Montelukast Accord (Montelukast Sodium)

Montelukast Accord, a leukotriene receptor antagonist, is used to treat conditions mediated by cysteinyl leukotrienes.

• Asthma maintenance therapy: improves long‑term control and reduces exacerbations.
• Allergic rhinitis: alleviates nasal congestion, sneezing and itching.
• Prevention of exercise‑induced bronchoconstriction: reduces airway narrowing during physical activity.

• Montelukast selectively blocks cysteinyl leukotriene (CysLT1) receptors on airway smooth muscle, inflammatory cells and vascular endothelium. By antagonizing the binding of leukotriene D4 and related mediators, it prevents leukotriene‑induced bronchoconstriction, mucus secretion, vascular permeability and eosinophilic inflammation, thereby improving airway patency and reducing allergic inflammation. The inhibition is reversible and does not affect prostaglandin pathways, allowing normal bronchodilator response to β2‑agonists.

Montelukast may be associated with a range of adverse reactions, which are generally categorized by frequency and severity.

Common Side Effects

• Headache
• Abdominal pain or dyspepsia
• Cough
• Nasopharyngitis
• Fatigue
• Diarrhoea

Serious or Rare Side Effects

• Neuropsychiatric events such as agitation, depression or suicidal thoughts
• Severe allergic reactions including angioedema, urticaria or anaphylaxis
• Hepatic enzyme elevations or hepatitis
• Eosinophilic granulomatosis with polyangiitis (Churg‑Strauss syndrome)
• Stevens‑Johnson syndrome or toxic epidermal necrolysis

Before prescribing Montelukast, clinicians should consider several safety aspects.

• Assess asthma control before initiating therapy: ensure the patient is on appropriate inhaled controller medication.
• Monitor for neuropsychiatric symptoms: report any mood changes, depression or suicidal thoughts promptly.
• Use with caution in patients with hepatic impairment: consider dose adjustment or close monitoring.
• Avoid in individuals with known hypersensitivity to montelukast or any excipient.
• Store at room temperature: keep in the original pack, protect from moisture and direct sunlight.

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

Major Interactions (Avoid)

• Phenobarbital, rifampin, carbamazepine: strong enzyme inducers that may lower montelukast plasma levels.
• Erythromycin, ketoconazole: potent CYP3A4 inhibitors that may raise exposure.
• Warfarin: possible increase in INR; monitor coagulation parameters.

Moderate Interactions (Monitor Closely)

• Theophylline: additive central nervous system effects may occur.
• β2‑agonists: no direct pharmacokinetic interaction, but overall asthma control should be assessed.
• Live attenuated vaccines: immune response may be altered; consider timing of vaccination.