How does montelukast help manage asthma symptoms. What are the common side effects of montelukast. How should montelukast be taken for optimal effectiveness. What precautions should be considered when using montelukast.

Understanding Montelukast: An Effective Asthma Medication

Montelukast is a widely prescribed medication for managing asthma and allergies. As a leukotriene receptor antagonist, it works by blocking certain natural substances that may cause or worsen asthma symptoms. This article delves into the essential aspects of montelukast, including its uses, dosage, potential side effects, and important precautions.

How Montelukast Works to Control Asthma Symptoms

Montelukast functions by inhibiting the action of leukotrienes, which are inflammatory substances produced by the body in response to allergens and other triggers. By blocking these substances, montelukast helps to:

• Reduce inflammation in the airways
• Prevent asthma attacks
• Alleviate symptoms of seasonal allergies
• Improve breathing and overall lung function

This mechanism of action makes montelukast an effective option for long-term asthma management, especially when used in conjunction with other asthma medications.

Can montelukast replace other asthma medications?

While montelukast is effective in managing asthma symptoms, it is not intended to replace quick-relief inhalers or other asthma medications. It is typically used as part of a comprehensive asthma management plan, often in combination with inhaled corticosteroids or other long-term control medications. Always consult your healthcare provider before making any changes to your asthma treatment regimen.

Proper Dosage and Administration of Montelukast

The appropriate dosage of montelukast varies depending on the patient’s age and the specific condition being treated. Here are the general guidelines for montelukast dosage:

• Adults and children 15 years and older: 10mg tablet once daily
• Children 6 to 14 years old: 5mg chewable tablet once daily
• Children 6 months to 5 years old: 4mg granules or chewable tablet once daily

Montelukast is typically taken in the evening to prevent nighttime asthma symptoms. However, for exercise-induced asthma, it may be taken 2 hours before physical activity. Always follow your doctor’s instructions regarding the timing and dosage of montelukast.

Is it safe to take montelukast long-term?

Montelukast is generally considered safe for long-term use when taken as prescribed. However, as with any medication, it’s essential to have regular check-ups with your healthcare provider to monitor its effectiveness and any potential side effects. Your doctor may periodically assess whether you need to continue taking montelukast or if adjustments to your treatment plan are necessary.

Common Side Effects of Montelukast and How to Manage Them

Like all medications, montelukast can cause side effects, although not everyone experiences them. Some common side effects include:

• Diarrhea
• High temperature
• Headaches
• Stomach pain
• Nausea or vomiting
• Mild rash

These side effects are usually mild and often resolve on their own as your body adjusts to the medication. However, there are steps you can take to manage these symptoms:

How to manage diarrhea while taking montelukast?

If you experience diarrhea while taking montelukast:

• Drink plenty of fluids to prevent dehydration
• Avoid caffeine and alcohol
• Eat small, frequent meals of bland, easily digestible foods
• Consider over-the-counter antidiarrheal medications, but consult your doctor first

If diarrhea persists or becomes severe, contact your healthcare provider.

What to do if you experience headaches with montelukast?

Headaches are a common side effect of montelukast, especially during the first week of treatment. To manage headaches:

• Ensure you’re well-hydrated
• Get adequate rest
• Use over-the-counter pain relievers as recommended by your pharmacist
• Apply a cold or warm compress to your forehead

If headaches persist beyond the first week or become severe, consult your doctor.

Serious Side Effects and When to Seek Medical Attention

While rare, montelukast can cause serious side effects that require immediate medical attention. Contact your doctor or seek emergency care if you experience:

• Mood changes, depression, or suicidal thoughts
• Hallucinations
• Difficulty concentrating or memory problems
• Changes in speech patterns
• Unusual trembling or shaking
• Abnormal heart rhythm
• Flu-like symptoms combined with numbness or tingling in limbs
• Yellowing of the skin or eyes (jaundice)

Are there any long-term risks associated with montelukast use?

While montelukast is generally considered safe, there have been reports of neuropsychiatric events in some patients. These can include mood changes, aggressive behavior, and suicidal thoughts. The FDA has added a boxed warning to montelukast’s labeling to address these potential risks. It’s crucial to discuss any concerns or unusual symptoms with your healthcare provider promptly.

Montelukast Interactions and Precautions

Before starting montelukast, it’s essential to inform your doctor about all medications, supplements, and herbal products you’re taking. Montelukast can interact with certain drugs, potentially affecting their efficacy or increasing the risk of side effects. Some medications that may interact with montelukast include:

• Other asthma medications
• Certain antibiotics
• Phenobarbital and similar seizure medications
• Rifampin (used to treat tuberculosis)

Additionally, be sure to tell your doctor if you have any liver problems, as montelukast is metabolized in the liver and may require dosage adjustments.

