Names and pronunciation
(mon-teh-loo′kast) Singulair
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Individual generic drug information
Extracted information for montelukast only.
(mon-teh-loo′kast) Singulair
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Func. class.: Bronchodilator
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Chem. class.: Leukotriene receptor antagonist, cysteinyl
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Do not confuse: Singulair/SINEquan
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ACTION: Inhibits leukotriene (LTD4) formation; leukotrienes exert their effects by increasing neutrophil, eosino- phil migration; aggregation of neutro- phils, monocytes; smooth muscle con- traction, capillary permeability; these actions further lead to bronchoconstric- tion, inflammation, edema
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USES: Chronic asthma in adults and children, seasonal allergic rhinitis, bron- chospasm prophylaxis
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Extracted information for montelukast only.
CONTRAINDICATIONS: Hyper- sensitivity Precautions: Pregnancy, breastfeeding, children <6 yr, acute attacks of asthma, alcohol consumption, severe hepatic dis- ease, corticosteroid withdrawal, phenyl- ketonuria, suicidal ideation, depression
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Black Box Warning: Neurologic/psychi- atric events
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SIDE EFFECTS CNS: Dizziness, fatigue, headache, behavior changes, hallucinations, sei- zures, agitation, anxiety, depression, fever, drowsiness, suicidal ideation, memory impairment, hostility, somnambulism GI: Abdominal pain, dyspepsia, nausea, vomiting, diarrhea, pancreatitis HEMA: Thrombocytopenia INTEG: Rash, pruritus, erythema MS: Asthenia, myalgia, muscle cramps RESP: Influenza, cough, nasal congestion SYST: Churg-Strauss syndrome, Stevens- Johnson syndrome, toxic epidermal necrolysis
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INTERACTIONS Increase: adverse reactions of CYP2C8 substrates Decrease: montelukast levels—barbitu- rates, rifabutin, rifapentine, carBAMaze- M pine, fosphenytoin, phenytoin, rifAMPin Drug/Herb Increase: stimulation—black, green tea, guarana Drug/Lab Test Increase: ALT, AST
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Extracted information for montelukast only.
DOSAGE AND ROUTES Asthma, seasonal/perennial allergic rhinitis • Adult/child ≥15 yr: PO 10 mg/day in PM • Child 6-14 yr: PO 5-mg chew tab/day in PM • Child 2-5 yr: PO (chew tab/granules) 4 mg/day Asthma Child 1-5 yr mo: PO 1 packet (4 mg) granules taken in PM Exercise-induced bronchoconstriction prevention • Adult/child ≥14 yr: PO 10 mg 2 hr before exercise; do not take another dose within 24 hr • Child 6 yr-<14 yr: PO 5 mg once given 2 hr before exercise, max 1 dose/24 hr
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Available forms: Tabs 10 mg; chew tabs 4, 5 mg; oral granules 4 mg/packet
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Administer: PO route • In PM daily for all uses except exer- cise-induced bronchoconstriction; then take 2 hr before exercise • Granules directly in mouth or mixed with spoonful of soft food (carrots, ap- plesauce, ice cream, rice) • Do not open granules packet until ready to use; mix whole dose; give within 15 min
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Extracted information for montelukast only.
Assess: • Respiratory symptoms: wheezing, de- crease in asthma exacerbations, rhinitis, urticaria • Churg-Strauss syndrome (rare): as- sess adult patients carefully for symp- toms: eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, neuropathy • For behavioral changes, suicidal idea- tion, other neuropsychiatric reactions • Severe hepatic disease: use cautiously • Stevens-Johnson syndrome: rash, fever, blisters, fatigue, muscle/joint aches; if these occur, discontinue, provide sup- portive therapy • Pregnancy/breastfeeding: use in preg- nancy only if clearly needed, no well- controlled studies; use cautiously in breastfeeding, unknown if excreted in breast milk
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Evaluate: • Therapeutic response: ability to breathe more easily
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To check OTC medications, stimula- tion; to avoid alcohol • To avoid hazardous activities; dizziness may occur • If aspirin sensitivity is known, not to take NSAIDs while taking this product • To report mood, behavioral changes to prescriber • Not to use for acute asthma/acute exercise-induced bronchospasm; not ef- fective • To take even if no symptoms are present • To continue to use inhaled β-agonists if exercise-induced asthma occurs • Granules: to give directly in mouth or mixed in a spoonful of room tempera- ture soft food (use only applesauce, car- rots, rice, or ice cream); use within 15 min of opening packets; discard unused portions HIGH ALERT
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Extracted information for montelukast only.
PHARMACOKINETICS Rapidly absorbed; peak 3-4 hr, chew tab (5 mg) 2-2.5 hr; half-life 2.7-5.5 hr, extended in hepatic disease; protein binding 99%; metabolized by liver; excreted via bile
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Filter the extracted dose blocks for this individual drug.
Asthma, seasonal/perennial allergic rhinitis
• Adult/child ≥15 yr: PO 10 mg/day in PM
Candidate age grouping · source page 911
Asthma, seasonal/perennial allergic rhinitis
• Adult/child ≥14 yr: PO 10 mg 2 hr before exercise; do not take another dose within 24 hr
Candidate age grouping · source page 911