Montelukast Disease Interactions

The use of montelukast is associated with neuropsychiatric events. Patients and prescribers should be alert for neuropsychiatric events. Care should be taken before using this agent in patients with any history of mental illness. If neuropsychiatric events occur during treatment, it is recommended to carefully evaluate the risks and benefits of continuing treatment with montelukast.

Reports of cholestatic hepatitis, hepatocellular liver-injury, and mixed-pattern liver injury have been reported in patients treated with montelukast sodium that had underlying potential for liver disease, such as alcohol use or other forms of hepatitis. Patients with mild-to-moderate hepatic insufficiency and clinical evidence of cirrhosis had evidence of decreased metabolism of montelukast. No dosage adjustment is required in patients with mild-to-moderate hepatic insufficiency. The pharmacokinetics of montelukast sodium in patients with more severe hepatic impairment or with hepatitis have not been evaluated. Use caution when prescribing montelukast to these patients.

Singulair (brand of montelukast) chewable tablets contain 0.842 mg of phenylalanine per each 5 mg tablet. The phenylalanine content should be considered when this product is used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).

Patients with asthma on therapy with montelukast may present with systemic eosinophilia, sometimes presenting with clinical features of vasculitis consistent with Churg-Strauss syndrome, a condition which is often treated with systemic corticosteroid therapy. Prescribers should be alert to eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, and/or neuropathy presenting in their patients. Care should be taken before using this agent in patients with history of pulmonary disorders.