Can montelukast be taken during pregnancy or while breastfeeding?

The safety of montelukast during pregnancy and breastfeeding is not fully established. While some studies suggest it may be safe, it’s crucial to discuss the potential risks and benefits with your healthcare provider. They can help you make an informed decision based on your individual circumstances and the severity of your asthma.

Maximizing the Benefits of Montelukast in Asthma Management

To get the most out of your montelukast treatment:

• Take it consistently as prescribed, even when you’re feeling well
• Use it as part of a comprehensive asthma management plan
• Continue to avoid known asthma triggers
• Keep regular appointments with your healthcare provider
• Monitor your symptoms and peak flow readings
• Don’t hesitate to seek medical advice if your asthma worsens

Remember, montelukast is not a rescue medication and should not be used to treat acute asthma attacks. Always keep your quick-relief inhaler on hand for emergencies.

How long does it take for montelukast to start working?

Montelukast typically begins to work within 24 hours of the first dose. However, it may take a few days to a few weeks to experience the full benefits of the medication. It’s important to continue taking montelukast as prescribed, even if you don’t notice immediate improvements in your symptoms.

Alternative Treatment Options for Asthma Management

While montelukast is an effective treatment for many people with asthma, it’s not the only option available. Depending on the severity of your asthma and your individual needs, your doctor may recommend other treatments, such as:

• Inhaled corticosteroids
• Long-acting beta-agonists (LABAs)
• Combination inhalers (containing both a corticosteroid and a LABA)
• Theophylline
• Biologics for severe asthma

Each of these medications works differently and may be used alone or in combination to achieve optimal asthma control.

How do inhaled corticosteroids compare to montelukast for asthma control?

Inhaled corticosteroids are often considered the gold standard for long-term asthma control. They work by reducing inflammation in the airways, which is the underlying cause of asthma symptoms. In comparison, montelukast targets a specific inflammatory pathway. While both medications can be effective, inhaled corticosteroids are generally more potent in controlling asthma symptoms for most people. However, montelukast may be preferred in certain situations, such as for patients who have difficulty using inhalers or those with mild asthma primarily triggered by exercise or allergies.

Your healthcare provider will consider various factors, including the severity of your asthma, your preferences, and potential side effects, when determining the best treatment approach for you. In some cases, a combination of montelukast and an inhaled corticosteroid may provide optimal asthma control.

Lifestyle Modifications to Complement Montelukast Therapy

While montelukast can significantly improve asthma control, combining medication with lifestyle modifications can enhance its effectiveness. Consider implementing the following strategies:

• Identify and avoid asthma triggers
• Maintain a healthy weight
• Exercise regularly, with appropriate precautions
• Quit smoking and avoid secondhand smoke
• Use air filters and keep your living space clean
• Manage stress through relaxation techniques
• Get vaccinated against influenza and pneumonia

These lifestyle changes, when combined with proper medication use, can significantly improve your overall asthma management and quality of life.

How can exercise be safely incorporated into an asthma management plan?

Regular exercise is beneficial for overall health and can improve lung function in people with asthma. However, exercise can also trigger asthma symptoms in some individuals. To safely incorporate exercise into your asthma management plan:

• Warm up properly before exercising
• Use your prescribed pre-exercise medications (such as a short-acting bronchodilator)
• Choose activities less likely to trigger asthma, such as swimming or yoga
• Exercise in environments with clean, warm air when possible
• Gradually increase the intensity and duration of your workouts
• Cool down slowly after exercise
• Monitor your symptoms and have your rescue inhaler readily available

Always consult with your healthcare provider before starting a new exercise regimen, especially if you have exercise-induced asthma.

Monitoring and Adjusting Montelukast Treatment

Effective asthma management requires ongoing monitoring and occasional adjustments to your treatment plan. When using montelukast:

• Keep track of your symptoms and peak flow readings
• Attend regular follow-up appointments with your healthcare provider
• Discuss any changes in your symptoms or concerns about side effects
• Be prepared to adjust your medication regimen as needed
• Review and update your asthma action plan periodically

Your doctor may recommend increasing or decreasing your montelukast dosage, adding or removing other medications, or exploring alternative treatments based on your asthma control and overall health status.

How often should asthma treatment plans be reviewed?

The frequency of asthma treatment reviews can vary depending on the severity of your condition and how well it’s controlled. Generally, it’s recommended to have a comprehensive asthma review at least once a year. However, more frequent reviews may be necessary if:

• Your asthma is not well-controlled
• You’ve recently had an asthma exacerbation
• You’re experiencing side effects from your medications
• There are significant changes in your lifestyle or environment
• You’re pregnant or planning to become pregnant

Regular reviews ensure that your treatment plan remains effective and appropriate for your current needs. Don’t hesitate to contact your healthcare provider between scheduled appointments if you have concerns about your asthma control or medication effects.

