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Drug Alerts:

On July 12, 2018, the Australian Therapeutic Products Authority announced plans to adopt new risk management measures for the “famous” leukotriene receptor antagonist montelukast.

– There is a known association between montelukast and neuropsychiatric events (such as excitement, sleep disorders, and depression), including suicidal ideation and behavior in rare cases.

 

Literature report:

Child, male, 5 years old. For bronchial asthma, give montelukast sodium chewable tablets (once once a day, 5mg each time, take it at night), procaterol tablets (oral), budesonide (halogenated inhalation), terbutaline (halogen inhalation) ) and other medications.

Two days after the medication, the child’s cough and asthma were alleviated, but the child had mental abnormalities such as laughing, shouting, beating, and biting. The montelukast sodium chewable tablets were suspended, the other treatments remained unchanged, and the mental symptoms disappeared after 2 days. The oral administration of montelukast sodium 5 mg was given again, and the child had symptoms of psychosis again that night.

 

The drug product manual has a warning:

Montelukast has a mild side effect and usually does not require termination of treatment. Common adverse reactions include headache, thirst, abdominal pain, and diarrhea.

Serious neuropsychiatric adverse events found after marketing include: dizziness, lethargy, paresthesia, epilepsy; tremors, night dream abnormalities, loss of direction perception, aggressive behavior, suicidal thoughts and behaviors.

– Montelukast sodium can pass the blood-brain barrier. Some researchers believe that the combination of montelukast sodium and cysteine ​​leukotriene receptors produces nitric oxide, which is toxic to brain tissue.

 

The difference between 5mg and 4mg of Montelukast:

Commonly used montelukast has three dosage forms: montelukast tablets, montelukast chewable tablets, and montelukast particles.

The montelukast sodium chewable tablets are available in 5mg and 4mg sizes. 2~5 years old patients: once daily, 4mg each time; 6~14 years old patients: once daily, 5mg each time.

– Montelukast is rapidly absorbed after oral administration, plasma concentration peak time is 2 hours, half-life is about 2.7 ~ 5.5 hours; plasma concentration increases with increasing dose.

——Beginning to take montelukast, or to increase the dose, you need to pay attention to observe whether there are neurological and mental abnormalities, especially in children (medication).

 

Use Montelukast:

1. Montelukast can alleviate asthma symptoms, improve lung function, reduce the deterioration of asthma, but the anti-inflammatory effect is not as good as inhaled glucocorticoids;

2. The current evidence does not support the use of montelukast in the treatment of acute bronchiolitis in infants;

3. Some small studies have reported that montelukast may be effective in treating eczema. Some large studies have shown that montelukast is no different from placebo.

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