotoxicity: Elevated LFTs (rare).
Acute Asthma:
Not a rescue medication → Patients must carry short-acting β₂-agonist (SABA) inhalers.
Corticosteroid Reduction:
Do not abruptly replace inhaled/oral steroids (taper gradually under supervision).
Aspirin-Sensitive Asthma:
Continue avoidance of NSAIDs (not a substitute).
Neuropsychiatric Events:
Monitor for behavior changes, mood swings, or suicidal thoughts (especially in children).
Hepatic Impairment:
Mild-moderate: No adjustment.
Severe: Avoid (limited data).
| Drug Class | Effect | Recommendation |
|---|---|---|
| CYP450 Inducers (Rifampicin, Phenytoin, Phenobarbital) | ↓ Montelukast levels | Monitor efficacy; consider dose adjustment |
| Beta-blockers | Potential antagonism | Use with caution |
Pregnancy (Category B): Use only if benefit > risk (limited human data).
Lactation: Excreted in milk; avoid or discontinue nursing.
Symptoms: Abdominal pain, somnolence, thirst.
Treatment: Supportive care (no specific antidote).
Leukotriene Receptor Antagonist
Below 30°C; protect from light/moisture.
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