Montelukast Ratiopharm (Montelukast Sodium)

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

• Asthma: improves long‑term control and reduces the frequency of asthma attacks.
• Exercise‑induced bronchoconstriction: prevents narrowing of the airways during physical activity.
• Allergic rhinitis: alleviates nasal congestion, sneezing and itching associated with seasonal allergies.

• Montelukast selectively blocks the cysteinyl leukotriene receptor CysLT1, preventing leukotrienes D4, E4 and C4 from binding. This inhibition reduces bronchoconstriction, airway edema, mucus secretion and inflammatory cell recruitment, thereby improving respiratory function in asthma and allergic conditions.

Montelukast may be associated with a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Headache: mild to moderate pain in the head.
• Abdominal pain: discomfort or cramps in the stomach area.
• Nausea: feeling of queasiness or urge to vomit.
• Dizziness: sensation of light‑headedness or unsteadiness.

Serious or Rare Side Effects

• Allergic reactions: rash, hives, or angioedema requiring medical attention.
• Neuropsychiatric events: mood changes, depression, or suicidal thoughts.
• Hepatic enzyme elevation: abnormal liver function tests.
• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.

Before prescribing Montelukast, clinicians should consider several safety measures.

• Assess asthma control: ensure patient’s baseline asthma is stable before initiation.
• Monitor neuropsychiatric symptoms: watch for mood changes or suicidal ideation.
• Use caution in hepatic impairment: adjust use if liver disease is present.
• Avoid in known hypersensitivity: discontinue if allergic reaction occurs.
• Pregnancy and lactation: weigh benefits against potential risks; use only if clearly needed.
• Store at room temperature: keep in the original packaging, protect from moisture.

Montelukast can interact with other medicines, affecting its efficacy or safety.

Major Interactions (Avoid)

• Rifampin: strong CYP3A4 inducer that may reduce montelukast plasma levels.
• Phenobarbital: enzyme inducer that can lower montelukast effectiveness.

Moderate Interactions (Monitor Closely)

• SSRIs (e.g., fluoxetine): may increase risk of neuropsychiatric side effects.
• Warfarin: potential for altered anticoagulant effect; monitor INR.
• Theophylline: may require dose adjustment due to metabolic interactions.