Is Singular (Montelukast) used for asthma management?

Montelukast (Singulair) for Asthma Management

Yes, Singulair (montelukast) is indicated for the prophylaxis and chronic treatment of asthma in adults and pediatric patients 12 months of age and older. 1

Role in Asthma Treatment

• Montelukast is a leukotriene receptor antagonist (LTRA) that works by blocking substances in the body called leukotrienes, which are released from mast cells, eosinophils, and basophils 2
• It is FDA-approved for long-term management of asthma but should not be used for immediate relief of acute asthma attacks 1
• Montelukast is taken once daily, which offers advantages in terms of ease of use and patient compliance 2

Position in Asthma Treatment Guidelines

• Montelukast is considered an alternative, but not preferred, therapy for the treatment of patients who require step 2 care (mild persistent asthma) 2
• It is most appropriate as an alternative to inhaled corticosteroids (ICS) in patients who are unable or unwilling to use inhaled medications 2, 3
• For moderate to severe persistent asthma, montelukast can be used as adjunctive therapy with ICS, but is not the preferred adjunctive therapy compared to long-acting beta-agonists (LABAs) in patients 12 years and older 2

Clinical Efficacy

• Montelukast is less effective than inhaled corticosteroids for most asthma control outcomes, but still provides significant improvement compared to placebo 3, 4
• In patients with mild asthma who remain uncontrolled on ICS, switching to montelukast has shown effectiveness in improving symptom control 5
• As add-on therapy to ICS or ICS/LABA, montelukast has demonstrated effectiveness in patients with both asthma and allergic rhinitis 6

Additional Indications

• Montelukast is also indicated for:
  • Prevention of exercise-induced bronchoconstriction in patients 15 years of age and older 1
  • Relief of symptoms of allergic rhinitis (seasonal and perennial) 1
  • Particularly valuable for patients who have both asthma and allergic rhinitis 7

Administration

• Dosing is age-dependent:
  • Children 1-5 years: 4 mg chewable tablet once daily 4
  • Children 6-14 years: 5 mg chewable tablet once daily 4
  • Adults and adolescents ≥15 years: 10 mg tablet once daily 4
• Should be taken in the evening for asthma management 1
• Can be taken with or without food 1

Important Considerations and Limitations

• Montelukast should never be used as monotherapy for moderate to severe persistent asthma 2
• It should not be used for immediate relief of asthma attacks; patients should always have a rescue inhaler available 1
• Patients should continue taking montelukast every day as prescribed, even when asymptomatic 1
• Some ethnic populations, particularly Black patients, may have genetic variations in the β-adrenergic receptor that could affect response to therapy 2

Montelukast represents an important option in the asthma treatment armamentarium, particularly for patients who cannot or will not use inhaled medications, or as add-on therapy for those with both asthma and allergic rhinitis.