Side effects of montelukast – NHS

Like all medicines, montelukast can cause side effects, although not everyone gets them.

Common side effects

These common side effects of montelukast happen in more than 1 in 100 people. There are things you can do to help cope with them:

Diarrhoea

Drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.

If you take contraceptive pills and you have severe diarrhoea for more than 24 hours, your contraception may not protect you from pregnancy. Check the pill packet for advice.

High temperature

Paracetamol will help to bring the temperature down. Drink plenty of fluids. See your doctor if it lasts for more than a few days.

Headaches

Make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller.

Headaches should usually go away after the first week of taking montelukast. Talk to your doctor if headaches last longer than a week or are severe.

Stomach pain

Try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on your stomach may also help.

If you’re in a lot of pain, speak to your pharmacist or doctor.

Feeling or being sick

Stick to simple meals and do not eat rich or spicy food. If you’re being sick, try small frequent sips of water to avoid dehydration. Signs of dehydration include peeing less than usual or having dark strong-smelling pee.

If you take contraceptive pills and you’re being sick your contraception may not protect you from pregnancy. Check the pill packet for advice.

A mild rash

It may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is right for you.

If the rash gets worse, speak to your doctor.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

Call your doctor or contact 111 immediately if:

• you notice mood changes and you become depressed, aggressive or you’re thinking of harming yourself
• you see things which are not there (hallucinations)
• you’re finding it harder than usual to concentrate or remember things
• your speech changes or you start stuttering
• you have shaking or trembling in any part of your body
• you have an unusual or fast heartbeat
• you develop a combination of symptoms such as a flu-like illness, pins and needles or numbness of arms or legs, worsening of asthma symptoms, or a rash
• the whites of your eyes turn yellow, or your skin turns yellow although this may be less obvious on brown or black skin – this can be a sign of liver problems

Serious allergic reaction

It is possible to have a serious allergic reaction (anaphylaxis) to montelukast.

Immediate action required: Call 999 or go to A&E now if:

• you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
• you’re wheezing
• you get tightness in the chest or throat
• you have trouble breathing or talking
• your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

Other side effects

These are not all the side effects of montelukast. For a full list see the leaflet inside your medicines packet.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

Page last reviewed: 14 March 2023

Next review due: 14 March 2026

How and when to take montelukast

Always follow your doctor’s instructions about how and when to take montelukast.

Dosage

Montelukast comes as 10mg non-chewable tablets, chewable tablets in strengths of 5mg or 4mg, and granules in sachets of 4mg.

The usual dose for adults and children aged 15 years old and over is one 10mg tablet once a day.

The usual dose for children aged 6 to 14 years old is one 5mg chewable tablet once a day.

The usual dose for children from 6 months to 5 years old is 4mg once a day. This can be taken as granules, or a chewable tablet for children over 2 years old.

How to take it

Most people take montelukast once a day in the evening to prevent symptoms of asthma or allergies. However, if exercise makes your asthma worse, your doctor might tell you to take montelukast 2 hours before you exercise.

Never take more than 1 dose a day.

How to take non-chewable tablets

You can take montelukast non-chewable tablets with or without food.

Swallow the tablets whole with water, juice or milk. Do not chew these tablets.

How to take chewable tablets

It’s important to take chewable tablets at least 1 hour before food, or 2 hours after food. This is so the medicine is absorbed into your body properly.

Chewable tablets can be chewed or sucked. You or your child can have a drink of water or squash afterwards.

How to give granules to a child

Montelukast granules come in a sachet with 4mg of granules inside (one dose). You can put them directly on your child’s tongue. You can also mix the granules with a spoonful of cold, soft food, such as yoghurt or ice-cream.

Make sure your child takes the whole dose immediately (or within 15 minutes).

It’s important not to dissolve the granules in a drink. You can give your child a drink afterwards.

How long to take it for

Take montelukast for as long as your doctor recommends it. It will only keep working while you’re taking it.

Do not stop taking montelukast without speaking to your doctor first, because your symptoms may get worse.

If you forget to take it

If you or your child miss a dose of montelukast, skip the missed dose and take your next dose the following day at the usual time.

Do not take 2 doses to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you. You could also ask a pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much

Urgent advice: Contact 111 for advice if:

• you take more than your prescribed dose of montelukast

Go to 111.nhs.uk or call 111. Call 111 if you’re asking about a child under the age of 5 years.

If you need to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the montelukast packet or leaflet inside it, plus any remaining medicine with you.

