Montelucaste Azevedos (Montelukast)

Montelukast acts on the leukotriene pathway to reduce airway inflammation and bronchoconstriction.

• Asthma (maintenance therapy): improves long‑term control and reduces exacerbations.
• Allergic rhinitis: alleviates nasal congestion, sneezing and itching.
• Exercise‑induced bronchoconstriction: prevents airway narrowing triggered by physical activity.

• Montelukast selectively blocks the cysteinyl leukotriene receptor CysLT1, preventing leukotrienes from binding and triggering bronchoconstriction, mucus secretion, and inflammatory cell recruitment. By inhibiting this pathway, it reduces airway edema and hyperresponsiveness, contributing to better respiratory function in asthma and allergic conditions.

Montelukast is generally well tolerated, but adverse reactions can occur.

Common Side Effects

• Headache: mild to moderate intensity.
• Abdominal pain: occasional discomfort.
• Cough: transient irritation.
• Fever: low‑grade elevations.
• Sore throat: mild irritation.
• Nausea: occasional upset stomach.

Serious or Rare Side Effects

• Angioedema: swelling of face, lips or tongue.
• Allergic reactions: rash, urticaria, or anaphylaxis.
• Mood changes: depression, anxiety, or suicidal thoughts.
• Hepatic injury: rare elevation of liver enzymes.
• Severe bronchospasm: paradoxical worsening of breathing.
• Stevens‑Johnson syndrome: rare severe skin reaction.

Before initiating therapy, clinicians should consider several safety aspects.

• Assess asthma control: ensure patient is stable on current regimen.
• Monitor for allergic reactions: watch for rash or swelling after first doses.
• Evaluate liver function: consider baseline tests in patients with hepatic disease.
• Caution in psychiatric history: monitor mood and suicidal ideation.
• Avoid in known hypersensitivity: discontinue if severe reaction occurs.
• Store at ambient temperature: keep in original packaging, protect from moisture and direct sunlight.

Montelukast may interact with other medicines, requiring attention to dosage and monitoring.

Major Interactions (Avoid)

• Rifampin, phenobarbital, carbamazepine: strong CYP3A4 inducers that markedly reduce montelukast exposure.
• St. John's wort: herbal inducer that may diminish therapeutic effect.

Moderate Interactions (Monitor Closely)

• Fluconazole, ketoconazole: CYP3A4 inhibitors that can increase montelukast plasma levels.
• SSRIs or SNRIs: may heighten risk of neuropsychiatric events.
• NSAIDs: concurrent use may increase bronchospasm risk in sensitive individuals.
• Warfarin: occasional reports of altered INR; monitor coagulation if combined.