From the Guidelines
Yes, loratadine and montelukast can be changed to alternative medications in an asthmatic patient, with inhaled corticosteroids being the preferred first-line controller medications for persistent asthma. For antihistamine alternatives to loratadine, options include cetirizine (10mg daily), fexofenadine (180mg daily), or desloratadine (5mg daily) 1. Instead of montelukast, which is a leukotriene receptor antagonist, the patient could be switched to zafirlukast (20mg twice daily) or zileuton (600mg four times daily), though these alternatives are less commonly used 1.
Key Considerations
- Inhaled corticosteroids like fluticasone or budesonide are the preferred first-line controller medications for patients with persistent asthma, often combined with long-acting beta-agonists (LABAs) like salmeterol or formoterol for moderate to severe cases 1.
- The decision to change medications should be based on the patient's symptom control, medication adherence, side effect profile, and overall asthma management plan.
- Any medication changes should be done under medical supervision with appropriate follow-up to ensure the patient's asthma remains well-controlled.
Alternative Treatment Options
- For patients with mild persistent asthma, leukotriene receptor antagonists like montelukast or zafirlukast can be used as alternative therapies, but are not preferred over inhaled corticosteroids 1.
- Long-acting beta2 agonists are not recommended for use as monotherapy for long-term control of persistent asthma, but can be used as an adjunct to inhaled corticosteroid therapy for providing long-term control of symptoms 1.
Important Recommendations
- Increasing the use of short-acting beta2 agonists or using them more than two days per week for symptom relief generally indicates inadequate control of asthma and the need to initiate or intensify anti-inflammatory therapy 1.
- Patients with mild to moderate persistent asthma treated with inhaled corticosteroids demonstrate improved symptom scores, lower exacerbation rates, and reduced symptom frequency compared to patients taking other single long-term control medications 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Alternatives to Loratadine and Montelukast in Asthmatic Patients
- The combination of loratadine and montelukast has been shown to be effective in treating chronic asthma, with significant improvement in forced expiratory volume in 1 second (FEV(1)) and other key secondary end points 2.
- However, there may be alternative treatment options available for asthmatic patients, including other antihistamines, leukotriene modifiers, and inhaled corticosteroids (ICS) 3, 4, 5.
- The 2020 Asthma Guideline Update from the National Asthma Education and Prevention Program recommends various treatment options for patients with asthma, including intermittent ICS, add-on long-acting muscarinic antagonists, and immunotherapy 5.
- Step-down therapy may be considered for patients receiving combination therapy with ICS and long-acting beta-agonists (LABAs) when asthma control has been achieved, but the optimal step-down approach is not well established 6.
Considerations for Changing Treatment
- The decision to change treatment should be based on individual patient needs and response to therapy 3, 4, 5, 6.
- Clinicians should consider the potential benefits and risks of alternative treatments, as well as the patient's medical history and current level of asthma control 2, 3, 4, 5, 6.
- Further research is needed to determine the most effective treatment strategies for asthmatic patients and to establish clear guidelines for step-down therapy 4, 6.