Nurses Compass
Drug Guide
Montelukast Sodium
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/ADrug-Herb Interactions
N/ANursing 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