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Generic Singulair ( Montelukast )
Singulair (montelukast sodium) is an oral leukotriene receptor antagonist indicated for the prophylaxis and chronic treatment of asthma in adults and children aged 12 months and older, and for the relief of symptoms of seasonal allergic rhinitis and perennial allergic rhinitis. Montelukast binds selectively to the cysteinyl leukotriene receptor (CysLT₁) in the airways, blocking the action of leukotrienes LTC₄, LTD₄, and LTE₄. This results in reduced airway inflammation, bronchoconstriction, mucus production, and vascular permeability. In asthma, Singulair is used as an add‑on controller in patients not adequately controlled with inhaled corticosteroids and short‑acting beta‑agonists, and may allow a reduction in the dose of inhaled corticosteroids. It is not a bronchodilator and must not be used for the relief of acute asthma attacks.
Usual adult dose: For adults and adolescents 15 years of age and older with asthma or allergic rhinitis, the recommended dose is one 10 mg tablet taken orally once daily in the evening, with or without food. For children aged 6 to 14 years, the dose is one 5 mg chewable tablet once daily in the evening. For children aged 2 to 5 years, the dose is one 4 mg chewable tablet once daily in the evening. Dosing is the same for both asthma and allergic rhinitis. When used for exercise‑induced bronchoconstriction, patients should take the prescribed dose 2 hours before exercise; a second dose within the same 24‑hour period is not recommended. Patients already taking a daily maintenance dose for asthma should not take an additional dose before exercise. No dose adjustment is required in the elderly or in patients with renal impairment.
Dosage form: Film‑coated tablets: 10 mg (beige, square‑shaped); chewable tablets: 5 mg (pink, round, cherry‑flavoured) and 4 mg (pink, oval, cherry‑flavoured). Chewable tablets contain phenylalanine (aspartame) and should be avoided in patients with phenylketonuria.
Onset of action: Improvement in asthma symptoms and lung function may be noticed within 24 hours of the first dose, with continued improvement over the first weeks of daily therapy. For allergic rhinitis, relief of nasal and ocular symptoms is typically seen within hours to days.
Duration of action: The therapeutic effect is maintained throughout a 24‑hour dosing interval, allowing for once‑daily administration. The plasma elimination half‑life of montelukast is 2.7 to 5.5 hours, but the duration of clinical effect is governed by receptor occupancy and downstream anti‑inflammatory activity.
Alcohol recommendation: No direct interaction between montelukast and alcohol is known. However, alcohol may worsen the symptoms of allergic rhinitis and gastroesophageal reflux, which can mimic or aggravate asthma symptoms. Moderation is advised.
Most common side effects: In adults, headache, abdominal pain, cough, and influenza‑like symptoms have been reported. In children, headache, abdominal pain, thirst, and hyperkinesia may occur. Rare but serious neuropsychiatric adverse events have been associated with montelukast, including agitation, aggression, depression, sleep disturbances, suicidal thoughts and behaviour, and hallucinations. Patients and caregivers should be counselled to monitor for these symptoms and to report any changes in mood or behaviour to a healthcare professional promptly. Singulair is not a rescue medication; a short‑acting bronchodilator must be available for acute asthma symptoms. Treatment with Singulair should not be used to abruptly replace inhaled or oral corticosteroids; any taper of corticosteroid therapy must be done gradually under medical supervision. Eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, and neuropathy (consistent with Churg‑Strauss syndrome) have been reported rarely, often in association with steroid withdrawal.
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