Therapy for asthma and allergies involves the use of one of various classes of medications and drugs, including leukotriene receptor antagonist. Montelukast known popularly by the branded version Singulair belongs to this category of medications, and is also used as a treatment option for allergic rhinitis, a seasonal condition. In use for more than two decades since FDA approval, the medication is known to be effective as a therapeutic option. Following subsections offer a detailed look at the drug including possible singulair montelukast side effects. This will help patients and caregivers identify and deal with symptoms of undesirable effects in a timely manner.

Overview – is montelukast a steroid?

The drug is used in preventing asthma attacks and also in treating the condition; however, it is not effective in offering relief from an active asthma attack.  Montelukast is available as tablets, chewable tablets, and in packets. One of the common misconceptions is that montelukast is a steroid. This is an incorrect assumption as it is not a steroid and works in a totally different manner to offer relief. However, it is to be noted that the drug is almost always recommended for use in combination with inhaled corticosteroids or other prescription drugs. In other words, it is effective when used alongside other drugs as a part of treatment regimen. In addition to the conditions outlined above, the drug is also used to prevent bronchoconstriction that is caused by exercise.

While the drug is FDA approved and is hugely popular globally, it is also known to cause certain reactions or undesirable effects among users. This includes agitated behavior in individuals with some having hallucinations. The medication is also known to sometimes induce or cause suicidal tendencies. Despite the announced effects, it is still popular and is actually prescribed for patients with asthma above 01 year of age.

Mechanism of action – how montelukast works?

The desired outcomes of the drug are attributed to the its action of binding to targeted receptors, and thereby inhibiting or preventing the receptors from binding to cysteinyl leukotrienes. Signalling molecules are released from various mast cells and eosinophils, and these signalling molecules bind to certain receptors that are located on the smooth muscle cells of respiratory airway. This binding action also occurs on eosinophils, pro-inflammatory cells. Consequences of this binding action are symptoms of asthma and allergic rhinitis.  The drug works by preventing this binding, and in turn helps manage or prevent asthma and allergic rhinitis symptoms.

It is important to add here that there is an FDA warning about montelukast, and users, caregivers and healthcare workers are cautioned about the possible mental health undesirable outcomes from the medication. The warning is also in the form of an advisory, suggesting a change in treatment of allergic rhinitis by choosing other options, instead of montelukast, wherever possible.

Recommended montelukast dosage for adults

A significant number of instances of undesirable effects of medications are attributed to incorrect dosage and schedule. It is necessary to stick to the dosage as prescribed by the specialist, and diligently follow the schedule. When medications are taken on a long-term basis, there is every likelihood of certain doses being missed due to one of various reasons. It is important not to take a double dose in an effort to make up for the missed dose. The best option is to skip the dose and continue the schedule from the next dose onwards. Here is a quick look at ideal dosages for different categories. The actual dosage will differ and will be prescribed on the basis of various factors, including age, overall heath, and condition being treated.

The tablet form of the drug is ideally taken in a dose of 10 mg daily by adults as well as children above the age of 15. The drugs are to be ideally taken in the evening, The dosage for children below the age of 15 is to be determined by the doctor on the basis of evaluations. The chewable form of the tablets is recommended to be taken in doses ranging from 4 mg to 5mg daily, preferably taken in the evening.  The granule form of the drug can also to be taken in a dosage of 4 mg daily, preferably in the evening.  When taken for preventing bronchoconstriction due to exercise, the tablets in dosage of 10 mg, are to be taken two hours prior to exercise. In such instances, individuals are not to take an additional (or regular) dose in the same day. The dosage for allergic rhinitis is the same as above, and is to be taken in the evening.

Montelukast precautions among certain categories of individuals

Medications are typically suitable for most categories of individuals and are developed, tested to determine suitability and efficacy. However, certain drugs are not considered as safe or suitable for specific categories of individuals. It is therefore necessary for patients and caregivers to clearly assess the patient and confirm suitability before commencing treatment. For instance, patients with a history of allergies, either to the product, or allergies to other substances are advised to seek explicit recommendations regarding use. This includes allergic reactions to animal dander, chemicals, dyes, preservatives and certain food products. Individuals who have taken montelukast in the past and have experienced allergic reactions are not to take the medication as subsequent reactions are often known to be more severe than the initial reaction.

