From the Guidelines
Montelukast does not need to be tapered when discontinuing; it can be stopped abruptly without withdrawal effects. When starting montelukast, patients typically notice benefits within 24 hours for allergic rhinitis symptoms, but it may take 3-7 days to achieve full effect. For asthma management, some improvement might be noticed within a few days, but optimal benefits usually develop over 2-4 weeks of consistent use.
Key Points to Consider
- Montelukast exhibits a flat dose-response curve; greater response in adults 1.
- As long-term control therapy, it may attenuate exercise-induced bronchospasm in some patients, but is less effective than ICS therapy 1.
- The standard adult dose is 10mg once daily, while children receive age-appropriate lower doses.
- It's essential to monitor patients for potential neuropsychiatric side effects including mood changes, behavior changes, and suicidal thoughts.
Important Considerations for Use
- Montelukast works by blocking leukotriene receptors, which reduces inflammation in the airways.
- Patients should be told to discontinue use if they experience signs and symptoms of liver dysfunction, as montelukast may affect liver function in some cases, similar to other medications like zafirlukast and zileuton 1.
- Various factors can affect the efficacy and safety of montelukast, and patients should be closely monitored for any adverse effects.
From the Research
Tapering Off Montelukast
- There is no evidence to suggest that montelukast needs to be tapered off when discontinuing, as the provided studies do not mention tapering as a necessary step 2, 3, 4, 5, 6.
Noticing Benefits of Montelukast
- The time it takes to notice the benefits of montelukast can vary, but significant improvements in asthma control and symptoms have been observed within 4-12 weeks of treatment 4, 5, 6.
- In one study, 61.3% of patients achieved asthma control after 4 weeks of montelukast monotherapy, and 75.0% achieved control after 12 weeks 4.
- Another study found that montelukast reduced the need for inhaled corticosteroids while maintaining asthma control over a 24-week period, with significant improvements in peak expiratory flow rate (PEFR) and asthma symptoms observed within 8 weeks 5.
- A study on patients with asthma and concurrent allergic rhinitis found that 76.1% of patients achieved asthma control after 8 weeks of montelukast add-on therapy, with significant improvements in asthma symptoms and quality of life 6.