Montelukast 6–14-Vuotiaille Pediatrisille Potilaille Accord (Montelukast)

Montelukast is a leukotriene receptor antagonist indicated for respiratory allergic conditions.

• Asthma: improves long‑term control and reduces the frequency of bronchospasm in pediatric patients.
• Allergic rhinitis: relieves nasal congestion, sneezing, and itching caused by seasonal or perennial allergens.
• Exercise‑induced bronchoconstriction: prevents airway narrowing triggered by physical activity in children.

• Montelukast selectively blocks the cysteinyl leukotriene receptor CysLT1, preventing leukotrienes from binding and triggering bronchoconstriction, vascular permeability, and inflammatory cell recruitment. By inhibiting this pathway, it reduces airway inflammation and hyper‑responsiveness associated with asthma and allergic rhinitis.

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

Common Side Effects

• Headache: mild to moderate pain often reported.
• Abdominal pain: discomfort or cramps in the stomach area.
• Nausea: feeling of queasiness without vomiting.
• Cough: occasional dry cough.
• Dizziness: transient light‑headedness.
• Fatigue: unusual tiredness or lack of energy.

Serious or Rare Side Effects

• Allergic reactions: rash, urticaria, or angioedema.
• Neuropsychiatric events: mood changes, anxiety, or suicidal thoughts.
• Hepatic enzyme elevation: abnormal liver function tests.
• Hematologic effects: neutropenia or eosinophilia.
• Stevens‑Johnson syndrome: severe skin blistering.
• Anaphylaxis: rapid, life‑threatening allergic response.

Before prescribing Montelukast, clinicians should consider several safety aspects.

• Assess asthma control: ensure baseline therapy is optimized.
• Monitor neuropsychiatric symptoms: watch for mood changes or suicidal ideation.
• Use caution in hepatic impairment: adjust therapy if liver disease is present.
• Avoid in patients with known hypersensitivity to montelukast or any component of the formulation.
• Review concomitant medications: consider potential interactions.
• Store at room temperature: keep in the original pack, protect from moisture.

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

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir): may increase montelukast plasma levels.
• CYP3A4 inducers (e.g., phenobarbital, rifampicin): may lower therapeutic concentrations.

Moderate Interactions (Monitor Closely)

• Warfarin: monitor INR as montelukast can affect anticoagulation.
• Other leukotriene modifiers (e.g., zafirlukast): additive effects may increase risk of side effects.
• Beta‑agonists: no direct pharmacokinetic interaction, but clinical response should be observed.