montelukast sodium

(mon tell oo' kast)

Singulair

Pregnancy Category B

Drug classes
Antasthmatic
Leukotriene receptor antagonist

Therapeutic actions
Selectively and competitively blocks the receptor that inhibits leukotriene formation, thus
blocking many of the signs and symptoms of asthma—neutrophil and eosinophil
migration, neutrophil and monocyte aggregation, leukocyte adhesion, increased capillary
permeability, and smooth muscle contraction. These actions contribute to inflammation,
edema, mucus secretion, and bronchoconstriction associated with the signs and symptoms
of asthma.

Indications
• Prophylaxis and chronic treatment of asthma in adults and children > 12 mo
• Relief of symptoms of seasonal allergic rhinitis in adults and children > 2 yr
• Unlabeled uses: Chronic urticaria, atopic dermatitis

Contraindications and cautions

• Contraindicated with hypersensitivity to montelukast or any of its components;
acute asthma attacks; status asthmaticus.
• Use cautiously with pregnancy and lactation.

Available forms
Tablets—10 mg; chewable tablets—4, 5 mg; granules—4 mg/packet

Dosages
ADULTS AND PATIENTS > 15 YR
One 10 mg tablet PO daily, taken in the evening.
PEDIATRIC PATIENTS
12–23 mo (asthma only): 4 mg granules PO daily, taken in the evening.
2–5 yr: One 4-mg chewable tablet PO daily, taken in the evening.
6–14 yr: One 5-mg chewable tablet PO daily, taken in the evening.

Pharmacokinetics
Route Onset Peak
Oral Rapid 2–4 hr

Metabolism: Hepatic; T1/2: 2.7–5.5 hr

Distribution: Crosses placenta and enters breast milk
Excretion: Feces, urine
Adverse effects
• CNS: Headache, dizziness
• GI: Nausea, diarrhea, abdominal pain, dental pain
• Respiratory: Influenza, cold, nasal congestion
• Other: Generalized pain, fever, rash, fatigue

Interactions
Drug-drug
• Decreased effects and bioavailability if taken with phenobarbital, rifampin;
monitor patient and adjust dosage as needed

Nursing considerations
Assessment
• History: Hypersensitivity to montelukast or any of its components; acute asthma
attacks; status asthmaticus, pregnancy and lactation
• Physical: T; orientation, reflexes; R, adventitious sounds; GI evaluation

Interventions
• Administer in the evening without regard to food.
• Ensure that drug is taken continually for optimal effect.
• Do not administer for acute asthma attack or acute bronchospasm.
• Avoid the use of aspirin or NSAIDs in patients with known sensitivities while
they are using this drug.
• Ensure that patient has a readily available rescue medication for acute asthma
attacks or situations when a short-acting inhaled agent is needed.

Teaching points
• Take this drug regularly as prescribed; do not stop taking this drug during
symptom-free periods; do not stop taking this drug without consulting your health
care provider. Continue taking any other antiasthma drugs that have been
prescribed for you. Notify your health care provider if your asthma becomes
worse.
• Do not take this drug for an acute asthma attack or acute bronchospasm; this drug
is not a bronchodilator, and routine emergency procedures should be followed
during acute attacks.
• Avoid the use of aspirin or NSAIDs if you have a known sensitivity to these
drugs. Montelukast will not prevent reactions.
• These side effects may occur: Dizziness (use caution when driving or performing
activities that require alertness if these effects occur); nausea, vomiting (eat
frequent small meals, take drug with food); headache (analgesics may be
available).
• Report fever, acute asthma attacks, flulike symptoms, lethargy.

Adverse effects in Italic are most common; those in Bold are life-threatening.