What is the treatment for Montelukast (Singulair)?

From the Guidelines

For the treatment of Montelukast (Singulair), the most effective approach is to use it as an add-on therapy to inhaled corticosteroids for asthma management or as a primary treatment for mild allergic rhinitis, with a typical dose of 10mg once daily for adults and adolescents 15 years and older, taken in the evening, as recommended by the most recent and highest quality study 1.

Key Considerations

• The medication works by specifically targeting the inflammatory pathway involved in both asthma and allergic rhinitis, providing symptom relief without the drowsiness associated with many antihistamines.
• Common side effects include headache, upper respiratory infection, and gastrointestinal discomfort, and patients should be aware of the potential for neuropsychiatric side effects like mood changes, depression, or suicidal thoughts, which should prompt immediate medical attention.
• According to the 2017 joint task force on practice parameters, 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.

Treatment Guidelines

• For adults and adolescents 15 years and older, the typical dose is 10mg once daily, taken in the evening.
• Children aged 6-14 typically receive 5mg once daily, while children 2-5 years old take 4mg chewable tablets or oral granules.
• Montelukast may be considered for patients with concurrent diagnosis of mild persistent asthma, as it may provide benefit for both conditions, but it is not the preferred agent for patients with either condition alone 1.

Important Notes

• Montelukast is less effective than intranasal corticosteroids for nasal symptom reduction, but may be preferred by some patients who do not tolerate or accept the use of an intranasal corticosteroid 1.
• The combination of an antihistamine and a leukotriene receptor antagonist may provide added benefit for allergic rhinitis and better protection against seasonal decrease in lung function 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) 2

From the Research

Treatment Overview

• Montelukast is a leukotriene receptor antagonist used to treat asthma, allergic rhinitis, and exercise-induced bronchoconstriction 3, 4, 5, 6.
• The recommended doses of montelukast in asthma are:
  • Children 1-5 years: 4 mg chewable tablet
  • Children 6-14 years: 5mg chewable tablet or 10mg tablet
  • Adults: 10mg tablet, administered once daily 3, 7.

Efficacy and Safety

• Montelukast has been shown to be effective in improving daytime and nighttime asthma symptoms, reducing the need for rescue medication, and improving quality of life 3, 5.
• It is also effective in treating allergic rhinitis, with improvements in symptoms such as sneezing, itching, rhinorrhea, and nasal congestion 4, 5.
• Montelukast is well-tolerated, with a low incidence of adverse drug reactions 5.

Specific Indications

• Montelukast may be used as an alternative treatment for mild persistent asthma as monotherapy where inhaled corticosteroids (ICS) cannot be administered 3.
• It may also be used as an add-on therapy to ICS for moderate to severe persistent asthma, although it is less efficacious and less cost-effective than long-acting beta agonists (LABA) 3.
• Montelukast is also indicated for the prevention of exercise-induced bronchoconstriction in patients 15 years of age and older 6.