Is it better to take montelukast (singulair) at bedtime?

Taking Montelukast at Bedtime: Optimal Timing for Effectiveness

Taking montelukast at bedtime is recommended for optimal effectiveness in managing asthma and allergic rhinitis symptoms, particularly for improving nighttime symptoms and sleep quality.

Rationale for Bedtime Administration

Montelukast (Singulair) is a leukotriene receptor antagonist that works by blocking inflammatory mediators involved in both asthma and allergic rhinitis. The timing of administration can impact its effectiveness:

• Montelukast is designed for once-daily dosing, with pharmacokinetics that are similar whether dosed in the morning or evening 1
• Bedtime dosing is particularly beneficial because:
  • It helps control nighttime symptoms that can disrupt sleep
  • It provides coverage during early morning hours when asthma symptoms often worsen
  • Clinical trials demonstrating efficacy were conducted with evening dosing 1

Evidence Supporting Bedtime Administration

Multiple studies have demonstrated the effectiveness of bedtime dosing:

• Clinical trials showed that treatment effect of montelukast, measured by symptom scores, "as-needed" β-agonist use, and peak expiratory flow rate measurements, was achieved after the first dose and maintained throughout the 24-hour dosing interval when administered in the evening 1

• Montelukast significantly improves the Nighttime Symptoms Score (NSS), which includes difficulty going to sleep, nighttime awakening, and nasal congestion on awakening 2

• In patients with allergic rhinitis, montelukast administered once daily at bedtime for 2 weeks demonstrated significant improvement in daytime nasal symptoms, nighttime symptoms, and quality of life parameters compared to placebo 3, 4

Benefits for Specific Symptoms

Bedtime dosing of montelukast provides particular benefits for:

1. Nighttime Asthma Symptoms:

   • Reduces nocturnal awakenings due to asthma 1
   • Decreases early morning symptoms when asthma often worsens

2. Sleep Quality:

   • Improves difficulty going to sleep and nighttime awakenings 2
   • Enhances the sleep domain of quality of life measures

3. Morning Nasal Congestion:

   • Addresses nasal congestion on awakening, which is often problematic in allergic rhinitis 2

Clinical Considerations

• For patients with both asthma and allergic rhinitis, bedtime dosing is particularly beneficial as it addresses both conditions simultaneously 5

• Montelukast is taken as a single 10mg tablet for adults or appropriate weight-based dosing for children 1

• The medication can be taken without regard to food intake 1

• Montelukast may be used as monotherapy for mild persistent asthma or in combination with inhaled corticosteroids for more severe asthma 6

Conclusion

While montelukast would be effective regardless of timing, bedtime administration is optimal for most patients, particularly those with nighttime symptoms or sleep disturbances. The once-daily dosing at bedtime provides 24-hour coverage with particular benefits during sleep and early morning hours when symptoms may be most problematic.