Montelukast 2–5-Vuotiaille Pediatrisille Potilaille Accord (Montelukast)

Montelukast acts on leukotriene pathways to control chronic respiratory and allergic conditions.

• Asthma: reduces frequency of asthma attacks and improves overall control in young children.
• Allergic rhinitis: alleviates nasal congestion, sneezing and itchy eyes associated with seasonal allergies.
• Exercise‑induced bronchoconstriction: helps prevent airway narrowing that occurs after physical activity.

• Montelukast selectively blocks the cysteinyl leukotriene receptor CysLT1, preventing leukotriene D4 from binding. This inhibition reduces leukotriene‑mediated bronchoconstriction, vascular permeability, and inflammatory cell recruitment in the airways, thereby improving respiratory function and decreasing allergic inflammation.

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

Common Side Effects

• Headache: mild to moderate intensity.
• Abdominal pain: occasional discomfort or cramps.
• Cough: transient dry cough.
• Sore throat: mild irritation of the throat.
• Fever: low‑grade temperature elevation.
• Nausea: occasional upset stomach.

Serious or Rare Side Effects

• Allergic reactions: rash, angioedema or anaphylaxis.
• Neuropsychiatric events: mood changes, depression or suicidal thoughts.
• Hepatic enzyme elevation: abnormal liver function tests.
• Stevens‑Johnson syndrome: severe skin blistering.
• Eosinophilic granulomatosis with polyangiitis: rare vasculitic disorder.
• Severe rash: widespread erythema or exfoliative dermatitis.

Before prescribing Montelukast, clinicians should consider several safety factors.

• Assess asthma control before initiating: ensure the patient is on appropriate inhaled therapy.
• Monitor for neuropsychiatric events: watch for mood changes or unusual behavior.
• Use with caution in hepatic impairment: dose adjustment may be required.
• Avoid in patients with known hypersensitivity to montelukast or any tablet components.
• Store at room temperature: keep in the original container, protect from moisture and heat.

Montelukast may interact with other medicines, requiring attention to avoid reduced efficacy or increased toxicity.

Major Interactions (Avoid)

• Rifampin: induces metabolism and may lower montelukast levels.
• Phenobarbital: enzyme induction can reduce therapeutic effect.
• Ketoconazole: strong CYP3A inhibition may raise montelukast concentrations.

Moderate Interactions (Monitor Closely)

• Warfarin: possible increase in INR, requiring closer coagulation monitoring.
• Beta‑agonists: additive bronchodilation may enhance respiratory effects.
• Antidepressants: monitor for amplified neuropsychiatric symptoms.