Montair LC (Montelukast 10 mg + Levocetirizine 5 mg) Dosing and Use
Montair LC is NOT recommended as first-line therapy for allergic rhinitis or asthma; intranasal corticosteroids are superior and should be used first, with this combination reserved only for patients who fail intranasal corticosteroid monotherapy. 1, 2
First-Line Treatment: What Should Be Used Instead
Intranasal corticosteroids (fluticasone, mometasone, triamcinolone) are the single most effective medication class for controlling all symptoms of allergic rhinitis—including congestion, rhinorrhea, sneezing, and itching—and should be initiated immediately for all patients with moderate-to-severe symptoms. 1, 2
Intranasal corticosteroids are more effective than oral antihistamines (like levocetirizine) and markedly more effective than leukotriene receptor antagonists (like montelukast) for comprehensive symptom control. 1, 2
Adding oral antihistamines to intranasal corticosteroids provides NO additional benefit for nasal symptom control in allergic rhinitis. 1, 2
Adding leukotriene receptor antagonists to intranasal corticosteroids provides NO additional benefit. 1
When Montair LC May Be Considered
The fixed-dose combination of montelukast + levocetirizine should only be considered in patients with perennial allergic rhinitis who have failed intranasal corticosteroid monotherapy, particularly when coexisting mild-to-moderate asthma is present. 3, 4, 5
Evidence Supporting Combination Use (Second-Line Only)
In patients with perennial allergic rhinitis and mild-to-moderate asthma, the montelukast 10 mg + levocetirizine 5 mg combination demonstrated significantly greater reduction in daytime nasal symptoms (nasal congestion and rhinorrhea) compared to montelukast alone. 3, 4
In pediatric patients (ages 6-14 years) with perennial allergic rhinitis, the combination showed greater improvement in quality of life and higher patient satisfaction compared to montelukast monotherapy. 4
The combination was well-tolerated with no serious adverse drug reactions in large observational studies of over 2,000 patients. 5
Dosing Guidelines
Adults and Adolescents ≥15 Years
Montelukast 10 mg + levocetirizine 5 mg once daily in the evening for allergic rhinitis. 6, 3
Take with or without food. 6
For patients with both allergic rhinitis and asthma, take only one dose daily in the evening—do not take additional doses. 6
Children 6-14 Years
Montelukast 5 mg + levocetirizine 5 mg once daily for perennial allergic rhinitis. 4
The 5 mg chewable tablet formulation of montelukast should be used in this age group. 6
Children 2-5 Years
Montelukast 4 mg once daily (as chewable tablet or oral granules) is FDA-approved for allergic rhinitis, but the combination with levocetirizine is not established in this age group. 6
Levocetirizine 5 mg once daily can be used in children ≥6 years; 2.5 mg once daily for ages 2-5 years (but this is NOT the Montair LC fixed combination). 7
Contraindications and Precautions
Absolute Contraindications
- Hypersensitivity to montelukast, levocetirizine, or any component of the formulation. 6
Critical Warnings
Neuropsychiatric events: Montelukast has been associated with agitation, aggressive behavior, depression, anxiety, hallucinations, suicidal thoughts and actions, sleep disturbances, and tremor. 6
Immediately discontinue and contact physician if behavior or mood-related changes occur. 6
Special Populations
Pregnancy: Congenital limb defects have been rarely reported; healthcare providers should report prenatal exposure to the Pregnancy Registry at (800) 986-8999. 6
Breastfeeding: Montelukast is excreted in rat milk; unknown if excreted in human milk—use with caution. 6
Phenylketonuria: Montelukast chewable tablets contain phenylalanine (0.674-0.842 mg per tablet). 6
Asthma-Specific Precautions
This combination is NOT for acute asthma attacks or exercise-induced bronchoconstriction relief—patients must always carry inhaled rescue medication. 6
Do not abruptly stop or reduce other asthma medications without physician guidance. 6
For exercise-induced bronchoconstriction prevention in patients ≥15 years, montelukast should be taken at least 2 hours before exercise, but not more than once in 24 hours. 6
Patients already taking daily montelukast for chronic asthma or allergic rhinitis should NOT take an additional dose for exercise-induced bronchoconstriction. 6
Drug-Specific Adverse Effects
Common adverse effects include drowsiness, headache, diarrhea, nausea, and upper respiratory infection. 6
Levocetirizine causes less sedation than first-generation antihistamines (0.4-3% at recommended doses). 7
Common Pitfalls to Avoid
Never use Montair LC as first-line therapy—intranasal corticosteroids must be tried first. 1, 2
Never assume combination therapy is superior to monotherapy—intranasal corticosteroid alone is often sufficient and more effective. 1, 2
Never use oral corticosteroids for routine allergic rhinitis management—reserve only for severe, intractable cases. 1, 2
Never use intranasal decongestants for >3-10 days due to risk of rhinitis medicamentosa. 1
Never ignore neuropsychiatric symptoms in patients taking montelukast—these require immediate discontinuation. 6