Can Montelukast Be Given With Levocetirizine?
Yes, montelukast can be safely given with levocetirizine, and this combination is supported by both FDA labeling and clinical guidelines for allergic rhinitis, though it should be reserved for patients who have failed or cannot tolerate intranasal corticosteroids. 1, 2, 3
Safety and Drug Interactions
The FDA label for montelukast explicitly states that it has been administered with antihistamines without evidence of clinical adverse interactions, and no dosage adjustment is needed when combining these medications. 3
Montelukast was used concomitantly with a wide range of commonly prescribed drugs in clinical studies, including antihistamines, without evidence of clinical adverse interactions. 3
There are no pharmacokinetic interactions between montelukast and antihistamines that would preclude their combined use. 3
Clinical Efficacy of the Combination
The combination of montelukast and levocetirizine provides additive benefit compared to either agent alone for allergic rhinitis symptoms, with gradual improvement over 6 weeks of treatment. 4
Both montelukast and levocetirizine significantly improve nasal symptoms within the first 24 hours, with continued improvement throughout 6 weeks of therapy. 4
The combination reduces both serum soluble ICAM-1 and nasal eosinophilia, which correlates with improvement in nasal symptom severity. 5
When to Use This Combination
The American Academy of Allergy, Asthma, and Immunology recommends this combination as alternative therapy for patients who are unresponsive to or not compliant with intranasal corticosteroids, which remain first-line treatment. 1, 2, 6
For patients with both allergic rhinitis and asthma, this combination offers the advantage of treating both upper and lower airway disease simultaneously. 2, 6
The combination may be particularly useful for patients who are "steroid-phobic" or prefer oral medications over nasal sprays. 6
Important Limitations and Caveats
Intranasal corticosteroids are more effective than the montelukast-levocetirizine combination and should be tried first for allergic rhinitis. 1, 6
This combination is not indicated for acute asthma attacks or acute cough—patients must have appropriate short-acting inhaled β-agonist medication available for rescue. 3
Patients should be instructed to notify their physician if neuropsychiatric events occur while using montelukast, as such events have been reported with leukotriene antagonists. 3
For non-allergic conditions (such as non-allergic rhinitis or non-allergic cough), this combination is not indicated. 2, 7
Practical Prescribing Considerations
The combination is formulated as a bilayer tablet to maintain stability, as montelukast sodium (alkaline stable) and levocetirizine dihydrochloride (acid stable) would be unstable in direct contact. 8
The montelukast-levocetirizine combination is more cost-effective than montelukast-fexofenadine combination while providing similar efficacy. 9
Patients should take the medication daily as prescribed, even when asymptomatic, for optimal control of allergic rhinitis symptoms. 3