From the Guidelines
Montelukast and levocetirizine can be used together as a combination therapy for allergic conditions, but the most recent and highest quality study suggests that montelukast added to intranasal corticosteroids does not show significant difference in outcomes for patients with chronic rhinosinusitis with nasal polyps (CRSwNP) 1. When considering the use of montelukast and levocetirizine, it's essential to evaluate the specific condition being treated. For CRSwNP, the evidence from the European position paper on rhinosinusitis and nasal polyps 2020 1 indicates that montelukast may not provide additional benefits when used with intranasal corticosteroids.
- Key points to consider:
- Montelukast is a leukotriene receptor antagonist that blocks inflammatory mediators.
- Levocetirizine is a second-generation antihistamine that blocks histamine receptors.
- The combination of montelukast and levocetirizine may be beneficial for patients with allergic rhinitis and asthma, but its effectiveness for CRSwNP is not supported by the most recent evidence.
- Side effects of montelukast and levocetirizine are generally mild, but should be considered when prescribing the combination therapy. The study by Van Gerven 2018 1 found no significant difference between the treatments for any outcome measured, suggesting that montelukast may not be effective in treating CRSwNP when added to intranasal corticosteroids.
- Important considerations:
- The study population and methods may influence the results, and more research may be needed to fully understand the effectiveness of montelukast and levocetirizine for CRSwNP.
- The combination therapy may still be beneficial for other allergic conditions, and the decision to use it should be based on individual patient needs and medical history.
From the Research
Efficacy of Montelukast and Levocetirizine
- The combination of montelukast and levocetirizine has been shown to be effective in reducing symptoms of allergic rhinitis, with a significant decrease in total nasal symptom score (TNSS) compared to baseline 2.
- A study comparing the effect of levocetirizine, montelukast, and their combination on symptoms of allergic rhinitis found that all three regimens were equally effective in improving daytime symptoms, but the combination of montelukast and levocetirizine was more effective in reducing nighttime symptoms 3.
- In patients with chronic urticaria, the combination of levocetirizine and montelukast was found to be comparable to a higher dose of levocetirizine alone in terms of efficacy, but with a better safety profile and improved quality of life 4.
Safety and Cost-Effectiveness
- The combination of montelukast and levocetirizine has been shown to be safe and well-tolerated, with a lower cost-effectiveness ratio compared to the combination of montelukast and fexofenadine 2.
- A study comparing the safety and efficacy of montelukast-levocetirizine combination therapy to montelukast monotherapy in children with allergic rhinitis found that the combination therapy was more effective and had a better safety profile, with fewer adverse events and higher overall satisfaction 5.
Meta-Analysis and Systematic Review
- A systematic review and meta-analysis of six studies found that the combination of montelukast and levocetirizine was effective in reducing nasal symptoms in patients with allergic rhinitis and asthma, with a significant improvement in symptoms compared to monotherapy 6.
- The meta-analysis also found that the combination therapy was safe and well-tolerated, with a low risk of adverse events 6.