From the Guidelines
Singulair (montelukast) can be taken instead of loratadine for the treatment of allergic rhinitis, as there is no significant difference in efficacy between leukotriene receptor antagonists and antihistamines, with loratadine as the usual comparator 1.
Key Points to Consider
- Singulair and loratadine work through different mechanisms to alleviate allergy symptoms, with Singulair blocking inflammatory chemicals and loratadine blocking histamine receptors.
- The combination of an antihistamine and a leukotriene receptor antagonist may be additive, providing better symptom control for some patients 1.
- Montelukast has an excellent safety profile and is approved for use in children as young as 6 months for perennial allergic rhinitis and 2 years for seasonal allergic rhinitis 1.
- For patients with coexisting asthma, montelukast may be considered as it can benefit both upper and lower airway diseases 1.
Clinical Decision Making
When deciding whether to switch from loratadine to Singulair, it is essential to consult with a healthcare provider to determine the best course of treatment based on individual symptoms and medical history.
- The provider may recommend using Singulair instead of loratadine, using them together, or suggesting a different approach.
- The fact that Singulair typically requires a prescription, while loratadine is available over-the-counter, should also be considered in the decision-making process.
Recent Guidance
More recent guidance from 2017 suggests that for initial treatment of seasonal allergic rhinitis in persons aged 15 years or older, an intranasal corticosteroid is recommended over a leukotriene receptor antagonist like montelukast 1. However, this does not preclude the use of montelukast in certain cases, especially when considering its benefits for patients with coexisting asthma or its use in combination with other therapies.
From the FDA Drug Label
SINGULAIR administered once daily in the morning or in the evening was generally well tolerated with a safety profile similar to that of placebo. The FDA drug label does not answer the question.
From the Research
Comparison of Singular (Montelukast) and Loratadine
- Montelukast and loratadine are both used to treat allergic rhinitis, but they work in different ways 2, 3.
- Montelukast is a cysteinyl leukotriene receptor antagonist, while loratadine is an H(1)-receptor antagonist 2, 3.
- Studies have shown that concomitant use of montelukast and loratadine can improve symptoms of seasonal allergic rhinitis more than treatment with either drug alone 2, 4, 5, 6.
Efficacy of Montelukast Alone
- Montelukast alone has been shown to be effective in reducing symptoms of seasonal allergic rhinitis, although its efficacy may be less than that of intranasally administered corticosteroids 3.
- Montelukast has been shown to improve daytime nasal symptom severity, individual nasal symptom scores, and quality of life in patients with seasonal allergic rhinitis 3, 5.
Efficacy of Loratadine Alone
- Loratadine alone has been shown to be effective in reducing symptoms of seasonal allergic rhinitis, although its efficacy may be less than that of concomitant montelukast and loratadine 2, 4, 5, 6.
- Loratadine has been shown to improve daytime nasal symptom severity, individual nasal symptom scores, and quality of life in patients with seasonal allergic rhinitis 2, 5.
Combination Therapy
- Concomitant use of montelukast and loratadine has been shown to be more effective than either drug alone in reducing symptoms of seasonal allergic rhinitis 2, 4, 5, 6.
- The combination of montelukast and loratadine has been shown to improve daytime nasal symptom severity, individual nasal symptom scores, and quality of life in patients with seasonal allergic rhinitis 2, 4, 5, 6.