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# Montelukast/Levocetirizine
## Overview
Montelukast is a leukotriene receptor antagonist used for asthma and allergic rhinitis. Levocetirizine is a second-generation antihistamine used for allergic rhinitis and chronic urticaria. This combination is indicated for the relief of symptoms associated with allergic rhinitis.
## Primary Indications
* Allergic rhinitis (seasonal and perennial).
## Adult Dosing
The typical adult dose is Montelukast 10 mg / Levocetirizine 5 mg orally once daily.
## Pediatric Dosing
* **Ages 6 months to 5 years:** Montelukast 4 mg / Levocetirizine 1.25 mg orally once daily.
* **Ages 6 to 11 years:** Montelukast 5 mg / Levocetirizine 2.5 mg orally once daily.
* **Ages 12 years and older:** Montelukast 10 mg / Levocetirizine 5 mg orally once daily.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised.
## Contraindications
* Hypersensitivity to montelukast, levocetirizine, its active enantiomer, or any of its inactive ingredients.
* Severe hepatic impairment (Child-Pugh C).
## Adverse Effects
Common adverse effects include somnolence, fatigue, upper respiratory tract infection, cough, fever, diarrhea, nasal congestion, rash, and pruritus. Neuropsychiatric events (e.g., hallucinations, insomnia, suicidal thoughts) have been reported with montelukast, though causality is not always established.
## Key Drug Interactions
* **Theophylline:** Montelukast may decrease theophylline concentrations; monitor theophylline levels.
* **CNS Depressants (e.g., sedatives, hypnotics, opioids):** Additive CNS depressant effects may occur with levocetirizine; use caution.
* **Ritonavir:** May increase montelukast plasma concentrations.
## Monitoring
* Monitor for efficacy in symptom control.
* Monitor for adverse effects, particularly neuropsychiatric changes for montelukast and somnolence for levocetirizine.
## Clinical Pearls
* This combination should not be used for acute bronchospasm.
* Montelukast should not replace inhaled or oral corticosteroids.
* While somnolence is less common with levocetirizine than cetirizine, it can still occur.
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**Disclaimer:** This information is intended for healthcare professionals and is a summary. Always consult the most current prescribing information and relevant literature before making clinical decisions. Dosing may vary based on patient-specific factors and local protocols.
