Singulair Dosing for a 13-Year-Old
For a 13-year-old, the recommended dose of Singulair (montelukast) is one 5-mg chewable tablet taken once daily in the evening. 1
Age-Appropriate Dosing
- Pediatric patients aged 6 to 14 years should receive one 5-mg chewable tablet once daily, as specified by FDA labeling 1
- This dosing applies to both asthma management and allergic rhinitis treatment 1
- The 5-mg dose was specifically selected for this age group based on pharmacokinetic studies demonstrating that it provides drug exposure comparable to the adult 10-mg dose 2
Administration Guidelines
- The medication should be taken once daily in the evening for asthma management 1
- For allergic rhinitis alone, the time of administration may be individualized, though evening dosing remains standard 1
- If the patient has both asthma and allergic rhinitis, only one tablet daily should be taken (not separate doses for each condition) 1
Special Considerations for Exercise-Induced Bronchoconstriction
- For prevention of exercise-induced bronchoconstriction (EIB) in patients 15 years and older, a single dose should be taken at least 2 hours before exercise 1
- However, at age 13, the patient falls below the FDA-approved age for EIB-specific dosing 1
- If already taking daily montelukast for chronic asthma, no additional dose should be taken for exercise 1
Clinical Efficacy Evidence
- The 5-mg dose in 6- to 14-year-olds has demonstrated significant improvements in FEV₁ (8.23% increase from baseline vs 3.58% with placebo, P<.001) 3
- Clinical benefits include reduced daytime and nighttime symptoms, decreased beta-agonist use, and improved quality of life 4, 3
- Improvements in lung function and symptom control are typically observed within 1 day of initiating therapy 4
Important Safety Notes
- Each 5-mg chewable tablet contains 0.842 mg phenylalanine (a component of aspartame), which is relevant for patients with phenylketonuria 1
- Montelukast is generally well tolerated in this age group, with adverse event rates comparable to placebo 5, 4
- No dose adjustment is needed based on renal function in children 6
Common Pitfalls to Avoid
- Do not prescribe the 10-mg tablet (adult formulation) for a 13-year-old; the 5-mg chewable tablet is the appropriate formulation 1
- Do not exceed one dose per 24-hour period, even if the patient exercises or has breakthrough symptoms 1
- Ensure patients have a short-acting beta-agonist available for rescue, as montelukast is a controller medication, not a rescue medication 1