From the Guidelines
Montelukast (Singulair) is a recommended treatment for allergic rhinitis, particularly for patients with coexisting asthma, and should be taken consistently as a preventative measure, with a typical dosage of 10mg once daily in the evening for adults and adolescents over 15 years old. The medication works by blocking leukotriene receptors, reducing inflammation in the airways and helping to prevent asthma symptoms and allergic reactions 1. According to the most recent and highest quality study, an intranasal corticosteroid is recommended over a leukotriene receptor antagonist, such as montelukast, for initial treatment of seasonal allergic rhinitis in persons aged 15 years or older 1. However, montelukast may be considered for patients who do not tolerate or accept the use of an intranasal corticosteroid, or for those with concurrent mild persistent asthma.
Key points to consider when prescribing montelukast include:
- Typical dosage: 10mg once daily in the evening for adults and adolescents over 15 years old
- Children aged 6-14: 5mg chewable tablets
- Children aged 2-5: 4mg chewable tablets or oral granules
- Potential side effects: headache, gastrointestinal issues, and rarely, neuropsychiatric effects like mood changes or behavior disturbances
- Montelukast is not a rescue medication and should be used alongside a rescue inhaler for asthma patients
- Improvement typically begins within 24 hours but full benefits may take 1-2 weeks of regular use
It's also important to note that the combination of an antihistamine and a leukotriene receptor antagonist may provide added benefit for allergic rhinitis, and montelukast may be considered for patients with coexisting asthma and allergic rhinitis 2. However, the most recent and highest quality study recommends an intranasal corticosteroid as the first-line treatment for seasonal allergic rhinitis 1.
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. Prevention of exercise-induced asthma. SINGULAIR is used for the prevention of exercise-induced asthma in patients 15 years of age and older. Allergic Rhinitis. SINGULAIR is used to help control the symptoms of allergic rhinitis (sneezing, stuffy nose, runny nose, itching of the nose)
The treatment for Montelukast (Singulair) is:
- For asthma: once a day in the evening for long-term management in adults and children 12 months and older
- For prevention of exercise-induced asthma: at least 2 hours before exercise in patients 15 years of age and older
- For allergic rhinitis: once a day, at about the same time each day, to help control symptoms in adults and children 2 years and older (seasonal) or 6 months and older (perennial) 3
From the Research
Treatment for Montelukast (Singulair)
- Montelukast is a selective and orally-active leukotriene-receptor antagonist that inhibits the cysteinyl leukotriene 1 (CysLT1) receptor 4.
- The recommended doses of montelukast in asthma are: + Children 1-5 years: 4 mg chewable tablet + Children 6-14 years: 5mg chewable tablet, 10mg tablet + Administered once daily 5.
- Montelukast has been shown to be effective in the treatment of chronic asthma, with a 10-mg film-coated tablet available for adults and a 5-mg chewable tablet available for children aged 6 to 14 years 6.
- Montelukast can be used as an alternative treatment for mild persistent asthma as monotherapy where inhaled corticosteroids (ICS) cannot be administered, and as an alternative to long-acting beta agonists (LABA) as an add-on therapy to ICS for moderate to severe persistent asthma 5.
- Montelukast has also been shown to be effective in the treatment of allergic rhinitis and exercise-induced bronchoconstriction, with approval for prevention of exercise-induced bronchoconstriction in patients aged 15 years and older 7.
- Addition of montelukast to current ICS therapy has been shown to improve long-term asthma control and result in substantial reductions in asthma-related resource use in patients with mild or moderate persistent asthma and concomitant seasonal allergic rhinitis 8.