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Montelukast
Always check the BNF link here before prescribing.
- 💊 Montelukast is a leukotriene receptor antagonist (LTRA).
- Used as add-on therapy in chronic asthma, particularly if symptoms are uncontrolled on inhaled corticosteroids (ICS).
- Also licensed for seasonal allergic rhinitis.
⚙️ Mode of Action
- Blocks CysLT₁ receptors in the airway.
- ⬇️ Leukotriene-mediated effects → reduced bronchoconstriction, mucus secretion, oedema, and inflammation.
- Helps prevent exercise-induced and allergen-induced bronchospasm.
📋 Dose / Indications
- 🌬️ Chronic asthma prevention: 10 mg nocte (adult).
- 👦 Children 6–14 years: 5 mg chewable tablet OD.
- 👶 Children 6 months–5 years: 4 mg granules OD (BNF guidance).
- 🌼 Seasonal allergic rhinitis (when antihistamines are insufficient).
🔄 Interactions
- See BNF for details.
- Metabolised by CYP3A4/2C9 – potential interactions with enzyme inducers (e.g. rifampicin, phenytoin).
⚠️ Cautions
- ❌ Not for acute asthma attacks (no bronchodilator effect).
- 🧪 Churg–Strauss syndrome (rare): eosinophilia, neuropathy, vasculitis, rash – typically occurs when tapering steroids.
- Use with caution in patients with psychiatric history (risk of neuropsychiatric side effects).
⛔ Contraindications
- See BNF – mainly hypersensitivity to montelukast or excipients.
⚠️ Side Effects
- 🤢 GI upset, nausea, diarrhoea.
- 🤕 Headache, myalgia.
- 🌸 Rash, allergic reactions.
- 🧠 Neuropsychiatric effects (agitation, sleep disturbance, depression, suicidal thoughts – rare but serious).
- 🧪 Churg–Strauss syndrome (rare, associated with systemic eosinophilia).
- Dry mouth, thirst (less common).
📊 Monitoring
- Routine FEV₁ and symptom control (asthma monitoring).
- Clinical vigilance for neuropsychiatric changes.
- If systemic features → consider vasculitis screen, CXR, FBC (to assess eosinophilia).
📚 References
- BNF: Montelukast
- NICE Asthma Guideline (NG80)
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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