Montelukast Accord (Montelukast)

Montelukast is a leukotriene receptor antagonist used to manage conditions mediated by cysteinyl leukotrienes.

• Asthma: reduces the frequency of asthma attacks and improves overall control in patients with persistent asthma.
• Allergic rhinitis: alleviates nasal congestion, sneezing and itching associated with seasonal or perennial allergic rhinitis.
• Exercise‑induced bronchoconstriction: prevents narrowing of the airways that occurs during or after physical exertion.

• Montelukast selectively blocks the cysteinyl leukotriene receptor type 1 (CysLT1) on airway smooth‑muscle cells, sub‑mucosal glands and inflammatory cells. By antagonizing CysLT1, it prevents leukotriene‑D4 and related mediators from binding, thereby reducing bronchoconstriction, mucus secretion and inflammatory cell recruitment that contribute to asthma and allergic rhinitis symptoms. The inhibition also dampens eosinophil activation and cytokine release, contributing to long‑term control of airway inflammation.

Montelukast may be associated with a range of adverse reactions, ranging from mild to serious.

Common Side Effects

• Headache: mild to moderate head pain reported by some patients.
• Abdominal pain: discomfort or cramps in the stomach area.
• Cough: transient irritation of the throat leading to coughing.
• Nausea: feeling of queasiness or urge to vomit.
• Sore throat: irritation or pain in the throat.
• Dizziness: light‑headed sensation, especially when standing quickly.

Serious or Rare Side Effects

• Angioedema: swelling of the face, lips, tongue or airway requiring urgent care.
• Allergic reactions: rash, itching, hives or anaphylaxis.
• Mood changes: depression, agitation or unusual behavior.
• Suicidal thoughts: emergence of suicidal ideation or behavior.
• Severe rash: Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Hepatic injury: signs of liver dysfunction such as jaundice or elevated enzymes.

When prescribing Montelukast Accord, consider the following precautions:

• Pregnancy: consult a healthcare provider as safety data are limited.
• Breastfeeding: weigh benefits against potential risks; data are insufficient.
• Pediatric use: approved for children; dosing must be individualized by the prescriber.
• Elderly: monitor for adverse effects, particularly neuropsychiatric symptoms.
• Drug interactions: review concomitant medications for potential interactions.
• Store at ambient temperature: keep in the original container, protect from moisture and light.

Montelukast can interact with several medicines; assess the clinical relevance before co‑administration.

Major Interactions (Avoid)

• Ritonavir: may increase montelukast plasma concentrations, raising risk of adverse effects.
• Phenobarbital: enzyme induction can lower montelukast levels, reducing efficacy.
• Carbamazepine: may decrease montelukast exposure through metabolic induction.

Moderate Interactions (Monitor Closely)

• Warfarin: potential alteration of anticoagulant effect; monitor INR.
• Beta‑agonists: combined bronchodilator effect may require dose adjustment.