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(mahn-teh-LOO-kast)
Singulair
Tablets: 10 mg
Tablets, chewable: 4 mg
Tablets, chewable: 5 mg
Class: Leukotriene receptor antagonist

  Action Blocks the effects of specific leukotrienes in the respiratory airways, thereby reducing bronchoconstriction, edema, and inflammation.

  Indications Prophylaxis and chronic treatment of asthma.

  Contraindications Standard considerations.

  Route/Dosage

Adults and children at least 15 yr: PO 10 mg once daily in the evening.

Children 6 to 14 yr: PO 5 mg chewable tablet once daily in the evening.

Children 2 to 5 yr: PO 4 mg chewable tablet once daily in the evening.

Children 12 to 23 mo: PO 1 packet of 4 mg granules daily in the evening.

  Interactions

Phenobarbital, rifampin:

Decreased montelukast levels.

  Lab Test Interferences None well documented.

  Adverse Reactions

CNS: Dizziness; headache. DERMATOLOGIC: Rash; urticaria. EENT: Dental pain; pharyngitis; laryngitis; nasal congestion; sinusitis; otitis; cough; ear pain; sneezing. GI: Dyspepsia; gastroenteritis; nausea; diarrhea; abdominal pain. HEPATIC: Increased AST and ALT. RESPIRATORY: Bronchitis. OTHER: Asthenia; fatigue; viral infection; influenza; pyuria; fever; leg pain; thirst.

  Precautions

Pregnancy: Category B. Lactation: Undetermined. CHILDREN: Safety and efficacy in children less than 12 mo not established. Acute asthma attacks: Do not use for the reversal of bronchospasm in acute asthma attacks, including status asthmaticus.

PATIENT CARE CONSIDERATIONS

  Administration/Storage

  • Administer in the evening.
  • Store tablets at room temperature. Protect from light and moisture.

  Assessment/Interventions

  • Review patient history, including drug history.
  • If potent cytochrome P450 enzyme inducers, such as phenobarbital, are prescribed, employ appropriate clinical monitoring.
  • Review history and laboratory tests for signs of decreased severe hepatic function.
  • Do not administer alone for acute attacks. This drug is for prophylaxis only. Have short-acting inhaled beta-agonists available for respiratory emergencies.
  • Monitor patients appropriately.
  • Monitor patient for effective prophylaxis and lessening of asthma symptoms.

  Patient/Family Education

  • Provide patient information pamphlet.
  • Advise patient to take montelukast daily in the evening as prescribed, even when asymptomatic, as well as during periods of worsening asthma.
  • Advise patient that oral tablets of montelukast are not for treatment of acute asthma attack but for prophylaxis purposes.
  • Advise patient to have short-acting inhaled beta-agonists available for respiratory emergencies to treat asthma exacerbations.
  • Instruct patient to seek medical attention if short-acting inhaled bronchodilators are needed more often than usual or respiratory difficulties are present.
  • Inform patient with phenylketonuria that the 4 and 5 mg chewable tablets contain phenylalanine.
  • Instruct patient who has exacerbations of asthma after exercise to use the usual treatment of inhaled beta-agonists for prophylaxis as prescribed.
  • Caution patient with known aspirin sensitivity to avoid aspirin or NSAIDs while taking montelukast.
  • Instruct patient not to decrease the dose or stop taking any other anti-asthma medication unless instructed by a health care provider.

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