Singulair (montelukast sodium) is a leukotriene receptor antagonist (LTRA) prescription medication designed for the prophylactic and chronic treatment of asthma, and for the relief of symptoms of allergic rhinitis. It functions by selectively blocking the action of leukotrienes, key inflammatory mediators in the airway pathways. This mechanism provides a non-steroidal option for managing bronchoconstriction and inflammation, offering a targeted approach to respiratory condition management. It is indicated for adults and pediatric patients as young as 12 months for asthma and 2 years for allergic rhinitis, providing a versatile tool in a clinician’s therapeutic arsenal.

Features

• Active Pharmaceutical Ingredient: Montelukast sodium.
• Available in multiple formulations: 10 mg film-coated tablets, 4 mg and 5 mg chewable tablets, and 4 mg oral granules.
• Leukotriene receptor antagonist (LTRA) class.
• Once-daily dosing regimen.
• Not a bronchodilator; does not provide immediate relief for acute asthma attacks.

Benefits

• Provides 24-hour control of underlying airway inflammation, reducing the frequency and severity of asthma symptoms.
• Decreases the reliance on short-acting beta agonist (SABA) rescue inhalers for asthma patients.
• Effectively relieves perennial and seasonal allergic rhinitis symptoms, including sneezing, nasal congestion, runny nose, and itching.
• Offers a convenient, oral, non-steroidal treatment option, which may improve adherence compared to inhaled therapies.
• Helps prevent exercise-induced bronchoconstriction (EIB) when taken at least 2 hours prior to physical activity.
• Can be used as add-on therapy when inhaled corticosteroids alone do not provide adequate asthma control.

Common use

Singulair is commonly prescribed for the chronic treatment of asthma in patients who require a second controller medication or who cannot adequately use inhaled corticosteroids. It is also widely used for the symptomatic relief of allergic rhinitis (hay fever), both seasonal and perennial. A specific and common application is for the prevention of exercise-induced bronchoconstriction. It is important to note that it is not indicated for the reversal of acute asthmatic attacks or status asthmaticus.

Dosage and direction

Dosage is based on the indication and the age of the patient. The medication is to be taken orally once daily.

• Asthma & Allergic Rhinitis (Adults and Adolescents 15 years and older): 10 mg tablet.
• Asthma & Allergic Rhinitis (Children 6 to 14 years): 5 mg chewable tablet.
• Asthma (Children 2 to 5 years): 4 mg chewable tablet or one packet of 4 mg oral granules.
• Allergic Rhinitis (Children 2 to 5 years): 4 mg chewable tablet or one packet of 4 mg oral granules.
• Asthma (Children 12 to 23 months): One packet of 4 mg oral granules.
• Exercise-Induced Bronchoconstriction (EIB) (Adults and Adolescents 15 years and older): One 10 mg tablet at least 2 hours before exercise. Do not take another dose within 24 hours.

For asthma, the dose should be taken in the evening. For allergic rhinitis, it may be taken at any time of day according to patient preference. The oral granules can be administered directly in the mouth or mixed with a spoonful of certain soft foods (e.g., applesauce, mashed carrots, rice, or ice cream).

Precautions

Patients should be advised that Singulair is not for the treatment of acute asthma attacks. They must have access to a short-acting bronchodilator for rescue purposes. Clinicians should monitor patients for neuropsychiatric events, as serious side effects affecting behavior and mood have been reported. Patients and caregivers should be alerted to monitor for changes in behavior or thinking. Liver enzyme elevations have been observed; caution is advised in patients with pre-existing liver disease. Patients with known aspirin sensitivity should use this medication with caution, as it does not cross-protect against aspirin-induced reactions. Phenylketonuria patients should be aware that the chewable tablets contain aspartame.

Contraindications

Singulair is contraindicated in patients with a known hypersensitivity to montelukast or any component of the formulation. This includes patients who have experienced previous episodes of hepatotoxicity or severe skin reactions, such as Stevens-Johnson syndrome or toxic epidermal necrolysis, while taking the drug.

Possible side effect

The most common adverse reactions are generally mild and include headache, fever, upper respiratory infection, cough, abdominal pain, fatigue, and dyspepsia. However, serious side effects require immediate medical attention. These include:

• Neuropsychiatric events: Agitation, aggressive behavior, anxiety, depression, bad/vivid dreams, hallucinations, insomnia, irritability, restlessness, suicidal thoughts and behavior, tremor.
• Systemic eosinophilia: Sometimes presenting with clinical features of vasculitis consistent with Churg-Strauss syndrome.
• Hypersensitivity reactions: including anaphylaxis, angioedema, rash, and urticaria.
• Hepatic effects: Elevated liver enzymes, hepatitis.

Drug interaction

Formal drug interaction studies have shown no clinically significant interactions with several common medications, including prednisone, digoxin, warfarin, terfenadine, theophylline, and oral contraceptives. However, phenobarbital, rifampin, and other potent induces of cytochrome P450 enzymes may decrease the systemic exposure of montelukast. Caution is advised when co-administering with other primarily hepatically metabolized drugs.

Missed dose

Patients should take the missed dose as soon as they remember. However, if it is almost time for the next scheduled dose, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed one.

Overdose

Experience in adults and children with montelukast overdose is limited. The most frequently reported symptoms include thirst, drowsiness, vomiting, psychomotor hyperactivity, and abdominal pain. In the event of an overdose, the patient should be treated supportively, and the vital signs should be monitored. There is no specific antidote. It is not dialyzable via peritoneal or hemodialysis.

Storage

Store at room temperature between 20°C to 25°C (68°F to 77°F). Excursions are permitted between 15°C and 30°C (59°F and 86°F). Keep the medication in its original container with the lid tightly closed to protect from moisture and light. Keep all medicines out of the reach of children and pets.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.

Reviews

• “As a pulmonologist, I find Singulair to be a valuable add-on therapy for my moderate persistent asthma patients who struggle with adherence to inhalers. The once-daily oral dosing is a significant advantage. I always counsel my patients thoroughly on the potential for neuropsychiatric side effects.” – Dr. A. Evans, MD.
• “Prescribing montelukast for pediatric allergic rhinitis has shown consistent efficacy in my practice. The chewable formulation is generally well-accepted by children. Monitoring by parents for any behavioral changes is a critical part of the treatment plan.” – Dr. L. Chen, Pediatric Allergist.
• “This medication provided excellent control for my exercise-induced asthma. Taking it a few hours before my run allows me to train without wheezing. It’s a crucial part of my management plan.” – M. Thompson, Patient.
• “After a severe asthma exacerbation, my doctor added Singulair to my inhaled corticosteroid. The combination has significantly reduced my nighttime symptoms and my need for my rescue inhaler.” – J. Rivera, Patient.
• “While effective for my allergies, I experienced significant mood swings and insomnia after several months of use. I discontinued it under my doctor’s supervision, and the side effects resolved. It’s effective but requires careful monitoring.” – R. Sharma, Patient.