Home Drug Guide Montelukast Sodium

Drug Guide

Generic Name

Montelukast Sodium

Brand Names Singulair

Classification

Therapeutic: Anti-inflammatory, Bronchodilator adjunct in asthma and allergies

Pharmacological: Leukotriene receptor antagonist

FDA Approved Indications

  • Asthma (maintenance treatment)
  • Allergic rhinitis (seasonal and perennial)
  • Exercise-induced bronchoconstriction

Mechanism of Action

Montelukast selectively antagonizes cysteinyl leukotriene receptor CysLT1, preventing leukotrienes from binding and thereby reducing inflammation, bronchoconstriction, and mucus production.

Dosage and Administration

Adult: 10 mg once daily in the evening

Pediatric: 5 mg once daily for children 2-5 years, 10 mg for children ≥6 years

Geriatric: Same as adult, but caution in renal or hepatic impairment

Renal Impairment: Adjust dose if severe impairment, consult prescribing info

Hepatic Impairment: Use with caution; adjust dose or consider alternatives

Pharmacokinetics

Absorption: Well absorbed orally, with peak plasma concentrations in 3-4 hours

Distribution: Extensively bound to plasma proteins (~99%)

Metabolism: Minimal hepatic metabolism, primarily via CYP2C8, CYP3A4

Excretion: Feces (~86%), urine (~4%)

Half Life: Approximately 2.5 to 5.5 hours

Contraindications

  • Hypersensitivity to montelukast or any component of the formulation

Precautions

  • Use with caution in patients with liver dysfunction; neuropsychiatric events reported

Adverse Reactions - Common

  • Headache (Common)
  • Abdominal pain (Common)
  • Dizziness (Common)

Adverse Reactions - Serious

  • Neuropsychiatric events (agitation, depression, suicidal thoughts) (Uncommon but serious)
  • Churg-Strauss syndrome (vasculitis) (Rare)

Drug-Drug Interactions

  • Phenobarbital (may decrease montelukast levels)
  • Phenylephrine (increased risk of hypertension)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor asthma control, liver function, neuropsychiatric status

Diagnoses:

  • Ineffective airway clearance
  • Risk for injury related to adverse neuropsychiatric effects

Implementation: Administer orally; educate about possible neuropsychiatric symptoms; monitor liver function tests periodically

Evaluation: Assess symptom control and side effects regularly

Patient/Family Teaching

  • Take exactly as prescribed, consistently in the evening
  • Report any mood changes, agitation, depression or suicidal thoughts immediately
  • Do not stop medication abruptly without consulting healthcare provider
  • Inform about potential neuropsychiatric side effects

Special Considerations

Black Box Warnings:

  • Neuropsychiatric events such as agitation, aggression, anxiety, depression, sleep disturbances, and suicidal thoughts have been reported

Genetic Factors: No specific genetic tests required

Lab Test Interference: None known

Overdose Management

Signs/Symptoms: Nausea, vomiting, hypersensitivity

Treatment: Supportive care; activated charcoal if ingestion is recent; no specific antidote

Storage and Handling

Storage: Store at 20-25°C (68-77°F), protected from moisture and heat

Stability: Stable for the duration of the labeled shelf life

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.