Studies have been conduction to ascertain the efficacy and possible effects of Montelukast on pediatric patients. There has been no indication to suggest that children suffer additional or severe side effects, other than the usual possible effects experienced by all users. Similarly, studies on geriatric patients have also not revealed any adverse outcomes. By virtue of being aged than others, there is every likelihood of the patient experiencing stronger effects from the drug, than patients of younger age category. Studies have not been conducted adequately to determine or study the effects on women breastfeeding milk and the infants. It is therefore necessary to let the doctor assess the condition and recommend its use or discontinuation.

Commonly reported singulair montelukast side effects

All medications come with the possibility of undesirable effects and Montelukast is no exception. Unwanted outcomes of medications are generally categorized as mild effects and serious effects. The former, also known as moderate effects is known to occur more frequently and may affect more patients easily. In most circumstances, it may not be necessary to look for medical intervention for mild effects as the outcomes are known to resolve naturally. Serious effects, also known as adverse effects are known to occur rarely among a very small section of patients. These effects, almost always require some kind of medical treatment. Certain serious effects may also require urgent or emergency treatment at a healthcare facility, to prevent the condition from worsening or aggravating into extremely serious conditions.

Here is a short compilation of some of the frequently reported undesirable effects of montelukast. This is not a complete list of effects and is only intended to serve as a reference of the types of effects. It is also necessary to bear in mind that the actual effects depend on a host of factors. For instance, the age of the patient, the dosage, the schedule of intake, the condition being treated, gender, overall health, existing health conditions and medications in use.

Montelukast mental health effects: Commonly reported symptoms of effects include agitated feelings in patients. Individuals are also known to be disoriented when on the medication. Abnormal irritation is also witnessed among patients, apart from possible suicidal tendencies. Other effects on mental health include possibility of increased depression and nervousness. The individual is likely to be unusually angry when on the medication, and also exhibit restlessness and anxiety.

Blood vessel disease: Effects of montelukast include increase in eosinophils, white blood cells and this could in turn result in a blood vessel disease, medically known as Churg-Strauss syndrome. This disease is known to affect asthma patients on steroids, that have been discontinued. Symptoms of blood vessel disease include pricking sensations, and a distinct numb feeling in the arms and legs, apart from painful sinus. Other symptoms similar to that of flu may also be experienced.

Common effects: Difficulty breathing, pain in the body, and cough are relatively common symptoms or effects that may be experienced when on the medication. The throat is likely to turn dry or sore when on the drug, while some patients are known to end up with low grade fever.  A small section of patients may lose voice temporarily, when on the medication, while pain is also likely to be experienced in the cheekbone area. Similarly, swelling in the ears, and running nose are also possible effects. Various other effects such as difficulty swallowing, pain in the joints, and diarrhea are also likely to be experienced. Impact on vision, outbreak of rashes, and heartburn are other typical symptoms that may be experienced.

Montelukast contraindications  

Known medically as relative contraindications, drug interactions occur when two or more medications are taken either as treatment for the same condition or for other conditions. This is mainly attributed to the conflict in mechanisms of actions of both the drugs or the properties of both the drugs. Interactions may also occur between prescription medications and OTC formulations, herbal remedies, supplements and alternative medicine. Interactions may typically trigger one of three different actions or results. For instance, either of the two drugs may end up with reduced potency or an increase in potency, beyond the desired outcomes. Another possible outcome of interactions is the aggravation or amplification of side effects of either of the two drugs.

Remedial actions: or preventive actions for contraindications include temporary suspension of either of the two medications, or complete discontinuation of either of the two medications. The drug to be discontinued is determined after assessing the relative importance of each drug and the condition being treated with the drug. The one with lesser importance or criticality is axed, and replaced with a different medication that does not trigger an interaction. In the event that both the drugs are equally important and cannot be discontinued or suspended, the next best option is chosen. This is essentially a staggering of intake time and schedule, apart from alteration of dosage. This helps to mitigate the possible outcomes from possible interactions. Here is a quick compilation of some the commonly occurring contraindications of montelukast.

The drug is not to be taken with medications prescribed for hepatitis C, and also with medications prescribed for treating rheumatoid arthritis.  Similarly, the medication is also not to be taken along with certain drugs prescribed for treating cancer. Other medications that are not suitable to be taken alongside montelukast includes drugs prescribed for treating multiple sclerosis. Medications recommended for treating high blood lipid levels are also not to be combined with montelukast. As outlined earlier, interactions are not limited to drugs alone and it is therefore essential for patients to avoid grapefruit juice when on the medication.

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