Singulair: Effective Leukotriene Receptor Antagonist for Asthma & Allergy Control
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Synonyms
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Singulair (montelukast sodium) is a prescription leukotriene receptor antagonist (LTRA) medication designed for the prophylactic and chronic treatment of asthma, and for the relief of symptoms of allergic rhinitis. It represents a cornerstone in the management of inflammatory pathways central to these conditions, offering a non-steroidal option for control. By specifically targeting and blocking the action of cysteinyl leukotrienes, key inflammatory molecules, it helps prevent bronchoconstriction, reduce airway inflammation, and decrease mucus production. Its oral formulation provides a convenient, once-daily dosing regimen suitable for adults and pediatric patients, making it a versatile tool in a comprehensive respiratory and allergy management plan.
Features
- Active ingredient: Montelukast sodium
- Available in multiple formulations: film-coated tablets (10 mg, 5 mg, 4 mg), chewable tablets (4 mg, 5 mg), and oral granules (4 mg packet)
- Prescription-only medication (Rx)
- Leukotriene receptor antagonist (LTRA) class
- Once-daily oral administration
- Stable at room temperature
Benefits
- Provides preventive control of asthma symptoms, reducing the frequency of daytime and nighttime episodes.
- Diminishes the need for rescue inhaled beta2-agonists in persistent asthma.
- Effectively relieves symptoms of seasonal and perennial allergic rhinitis, including sneezing, nasal congestion, runny nose, and itching.
- Offers a non-steroidal treatment option, avoiding the side effects associated with chronic inhaled or oral corticosteroid use.
- Convenient oral dosing supports improved adherence compared to inhaled therapies, especially in pediatric populations.
- Helps manage exercise-induced bronchoconstriction (EIB) when taken prior to physical activity.
Common use
Singulair is indicated for the prophylaxis and chronic treatment of asthma in adults and pediatric patients 12 months of age and older. It is also approved for the relief of symptoms of allergic rhinitis (seasonal and perennial) in adults and children ages 2 years and older. Furthermore, it is prescribed for the prevention of exercise-induced bronchoconstriction (EIC) in patients 6 years of age and older. It is not indicated for the reversal of acute asthma attacks, for which a rescue inhaler remains necessary.
Dosage and direction
The dosage of Singulair is age-dependent and should be taken once daily, as prescribed. For asthma and allergic rhinitis: Adults and adolescents 15 years and older: one 10 mg tablet daily. Children 6 to 14 years: one 5 mg chewable tablet daily. Children 2 to 5 years: one 4 mg chewable tablet or one 4 mg packet of oral granules daily. Children 12 to 23 months: one 4 mg packet of oral granules daily. For exercise-induced bronchoconstriction: Patients 15 years and older: one 10 mg tablet at least 2 hours before exercise. Patients 6 to 14 years: one 5 mg chewable tablet at least 2 hours before exercise. Administration for asthma should be in the evening; for allergic rhinitis, it can be taken at any time of day but should be consistent. 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 a rescue medication for acute asthmatic attacks and will not treat a sudden onset of symptoms. They must keep their prescribed rescue inhaler accessible at all times. Physicians should monitor patients for neuropsychiatric events, as serious side effects affecting behavior and mood have been reported. Use caution in patients with known phenylketonuria (PKU), as the chewable tablets contain aspartame, a source of phenylalanine. Patients should not use Singulair to treat acute bronchospasm and should not abruptly substitute it for inhaled or oral corticosteroids; any reduction in corticosteroid dose must be gradual and under medical supervision. The safety and efficacy in children younger than 12 months for asthma, or younger than 2 years for allergic rhinitis, have not been established.
Contraindications
Singulair is contraindicated in patients with a known hypersensitivity to montelukast or any other component of the formulation. This includes patients who have experienced previous episodes of hepatotoxicity, severe skin reactions (like Stevens-Johnson syndrome or toxic epidermal necrolysis), or eosinophilic conditions in response to the drug.
Possible side effect
Like all medicines, Singulair can cause side effects, although not everybody gets them. Very common (≥1/10) and common (≥1/100 to <1/10) side effects include headache, abdominal pain, thirst, and upper respiratory infection. Uncommon (≥1/1,000 to <1/100) side effects include drowsiness, dizziness, palpitations, nausea, vomiting, dyspepsia, diarrhea, elevated liver enzymes, rash, and bruising. Rare but serious side effects require immediate medical attention and include severe neuropsychiatric events (e.g., agitation, aggressive behavior, bad/vivid dreams, depression, hallucinations, insomnia, irritability, restlessness, suicidal thoughts and behavior), hypersensitivity reactions (e.g., swelling of the face, lips, tongue, and/or throat, which may cause trouble breathing or swallowing, hives, itching), symptoms of liver dysfunction (e.g., right upper abdominal pain, nausea, fatigue, lethargy, flu-like symptoms, jaundice), and eosinophilia with systemic symptoms.
Drug interaction
Formal drug interaction studies have shown montelukast to have no clinically significant interactions with a wide range of common medications, including prednisone, theophylline, oral contraceptives, terfenadine, digoxin, and warfarin. It is metabolized by cytochrome P450 enzymes (CYP3A4 and CYP2C9); therefore, potent inducers of these enzymes (e.g., rifampicin, phenobarbital, carbamazepine) may decrease the plasma concentrations of montelukast. Conversely, co-administration with gemfibrozil, a strong CYP2C8 inhibitor, can significantly increase montelukast plasma concentration. Clinicians should be aware of these potential interactions when prescribing.
Missed dose
If a dose is missed, it should be taken as soon as it is remembered. 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. Maintaining a consistent daily schedule is important for optimal therapeutic effect.
Overdose
Experience in adults and children with montelukast overdose is limited. The most frequently reported symptoms in documented cases include abdominal pain, somnolence, thirst, headache, vomiting, and psychomotor hyperactivity. There is no specific antidote for montelukast overdose. In the event of an overdose, standard supportive measures should be employed, and the patient’s clinical status should be monitored. Treatment should be symptomatic and supportive. Considering the drug’s extensive plasma protein binding, dialysis is not likely to be effective in enhancing elimination.
Storage
Store Singulair tablets, chewable tablets, and oral granules at 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 or blister pack to protect it from light and moisture. Keep all medicines out of the sight and reach of children. Do not use the medicine after the expiration date printed on the pack.
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 medication. Never disregard professional medical advice or delay in seeking it because of something you have read here. The content has been compiled from various pharmacological resources but may not be exhaustive or fully up-to-date.
Reviews
Clinical trials and post-marketing surveillance have consistently demonstrated the efficacy of Singulair in reducing asthma exacerbations and improving allergy symptoms. Many patients and clinicians report high satisfaction with its convenience and effectiveness as a controller medication. It is often noted for its utility in pediatric asthma management and for patients who struggle with inhaler technique. However, the prescribing information carries a Boxed Warning from the FDA regarding serious neuropsychiatric events, which is a significant consideration for prescribers and patients. Reviews often highlight the importance of using this medication under strict medical supervision and being vigilant for any changes in behavior or mood.