Can I give montelukast (Singulair) 5 mg at bedtime (hs) to a 12-year-old child weighing 26 kg for allergic bronchitis?

Montelukast 5 mg for a 12-Year-Old Child with Allergic Bronchitis

Yes, montelukast 5 mg at bedtime is an appropriate dose for a 12-year-old child weighing 26 kg with allergic bronchitis. 1

Dosing Rationale

The FDA-approved dosing for montelukast (Singulair) is age-based rather than weight-based:

• 5 mg chewable tablet for children 6-14 years of age 1
• 4 mg chewable tablet for children 2-5 years of age 1
• 10 mg tablet for adults and adolescents 15 years and older 1

Since this patient is 12 years old, the 5 mg dose is appropriate regardless of the 26 kg weight. This dosing was established through pharmacokinetic studies that demonstrated the 5 mg chewable tablet in children provides comparable drug exposure to the 10 mg tablet in adults 2.

Administration Considerations

• Montelukast should be administered once daily in the evening 1
• The medication can be taken with or without food 1
• For allergic conditions, the onset of action typically occurs by the second day of daily treatment 3

Efficacy for Allergic Bronchitis

Montelukast is effective for allergic respiratory conditions through its mechanism as a leukotriene receptor antagonist. It blocks cysteinyl leukotrienes, which are potent bronchoconstrictors 4. For allergic bronchitis specifically:

• Montelukast has demonstrated efficacy in controlling asthma symptoms in children 6-14 years old 5
• It is particularly useful in conditions with an allergic component, as it helps manage both upper and lower airway symptoms 3
• Clinical studies show montelukast improves FEV1 by approximately 8% from baseline in children with asthma 5

Comparative Efficacy

It's important to note that while montelukast is effective, inhaled corticosteroids (ICS) generally provide superior control for persistent asthma symptoms:

• The PACT study demonstrated that fluticasone propionate monotherapy was superior to montelukast for asthma control days and other control outcomes in children 3
• Montelukast may be considered an alternative when ICS cannot be administered or when there are concerns about steroid use 4
• For children with both allergic rhinitis and asthma symptoms (which may present as allergic bronchitis), montelukast offers the advantage of treating both conditions 3

Monitoring and Follow-up

After initiating montelukast:

• Evaluate response within 4-6 weeks 3
• If no clear benefit is observed within this timeframe, consider alternative therapies or diagnoses 3
• Monitor for symptom improvement, reduction in rescue medication use, and improved quality of life

Safety Considerations

Montelukast is generally well-tolerated in children. Growth over 48 weeks was not statistically different between children treated with montelukast versus other controller medications in clinical trials 3.

Conclusion

For this 12-year-old child with allergic bronchitis, montelukast 5 mg once daily at bedtime is the appropriate dose. While it may not be as effective as inhaled corticosteroids for controlling lower airway symptoms, it offers the advantage of treating both upper and lower airway allergic symptoms with convenient once-daily oral dosing.