From the Guidelines
Montelukast (Singulair) should be prescribed for patients with asthma as an alternative therapy for mild persistent asthma in patients who are unable or unwilling to use inhaled corticosteroids, or as an add-on therapy for moderate persistent asthma in patients 12 years and older. This recommendation is based on the most recent and highest quality study available, which suggests that leukotriene receptor antagonists, such as montelukast, are an effective alternative to inhaled corticosteroids for mild persistent asthma, and can be used in combination with inhaled corticosteroids for moderate persistent asthma 1.
Key Points to Consider
- Montelukast is taken once daily, which can improve compliance and provide good control of asthma symptoms in many patients 1.
- The medication works by blocking leukotriene receptors, which are inflammatory mediators that cause bronchoconstriction, increased mucus production, and airway edema.
- Montelukast is not a rescue medication and should not replace quick-relief inhalers for acute symptoms.
- Patients should be monitored for potential neuropsychiatric side effects, including mood changes, behavior changes, and suicidal thoughts.
- The standard dosage is 10 mg once daily for adults and adolescents 15 years and older, 5 mg once daily for children 6-14 years, and 4 mg once daily for children 2-5 years, typically taken in the evening.
Clinical Considerations
- Inhaled corticosteroids are the preferred controller medication for persistent asthma, but montelukast can be used as an alternative for patients who are unable or unwilling to use inhaled corticosteroids 1.
- Combining long-acting beta agonists and inhaled corticosteroids is effective and safe when inhaled corticosteroids alone are insufficient, but for persons 12 years and older, the addition of long-acting beta2 agonists is preferred over leukotriene receptor antagonists 1.
- Montelukast can also be used as an adjunctive therapy with inhaled corticosteroids, but its use should be individualized based on patient response and medical history.
From the FDA Drug Label
SINGULAIR is prescribed for the treatment of asthma, the prevention of exercise-induced asthma, and allergic rhinitis: Asthma. SINGULAIR should be used for the long-term management of asthma in adults and children ages 12 months and older. Do not take SINGULAIR for the immediate relief of an asthma attack If you get an asthma attack, you should follow the instructions your doctor gave you for treating asthma attacks.
Montelukast (Singulair) should be prescribed for patients with asthma for the long-term management of asthma in adults and children ages 12 months and older. It is not intended for the immediate relief of an asthma attack. Patients should have a rescue medication available for acute asthma attacks. 2
From the Research
Indications for Montelukast in Asthma
Montelukast can be prescribed for patients with asthma in the following situations:
- As add-on therapy to improve asthma symptom control in patients with symptomatic asthma maintained on a stable low to moderate dose of inhaled corticosteroids (ICS) 3
- For patients with non-controlled asthma despite chronic treatment with ICS and long-acting beta(2) agonist (LABA) 4
- As an alternative to low-dose inhaled corticosteroids in the management of mild asthma 5, 6
Patient Profiles
Montelukast may be suitable for:
- Children with symptomatic asthma maintained on a stable low to moderate dose of ICS 3
- Patients with mild persistent asthma who are uncontrolled or unsatisfied with low-dose ICS therapy 5
- Children aged 5-15 years with recently diagnosed mild persistent asthma 6
Comparison with Inhaled Corticosteroids
- Montelukast is as effective as inhaled budesonide in the treatment of mild persistent asthma in children aged 5-15 years 6
- However, inhaled corticosteroids (such as fluticasone) may be more effective than montelukast in the long-term management of mild to moderate persistent asthma, especially in patients with more severe disease or markers of allergic inflammation 7