Page last reviewed: 14 March 2023

Next review due: 14 March 2026

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9Bronchial therapy asthma | Controlling Asthma Symptoms

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Asthma therapy devices help you administer medication more effectively and reduce the risk of side effects ^{1, 2} .

Asthma therapy – patient benefits

Why is asthma therapy important?

Many people with asthma find they have effective asthma control if they have irregular symptoms and use their inhaler less frequently. In reality, this may mean that the asthma treatment program is not effective enough or that you are not following the prescribed recommendations to the right extent. Often this behavior is associated with side effects from taking medications (for example, an unpleasant aftertaste in the back of the throat).

Asthma devices help you administer your medicine more effectively and reduce the risk of side effects ^1.2 . With the correct administration of the medicine, in accordance with the recommendations of the doctor regarding the frequency of administration and dosage, you can reduce the number of attacks and live a more fulfilling life.

Take control of the situation!

Find out how our asthma devices can help you manage your asthma.

The goal of therapy is to control asthma symptoms so that

⁷ :

No (or little) symptoms occur during the day ³

Prevent asthma symptoms from occurring at night ³

Reduce the number of appointments relief drug to relieve symptoms up to 2 times a week ³

Are you sure that you control bronchial asthma?

Take a little quiz to test yourself

The Global Initiative for Asthma (GINA) recommends asking yourself the following questions to gauge how well your disease is being controlled ⁷ :

1. If you or your child has asthma, do you or your child have symptoms such as coughing, wheezing, or chest tightness more than twice a week? Yes or no.

2. If you or your child has asthma, does the illness interfere with sports or normal physical activity? Yes or no.

3. If you or your child has asthma, do you/he/she wake up at night because of symptoms? Yes or no.

4. If you or your child have asthma, do you/he have to use emergency medicine more than twice a week to stop asthma attacks? Yes or no.

If you answered yes to any of these questions, it may mean that you or your child is not well controlled. Make an appointment with your healthcare provider to discuss your symptoms and review your asthma treatment program.

Tips for Relieving Children’s Asthma Symptoms:

Asthma Therapy Program and Green Zone Control

The Asthma Program is a document that you develop with your doctor. It tells you when and how much of the control medication you or your child should take daily to control asthma symptoms, how often you take the rescue medication, and what to do if your symptoms flare up.

A color chart is used to monitor the patient’s condition, which is divided into three zones – green, yellow and red. With it, you can easily determine if your condition is stable or deteriorating and what actions need to be taken. When using the asthma treatment program, along with a graph and a peak flow meter that measures lung performance, you will be able to strictly follow the doctor’s instructions for effective disease prevention.

The Philips PersonalBest peak flow meter is based on a three-zone system organized similarly to the colors of a traffic light

More effective drug delivery

When using a single inhaler, the drug often does not enter the lungs, but remains in the mouth, throat or stomach. The valve chamber, also referred to as the “spacer”, helps to inject the substance directly into the lungs, improving the quality of therapy (up to 4 times more effective delivery) ⁴ .

Administering the correct amount of medication reduces the number of recurring symptoms so that the patient is in the Green Zone ² .

Peak expiratory flow monitoring for effective asthma symptom control

A peak flow meter is used to measure the rate at which air leaves the lungs.

The device also allows you to track whether you are in the yellow or red zone of the asthma program.

Direct Bronchial Delivery

Your healthcare provider may prescribe you an emergency medication using a pressurized metered dose inhaler (pMAI) or inhalation therapy using a nebulizer if your symptoms worsen. A nebulizer converts liquid medication into a fine aerosol that is easier to absorb into the lungs. The goal of treatment is to optimize the patient’s condition to the green zone.

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Hard facts

Learn about common misconceptions about asthma your doctor or pharmacist about preventing asthma attacks

Your doctor or pharmacist can help you understand how asthma prevention devices work and the benefits of using them. Some devices are only available with a doctor’s prescription.

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DISCLAIMER.
The information on this website is for reference only and should not be used as a substitute for advice from a therapist.

FOOTNOTES:
[1] Newman S. P., et al. Improvement of pressurized aerosol deposition with Nebuhaler spacer device. Thorax, 1984, 39(12), 935–41.

[2] Asthma.org.uk. Advice/inhalersmedicines.treatments/inhalers-and-spacers. Accessed January 2016

[3] Asthma.org.uk. Advice/manage-your-asthma. Accessed January 2016

[4] Gardenhire D., Arzu A., Dean H., Myers T. A guide to aerosol delivery devices for respiratory therapists 3rd edition, American Association for Respiratory Care, 2013.

[5] Compared to previous Aeroneb Go.

[6] When using 2.