Montelukast

Leukotriene Receptor Antagonist·Respiratory - Asthma & COPD

Prophylaxis and chronic treatment of asthma, symptomatic relief of seasonal allergic rhinitis

Authority requiredPBSLTRASingulair, Lukair10 mg tablet+2

Max Dose

10 mg/day

Half-life

3-5 h

Psych Risk

BLACK BOX

Freq

NOCTE

Rapid Summary

Overview

Oral leukotriene receptor antagonist. An add-on therapy for asthma and allergic rhinitis, particularly effective in exercise-induced or aspirin-exacerbated asthma.

Maximum Dose

Max 10 mg/day.

Clinical Focus

Black Box Warning for severe neuropsychiatric side effects (suicidality, nightmares, agitation), especially in children/adolescents.

Bottom Line

Montelukast is a useful add-on for exercise-induced and allergic asthma, but carries an FDA black box warning for neuropsychiatric events including suicidality.

Formulation & Access

Brand Names

Singulair, Lukair

Oral Routes

Tablets (10 mg). Chewable tablets (4 mg, 5 mg).

Prescribing & PBS

Authority Required (PBS) for chronic asthma.

Indications & Use

Primary

PBSTGA

Prophylaxis and chronic treatment of asthma, symptomatic relief of seasonal allergic rhinitis.

Clinical Place

Second- or third-line add-on to ICS. Exceptionally useful in patients whose asthma is heavily triggered by allergies, cold air, or NSAIDs.

Quick reference

Class & Role

Leukotriene Receptor Antagonist — Oral leukotriene receptor antagonist.

Route / Formulation

Tablets (10 mg). Chewable tablets (4 mg, 5 mg). (Singulair, Lukair)

Usual Dose & Max

PO 10 mg NOCTE. Max 10 mg/day.

Key Indication Doses

Asthma (Adults): PO 10 mg NOCTE. Asthma (Children 6-14): PO 5 mg chewable tablet NOCTE. Asthma (Children 2-5): PO 4 mg chewable tablet NOCTE.

Best Uses

Montelukast is a useful add-on for exercise-induced and allergic asthma, but carries an FDA black box warning for neuropsychiatric events including suicidality.

Avoid / Cautions

Not for acute bronchospasm. Pregnancy Category B1.

Key Risks

Neurological: Neuropsychiatric events: agitation, aggressive behavior, dream abnormalities, hallucinations, depression, suicidal ideation. Gastrointestinal: Mild GI upset. Immunological: RARE — Churg-Strauss syndrome (eosinophilic granulomatosis with polyangiitis).

Key Interactions

Phenytoin and phenobarbital can induce CYP enzymes and reduce montelukast levels.

Monitoring

Warn parents/patients strictly to monitor for mood changes, horrific nightmares, or behavioral shifts within the first weeks of therapy. No specific routine laboratory tests required.

Clinical Pearl

Should ideally be taken in the evening (NOCTE) to match the circadian rhythm of leukotriene release, which naturally peaks overnight and causes early-morning asthma symptoms.

Access

Authority requiredSingulair, Lukair10 mg tablet

Brand: Singulair, Lukair
PBS status: Authority required
Formulation: Tablets (10 mg)

Montelukast

Leukotriene Receptor Antagonist·Respiratory - Asthma & COPD

Prophylaxis and chronic treatment of asthma, symptomatic relief of seasonal allergic rhinitis

Authority requiredPBSLTRASingulair, Lukair10 mg tablet+2

Max Dose

10 mg/day

Half-life

3-5 h

Psych Risk

BLACK BOX

Freq

NOCTE

Rapid Summary

Overview

Oral leukotriene receptor antagonist. An add-on therapy for asthma and allergic rhinitis, particularly effective in exercise-induced or aspirin-exacerbated asthma.

Maximum Dose

Max 10 mg/day.

Clinical Focus

Black Box Warning for severe neuropsychiatric side effects (suicidality, nightmares, agitation), especially in children/adolescents.

Bottom Line

Montelukast is a useful add-on for exercise-induced and allergic asthma, but carries an FDA black box warning for neuropsychiatric events including suicidality.

Formulation & Access

Brand Names

Singulair, Lukair

Oral Routes

Tablets (10 mg). Chewable tablets (4 mg, 5 mg).

Prescribing & PBS

Authority Required (PBS) for chronic asthma.

Indications & Use

Primary

PBSTGA

Prophylaxis and chronic treatment of asthma, symptomatic relief of seasonal allergic rhinitis.

Clinical Place

Second- or third-line add-on to ICS. Exceptionally useful in patients whose asthma is heavily triggered by allergies, cold air, or NSAIDs.

Quick reference

Class & Role

Leukotriene Receptor Antagonist — Oral leukotriene receptor antagonist.

Route / Formulation

Tablets (10 mg). Chewable tablets (4 mg, 5 mg). (Singulair, Lukair)

Usual Dose & Max

PO 10 mg NOCTE. Max 10 mg/day.

Key Indication Doses

Asthma (Adults): PO 10 mg NOCTE. Asthma (Children 6-14): PO 5 mg chewable tablet NOCTE. Asthma (Children 2-5): PO 4 mg chewable tablet NOCTE.

Best Uses

Montelukast is a useful add-on for exercise-induced and allergic asthma, but carries an FDA black box warning for neuropsychiatric events including suicidality.

Avoid / Cautions

Not for acute bronchospasm. Pregnancy Category B1.

Key Risks

Key Interactions

Phenytoin and phenobarbital can induce CYP enzymes and reduce montelukast levels.

Monitoring

Warn parents/patients strictly to monitor for mood changes, horrific nightmares, or behavioral shifts within the first weeks of therapy. No specific routine laboratory tests required.

Clinical Pearl

Should ideally be taken in the evening (NOCTE) to match the circadian rhythm of leukotriene release, which naturally peaks overnight and causes early-morning asthma symptoms.

Access

Authority requiredSingulair, Lukair10 mg tablet

Brand: Singulair, Lukair
PBS status: Authority required
Formulation: Tablets (10 mg)