What is the recommended dosing for Montelukast (Singulair)?

From the Guidelines

Montelukast should be dosed at 10 mg once daily for patients 12 years and older, while dosing for younger patients is not explicitly stated in the most recent guidelines. When considering the management of asthma, it's crucial to prioritize treatments that balance efficacy with safety and compliance. According to 1, montelukast is an appropriate alternative therapy for mild persistent asthma, especially in patients who cannot or will not use inhaled corticosteroids. The advantages of montelukast include ease of use and high compliance rates, contributing to good control of asthma symptoms in many patients.

Key considerations for montelukast dosing include:

• The medication is taken once daily.
• For patients 12 years and older, it can be used as an alternative for moderate persistent asthma when combined with inhaled corticosteroids, although studies on this combination are limited.
• Montelukast has been shown to provide similar patient-oriented outcomes compared to other treatments like fluticasone and fluticasone/salmeterol in certain patient groups, with the added benefit of fewer respiratory infections in some cases.

Given the information from 1, while specific dosing recommendations for all age groups are not provided, the general principle of once-daily dosing is clear. The dosing should be tailored based on the patient's age and specific condition, with a preference for evening administration to align with the body's natural circadian rhythms and potentially enhance therapeutic effects. It's also important for patients to be aware of potential side effects, including neuropsychiatric effects, and to report these to their healthcare provider promptly.

From the Research

Montelukast Dosing

• The recommended dosing for Montelukast (Singulair) is as follows:
  • For adults (> or = 15 years of age): 10-mg film-coated tablet once daily 2, 3, 4
  • For children (6-14 years): 5-mg chewable tablet once daily 2, 3, 5, 4
  • For children (2-5 years): 4-mg chewable tablet once daily 6

Dose Selection

• The adult montelukast dose (10-mg film-coated tablet) was selected on the basis of classic dose-ranging studies as the lowest dose that produces maximal improvement in both measures of airway function and patient-reported outcomes in chronic asthma 2
• The pediatric dose selection for montelukast was based on the determination of a chewable tablet dose that would provide an overall systemic exposure to montelukast in children similar to that in adults who receive a 10-mg film-coated tablet dose 2, 5

Safety and Tolerability

• Montelukast has been shown to be well tolerated in clinical trials, with an adverse event profile similar to that of placebo 3, 6, 4
• No dose-related adverse effects of montelukast were observed in adults treated with dosages as high as 200 mg per day (20 times the recommended dose) for 5 months 3