Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Montelukast is an oral leukotriene
receptor antagonist for the treatment of
asthma and seasonal allergic rhinitis (hay fever). Leukotrienes are a group
of naturally occurring chemicals in the body that promote inflammation in asthma
and seasonal allergic rhinitis and in other diseases in which inflammation is
important (such as allergy).
They are formed by cells, released, and then bound to other cells, and it is the
binding to these other cells that stimulates the cells to promote inflammation.
Montelukast works in a manner similar to
zafirlukast
(Accolate), blocking the binding of some leukotrienes. Unlike zafirlukast,
montelukast does not inhibit CYP2C9 or CYP3A4, two enzymes in the liver that are
important in breaking down and eliminating many drugs. Therefore, unlike
zafirlukast, montelukast is not expected to affect the elimination of other
drugs. The safety and effectiveness of montelukast has been demonstrated in
children as young as 6 months of age. It was approved by the FDA in 1998.
GENERIC AVAILABLE: Yes
PRESCRIPTION: Yes
PREPARATIONS: Tablets: 10mg. Chewable tablets: 4mg and 5mg.
STORAGE: Tablets should be stored at room temperature, 15-30 C
(59-86 F).
PRESCRIBED FOR: Montelukast is used for the treatment of asthma and
seasonal allergic rhinitis. Montelukast begins working after 3 to 14 days of
therapy. Therefore, it should not be used for the treatment of an acute
asthmatic attack.
DOSING: The recommended dose of montelukast is 4, 5, or 10 mg daily.
The 4 and 5 mg tablets are used in children. Montelukast should be taken in the
evening with or without food.
DRUG INTERACTIONS: Phenobarbital increases the blood concentration
of montelukast by about 40%. Rifampin may have the same effect. Therefore, the
dose of montelukast may need to be reduced when given concurrently with these
drugs.
PREGNANCY: Montelukast crosses the placenta into the fetus following
oral administration to animals, but there have been no adequate studies in
pregnant women to determine the effects on the fetus. Physicians may prescribe
zafirlukast during pregnancy if it is felt that its benefits outweigh the
potential but unknown risks to the fetus.
NURSING MOTHERS: Studies in animals have shown that montelukast is
excreted in milk; however, it is not known if montelukast is secreted into
breast milk in humans.
SIDE EFFECTS: The most common side effects with montelukast are
headache, dizziness,
abdominal pain, sore throat,
and rhinitis (inflammation of the inner lining of the nose). These side effects
occur in 1 in 50 to 1 in 7 persons who take montelukast. Rarely, patients may
experience nose bleeds.
Allergic rhinitis symptoms include an itchy, runny nose, sneezing, itchy ears, eyes, and throat. Seasonal allergic rhinitis (also called hay fever) is usually caused by pollen in the air. Perennial allergic rhinitis is a type of chronic rhinitis and is a year–round problem, often caused by indoor allergens, such as dust, animal dander, and pollens that may exist at the time. Treatment of chronic rhinitis and post nasal drip are dependant upon the type of rhinitis condition.
Hives, also called urticaria, is a raised, itchy area of skin that is usually a sign of an
allergic reaction. The allergy may be to food or medications, but usually the
cause of the allergy (the allergen) is unknown.
Asthma is a common disorder in which
chronic inflammation of the bronchial tubes (bronchi) makes them swell, narrowing the airways. Signs and symptoms include shortness of breath, chest tightness,
cough and wheezing.
Patients who have infrequent, mild bouts of asthma attacks may use over-the-counter (OTC) medications to treat their asthma symptoms. OTC asthma medicines are limited to epinephrine and ephedrine. These OTC drugs are best used with the guidance of a physician, as there may be side effects and the drugs may not be very effective.
Asthma, the main cause of chronic illness in children, has signs and symptoms in children that include frequent coughing spells, low energy while playing, complaints of chest "hurting," wheezing while breathing, shortness of breath, and feelings of tiredness. Treatment will involve a doctor creating an asthma action plan which will describe the use of asthma medications and when to seek emergency care for the child.
Hay fever (allergic rhinitis) is an irritation of the nose caused by pollen and is associated with the following allergic symptoms: nasal congestion, runny nose, sneezing, eye and nose itching, and tearing eyes. Avoidance of known allergens is the recommended treatment, but if this is not possible, antihistamines, decongestants, and nasal sprays may help alleviate symptoms.
There are many unusual symptoms of asthma, including sighing, difficulty sleeping, anxiety, chronic cough, recurrent walking pneumonia, and rapid breathing. These symptoms may vary from individual to individual. These asthma complexities make it difficult to accurately diagnose and treat asthma.
There are two types of asthma medications: long-term control with anti-inflammatory drugs and quick relief from bronchodilators. Asthma medicines may be inhaled using a metered dose inhaler or nebulizer or they may be taken orally. People with high blood pressure, diabetes, thyroid disease, or heart disease shouldn't take OTC drugs like Primatene Mist and Bronkaid.
The cause of asthma is unknown. More is known about the abnormal conditions
that occur in asthma. These conditions include (1) hyper-responsiveness
(contraction) of the muscles of the breathing airways in response to many
stimuli such as exercise or allergies (for example, drugs, food additives, dust mites,
animal fur, and mold), (2) inflammation of the airways, (3) shedding of the
tissue lining the airways, (4) increased secretion of mucus in the airways, and
(5) swelling of the walls of the airways with fluid. All of these conditions
narrow the airways and make breathing difficult. Symptoms of asthma include
wheezing (the hallmark of asthma), coughing, difficulty breathing, and
tightness of the chest. Asthma is diagnosed by the presence of wheezing, but
it can be confirmed by breathing tests (spirometry) that evaluate the movement of air into
and out of the lungs.
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