MontelukastMontelukast Sodium

About Montelukast

Montelukast blocks leukotrienes, chemicals that narrow and inflame the airways. Its label covers the prevention and chronic treatment of asthma in patients 12 months and older, the acute prevention of exercise-induced bronchoconstriction from age 6, and relief of seasonal allergic rhinitis from age 2 and perennial allergic rhinitis from 6 months. It is taken once a day: 10 mg tablets from age 15, 5 mg chewable tablets from 6 to 14, 4 mg chewable tablets or granules from 2 to 5, and 4 mg granules for younger children. For asthma it is taken in the evening; for allergies, at a time that suits the patient. To prevent exercise symptoms, one dose is taken at least 2 hours before exercise, never within 24 hours of a previous dose, and not as an extra dose by someone already taking it every day.

Its boxed warning says serious neuropsychiatric events have been reported, including agitation, aggression, depression, sleep disturbances and suicidal thoughts and behavior. Anyone who notices such changes should stop it and contact a health care provider right away, and symptoms can persist after it is stopped. Because the benefits may not outweigh this risk in allergic rhinitis, the label reserves it there for patients with an inadequate response to, or intolerance of, other treatments. It is not for reversing an acute attack and must not be substituted abruptly for inhaled or oral steroids. People sensitive to aspirin keep avoiding aspirin and NSAIDs, and systemic eosinophilia, sometimes with vasculitis, has been reported, though a causal link has not been established. Anyone allergic to its ingredients must not take it. Common side effects include upper respiratory infection, fever, headache, sore throat, cough, stomach pain and diarrhea.

The FDA required the boxed warning in March 2020. The chewable tablets contain phenylalanine (0.674 mg in the 4 mg tablet, 0.842 mg in the 5 mg), which matters for people with phenylketonuria. Granules can go directly in the mouth, be dissolved in a teaspoon (5 mL) of cold or room-temperature baby formula or breast milk, or be mixed with a spoonful of applesauce, carrots, rice or ice cream; the whole dose is given within 15 minutes of opening the packet, and any mixture left over is thrown away. The labels say available data have not established a risk of major birth defects, and montelukast has been found in breast milk.

Taking Montelukast

How to take it

Once a day, with or without food: in the evening for asthma, at any time of day for allergies. To prevent exercise symptoms, take it at least 2 hours before exercise, but not if you already took a dose in the past 24 hours. Give granules within 15 minutes of opening the packet, and keep a quick-relief inhaler for attacks.

If you miss a dose

Skip the missed dose and continue your regular schedule. Do not take a double dose, and never take more than one dose in 24 hours.

Storage

At room temperature, protected from light and moisture, in the original package and out of reach of children. Keep granule packets closed until it is time for the dose, and do not save a mixed dose for later.

Interactions to know about

The label lists no dose changes with drugs such as theophylline, prednisone, birth control pills, warfarin or digoxin. Potent enzyme inducers such as phenobarbital or rifampin can lower its levels, so the label calls monitoring reasonable. People sensitive to aspirin should keep avoiding aspirin and NSAIDs.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Montelukast differs from pharmacy to pharmacy

Montelukast 10 mg tablets and 5 mg chewable tablets each have many rated generic makers, so quotes for the same tablets differ by each pharmacy’s fee and markup and by whether montelukast is on its flat-price generic list. Granules come from fewer makers. A prescription that names Singulair and blocks substitution is filled with the brand.

Tablets, chewable tablets and granules are different forms, and the pharmacist fills the form and strength written; switching a growing child to the next form needs the prescriber.

Ways to pay less for Montelukast without insurance

• Ask whether montelukast is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• If the prescription names Singulair, check that it allows a generic.
• Once the dose is settled, ask the prescriber about a ninety-day supply.
• For allergic rhinitis, ask the prescriber about the alternatives the FDA names, such as antihistamines and steroid nasal sprays, since the label reserves montelukast for when other treatments do not work or are not tolerated.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Montelukast

1. 1.Which mood, sleep or behavior changes should make me stop it and call?
2. 2.Is this the right form and strength for my child’s age?
3. 3.How do I give my child the granules, and what can I mix them with?
4. 4.If I take it every evening, do I need another dose before exercise?

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