Montelukast

Montelukast remains among the top 25 most common medicines with in excess of 25 million prescriptions each year.   In spite of its popularity, montelukast regularly fails to provide sufficient advantages to warrant its use.  Supposedly it improves symptoms of asthma and nasal allergies but studies suggest monetlukast and placebo may offer about the same degree of relief.

Accepted international guidelines fail to list montelukast as a preferred treatment for asthma and the American Academy of Allergy, Asthma and Immunology suggests not offering montelukast for allergic rhinitis.  

In addition to its overall lack of effect, montelukast may cause significant neuropsychiatric adverse reactions.  Postmarketing reports identify agitation, aggressive behavior, hostility, depression, disorientation, irritability, memory impairment and abnormal dreams.  Although initially approved in 1998, it took until March 4, 2020 for the FDA to require stronger warnings about montelukast.

Prior to prescribing montelukast, doctors are now urged to inquire about prior psychiatric problems and direct patients to read the accompanying medication guide.  Patients should be cautioned about the neuropsychiatric associations and advised to immediately discontinue montelukast and contact their healthcare worker should symptoms develop.

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