What is the dosage and usage of Montek LC (montelukast) for asthma and allergy treatment?

Montek LC (Montelukast) Dosage and Usage for Asthma and Allergy Treatment

For adults with asthma and allergic rhinitis, Montek LC (montelukast) is recommended at a dose of 10 mg once daily, taken in the evening without regard to food intake. 1

Dosage Recommendations by Age Group

• Adults and adolescents 15 years and older: 10 mg once daily in the evening 1
• Children 6-14 years: 5 mg chewable tablet once daily in the evening 1, 2
• Children 2-5 years: 4 mg chewable tablet or oral granules once daily in the evening 1
• Infants 6 months to 2 years: For perennial allergic rhinitis only, 4 mg oral granules once daily 3

Clinical Efficacy in Allergic Rhinitis

• Montelukast produces statistically significant improvement in nasal symptoms and quality of life scores compared to placebo in allergic rhinitis patients 3, 4
• However, montelukast is less effective than intranasal corticosteroids for allergic rhinitis symptoms 5, 3
• For seasonal allergic rhinitis, intranasal corticosteroids are preferred over montelukast for initial treatment 5, 3
• In persistent allergic rhinitis, oral antihistamines are recommended over montelukast in adults 5

Clinical Efficacy in Asthma

• Montelukast is effective as maintenance therapy for asthma in all age groups 1
• In adults with asthma, montelukast improves FEV1 by approximately 7.49% from baseline 1
• In children 6-14 years, montelukast improves morning FEV1 by 8.7% from baseline 1
• Montelukast reduces "as-needed" β-agonist use by approximately 26.1% in adults and decreases asthma exacerbations 1

Combination Therapy Considerations

• For patients with both asthma and allergic rhinitis, montelukast can manage both conditions simultaneously 3, 4
• Combining montelukast with an antihistamine provides better symptom control for allergic rhinitis than either therapy alone 3, 6
• In patients with persistent asthma already on inhaled corticosteroids, adding montelukast can provide additional benefit and may allow for reduction in corticosteroid dose 1
• The combination of montelukast and levocetirizine shows greater improvement in nasal symptoms than montelukast alone in patients with both conditions 6

Special Considerations

• Onset of action typically occurs on the second day of treatment, unlike antihistamines which work more quickly 3
• Montelukast does not significantly suppress skin tests, which can be advantageous when allergy testing is needed 3
• Some patients prefer oral agents like montelukast despite lesser efficacy compared to intranasal corticosteroids 5, 3
• Montelukast is particularly valuable for patients who are "steroid-phobic" or cannot tolerate intranasal corticosteroids 3

Safety Considerations

• Montelukast has a favorable safety profile and is generally well-tolerated 3, 7
• However, psychiatric side effects including potential life-threatening events have been reported, prompting FDA warnings 8
• Treatment should be discontinued if neuropsychiatric side effects occur 8
• No significant drug interactions with most medications, though phenobarbital can decrease montelukast levels by approximately 40% 1

Clinical Decision Algorithm

1. For patients with asthma only: Use montelukast 10 mg daily (adults) or age-appropriate dose 1
2. For patients with allergic rhinitis only: Consider intranasal corticosteroids first; use montelukast if corticosteroids are not tolerated 5
3. For patients with both conditions: Montelukast can effectively treat both simultaneously 3, 4
4. For inadequate response: Consider combination therapy with antihistamines for rhinitis or inhaled corticosteroids for asthma 3, 6