Understanding Montelukast: How it Works
Montelukast is a leukotriene receptor antagonist that treats chronic asthma, seasonal and perennial allergic rhinitis, and exercise-induced bronchoconstriction (EIB). It works by blocking the action of leukotrienes, substances produced by the body that cause inflammation and narrowing of the airways. By inhibiting these substances, montelukast helps to reduce symptoms like wheezing, shortness of breath, and nasal congestion.
Montelukast is Not a Rescue Medication
It is critical to understand that montelukast is a long-term controller medication and not a rescue inhaler. It does not provide immediate relief for an acute asthma attack. Patients should always have their fast-acting rescue inhaler (like albuterol) available for sudden symptoms.
How to Use Montelukast Tablets Correctly
Proper use of montelukast depends on the condition being treated and the patient's age. It is typically taken once daily, but the timing varies. Always follow your healthcare provider's specific instructions.
For Asthma
For asthma, it is important to take the dose in the evening. Consistency is key, so try to take it at the same time every night.
For Allergic Rhinitis (Allergies)
When treating allergies alone, montelukast can be taken at any time of day. However, if a patient also has asthma, they should take the medication in the evening to cover both conditions with a single administration time.
For Exercise-Induced Bronchoconstriction (EIB)
To prevent EIB, the medication is taken as a single dose at least two hours before exercise. A single dose should not be taken within 24 hours of a previous dose. If you already take montelukast daily for asthma or allergies, you should not take an extra dose for EIB prevention.
What to Do if You Miss a Dose
If you forget a dose, skip it entirely and take your next dose at the regularly scheduled time. Never take two doses at the same time to make up for a missed one, as this can increase the risk of side effects.
Different Montelukast Tablet Forms
Montelukast is available in a few different forms, and how you take it depends on which one you have. The standard film-coated tablet is for older patients and is swallowed whole. Chewable tablets are available for children and must be chewed completely before swallowing. Granules are available for younger children and can be mixed with soft food. Always use the form prescribed by your healthcare provider for the appropriate age group.
Administering Montelukast Tablets: Standard vs. Chewable
| Feature | Standard Tablet | Chewable Tablet |
|---|---|---|
| Typical Age Range | Generally for adults and adolescents 15+ years | Generally for children 2-14 years |
| Administration | Swallow whole, often with water | Chew or suck completely |
| With Food | Can typically be taken with or without food | May have specific instructions regarding food intake for optimal absorption |
| Contains Phenylalanine | Usually does not | May contain phenylalanine (a concern for patients with PKU) |
Important Safety Considerations and Side Effects
Montelukast is generally well-tolerated, but it's important to be aware of potential side effects, particularly the risk of serious mental health changes. The FDA has issued a boxed warning about neuropsychiatric events associated with the medication.
Behavioral and Mood Changes
Serious side effects affecting mood and behavior can occur, even in patients with no prior history of mental health issues. These symptoms can include:
- Agitation or aggressive behavior
- Anxiety and irritability
- Depression, including suicidal thoughts or actions
- Restlessness and sleepwalking
- Vivid or unusual dreams
- Hallucinations
- Memory problems
- Tremor
If you or your child experience any of these symptoms, contact your doctor immediately and stop taking the medication. A family member or caregiver should also be aware of this risk and monitor for changes.
Montelukast and Drug Interactions
Before starting montelukast, inform your doctor of all medications, vitamins, and herbal supplements you are taking. Some substances can interact with montelukast, including:
- Phenobarbital: An anti-seizure medication.
- Phenytoin: An anti-seizure medication.
- Rifampin: An antibiotic used to treat tuberculosis.
- Gemfibrozil: A medication for high cholesterol.
Special Warnings for Asthma Patients
For individuals with asthma sensitive to aspirin or NSAIDs (non-steroidal anti-inflammatory drugs like ibuprofen), it is crucial to continue avoiding them while taking montelukast. Additionally, if a patient on oral steroids for asthma starts or changes their montelukast administration, they should be monitored for Churg-Strauss syndrome, a rare blood vessel condition.
Conclusion: Consistent Use for Effective Management
To get the most out of your montelukast treatment, consistent and correct use is paramount. Follow your doctor's prescribed timing diligently, and never stop taking the medication without consulting them first. Montelukast is a powerful tool for managing chronic respiratory conditions, but it must be used with care and full awareness of its potential side effects.
Always consult with a healthcare provider or pharmacist for personalized medical advice. For more detailed information, you can also review the FDA's safety communication regarding montelukast.
