What is Montel (Montelukast)?
Montelukast is an oral medication that belongs to a class of drugs called leukotriene receptor antagonists (LTRAs). Leukotrienes are inflammatory chemicals released by the body in response to an allergen, which can cause swelling and constriction of the airways. By blocking these leukotrienes, montelukast helps to reduce inflammation, relax the muscles around the airways, and prevent symptoms related to asthma and allergies.
Unlike rescue inhalers, which are used to treat sudden breathing problems, montelukast is a long-term control medication. It must be taken regularly, even when symptoms are not present, to be effective.
Primary Conditions Treated by Montelukast
Montelukast is approved by the U.S. Food and Drug Administration (FDA) for several key conditions. Understanding how and why it is prescribed is crucial for proper usage.
Asthma
For asthma management, montelukast is used for prophylaxis and chronic treatment in adults and children as young as 12 months. It helps reduce the severity and frequency of asthma attacks by controlling the underlying inflammation in the airways. However, it is important to remember that montelukast is not a rescue medication and will not provide immediate relief during an acute asthma attack.
- Asthma symptoms addressed: Chronic coughing, wheezing, shortness of breath, and chest tightness.
- Mechanism: By blocking leukotrienes, the medication reduces the inflammation and swelling in the airways that lead to asthma symptoms.
- Patient population: Often used in patients who are not adequately controlled on other asthma medications, such as inhaled corticosteroids.
Allergic Rhinitis
Montelukast is also effective in treating the symptoms of allergic rhinitis, commonly known as hay fever. It is approved for use in both seasonal and perennial (year-round) allergic rhinitis, though it is often reserved for patients who do not respond well to alternative treatments, such as antihistamines or nasal corticosteroids.
- Seasonal allergic rhinitis: Symptoms occur during specific seasons, typically spring, summer, or early fall, and are often caused by pollen from trees, grasses, and weeds.
- Perennial allergic rhinitis: Symptoms persist throughout the year and are commonly triggered by allergens such as pet dander, dust mites, or mold.
- Symptom relief: It helps alleviate nasal congestion, sneezing, itchy nose, and runny nose.
Exercise-Induced Bronchoconstriction (EIB)
EIB, sometimes called exercise-induced asthma, involves a narrowing of the airways triggered by physical activity. Montelukast can be used to prevent these symptoms, and unlike some other medications, it does not lose its effectiveness with long-term, regular use.
- Prevention: Patients should take montelukast at least two hours before exercising to help prevent breathing difficulties.
- Dosage considerations: It should not be used as an additional dose if the patient is already taking it daily for asthma or allergies.
Important Side Effects and Precautions
Like all medications, montelukast can cause side effects. Some are common and mild, while others can be serious and require immediate medical attention. The U.S. FDA has issued a boxed warning about the risk of serious behavior and mood-related changes associated with montelukast.
Common Side Effects
- Headache
- Fever or upper respiratory tract infection
- Stomach pain or diarrhea
- Cough or sore throat
Serious Neuropsychiatric Side Effects
Patients and caregivers should be aware of and monitor for changes in behavior and mood. If any of the following symptoms occur, discontinue the medication and contact a healthcare provider immediately.
- Agitation or aggressive behavior
- Anxiety, confusion, or depression
- Sleep disturbances, including nightmares or insomnia
- Hallucinations
- Forgetfulness or memory problems
- Suicidal thoughts or actions
Montelukast vs. Other Medications
| Feature | Montelukast (Oral Pill) | Inhaled Corticosteroids (e.g., Fluticasone) | Antihistamines (Oral Pill) |
|---|---|---|---|
| Mechanism | Blocks leukotrienes, reducing airway inflammation. | Reduces inflammation throughout the lungs. | Blocks histamine, controlling sneezing and itching. |
| Onset of Action | Gradual, for long-term control. | Slower onset; requires consistent use. | Fast-acting, for immediate symptom relief. |
| Role in Treatment | Preventive for asthma, EIB, and allergic rhinitis. | First-line, most effective controller medication for asthma. | First-line for mild-to-moderate allergy symptoms. |
| Asthma Attack Treatment | Not for rescue during an acute attack. | Not a rescue treatment. | Not applicable for asthma attacks. |
| Ideal Use Case | Patients needing additional asthma control or those with associated allergic rhinitis or EIB. | Standard maintenance treatment for mild to severe asthma. | Primarily for controlling mild allergy symptoms, not for asthma. |
How to Take Montelukast
Montelukast is available as tablets, chewable tablets, and oral granules. The dosage and timing depend on the condition being treated:
- For asthma: Take once daily in the evening.
- For allergic rhinitis: Take once daily, either morning or evening.
- For EIB prevention: Take a single dose at least two hours before exercise. Do not take an additional dose if already taking it daily for another condition.
Montelukast can be taken with or without food. Chewable tablets contain phenylalanine and should be used with caution in individuals with phenylketonuria (PKU).
Conclusion
In summary, Montel is used to treat several respiratory and allergy-related conditions by acting as a leukotriene receptor antagonist. Its primary uses include the long-term management of asthma, the symptomatic relief of seasonal and perennial allergic rhinitis, and the prevention of exercise-induced bronchoconstriction. While generally effective and well-tolerated, awareness of the potential for serious neuropsychiatric side effects is critical for safe use. It is essential to follow a healthcare provider's guidance, take the medication consistently as prescribed, and never use it as a rescue medication during an acute asthma attack.
For more information on respiratory health, visit the American Lung Association.
