Class: Leukotriene Receptor Antagonist
Dosage Forms. Tablet: 10 mg; Chewable Tablet: 4 mg, 5 mg; Granules for Oral Use: 4 mg/packet
Common FDA Label Indication, Dosing, and Titrations.
1. Asthma: Children 12 mo to 5 y, 4 mg po daily; Children 6-14 y, 5 mg po daily; Children 15 y of age and older and Adults, 10 mg po daily hs
2. Exercise-induced asthma: Children 15 y and older and Adults, 10 mg po 2 h before exercise, max 1 dose/24 h
3. Perennial or seasonal allergic rhinitis: Children 12 mo to 5 y, 4 mg po daily; Children 6-14 y, 5 mg po daily; Children 15 y and older and Adults, 10 mg po daily hs
1. Atopic dermatitis: 10 mg po daily
MOA. Leukotrienes are products of arachidonic acid metabolism and are released from various cells, including mast cells and eosinophils, and bind to leukotriene receptors. Montelukast binds with leukotriene receptors to inhibit physiologic actions of leukotriene.
Drug Characteristics: Montelukast
Medication Safety Issues: Montelukast
Drug Interactions: Montelukast
Adverse Reactions: Montelukast
Efficacy Monitoring Parameters. Resolution of clinical signs of asthma (improved pulmonary function tests) or symptoms of rhinitis.
Toxicity Monitoring Parameters. Seek medical attention if change in behavior/mood, including suicidal thinking or suicide or neuropsychiatric symptoms (eg, agitation, aggression, anxiousness, etc) occurs; monitor blood chemistry and liver function test monitoring.
Key Patient Counseling Points. Not indicated for acute asthma attacks. Report increased use or frequency of short-acting inhaled bronchodilators and advise patients not to discontinue or decrease the dose of other asthma medications unless instructed by a healthcare professional. Patients with asthma should take dose in the evening.
Clinical Pearls. Current treatment guidelines published by the National Heart, Lung, and Blood Institute (NHLBI) emphasize the use of inhaled corticosteroids as first-line therapy for long-term control of persistent asthma symptoms in both children and adults. Leukotriene receptor antagonists are alternative agents, but not preferred, for the treatment of mild persistent asthma in children 5 y and older, and in adults. Consult guidelines for more information on asthma management.