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# Tab Montel L (montelukast)
## Overview
Montelukast is a selective, competitive leukotriene receptor antagonist (LTRA) that inhibits the cysteinyl leukotriene receptor (CysLT1). It is used for the maintenance treatment of asthma and the relief of symptoms of allergic rhinitis.
## Primary Indications
* Prophylaxis and chronic treatment of asthma.
* Prevention of exercise-induced bronchoconstriction (EIB).
* Relief of symptoms of seasonal and perennial allergic rhinitis.
## Adult Dosing
* **Asthma/Allergic Rhinitis:** 10 mg orally once daily in the evening.
* **Exercise-Induced Bronchoconstriction:** 10 mg orally at least 2 hours before exercise. Do not take an additional dose within 24 hours.
## Pediatric Dosing
* **6 months to 5 years:** 4 mg (oral granules or chewable tablet) once daily in the evening.
* **6 years to 14 years:** 5 mg (chewable tablet) once daily in the evening.
* **15 years and older:** 10 mg (film-coated tablet) once daily in the evening.
## Dose Adjustments
* **Renal Impairment:** No dosage adjustment necessary.
* **Hepatic Impairment:** No dosage adjustment necessary for mild to moderate impairment. Use caution in severe hepatic impairment (clinical data is limited).
## Contraindications
* Hypersensitivity to montelukast or any component of the formulation.
## Adverse Effects
* **Common:** Upper respiratory infection, fever, headache, pharyngitis, cough, abdominal pain, diarrhea.
* **Serious (Black Box/Warning):** Serious neuropsychiatric events, including agitation, aggression, depression, sleep disturbances, suicidal ideation, and suicide. If these occur, discontinue the medication.
## Key Drug Interactions
* **CYP Inducers (e.g., phenobarbital, rifampin):** May decrease montelukast plasma concentrations. Monitor for loss of asthma control.
* **Gemfibrozil:** May significantly increase systemic exposure to montelukast. Monitor for increased adverse effects.
## Monitoring
* Monitor for asthma control and relief of allergic rhinitis symptoms.
* Monitor for neuropsychiatric changes (behavioral/mood changes).
* Monitor for signs of Churg-Strauss syndrome (systemic eosinophilia, vasculitic rash, worsening pulmonary symptoms, or cardiac complications), though rare.
## Clinical Pearls
* Montelukast is **not** indicated for the treatment of acute asthma attacks (rescue therapy). Patients should always have a fast-acting beta-agonist available.
* Oral granules can be administered directly in the mouth, dissolved in 5 mL of cold/room temperature baby formula or breast milk, or mixed with a spoonful of cold/room temperature soft foods (e.g., applesauce, carrots, rice, ice cream). Must be used within 15 minutes of opening the packet.
* The FDA issued a boxed warning regarding serious neuropsychiatric events; clinicians should weigh the benefits against the risks, especially for mild allergic rhinitis where alternative therapies (e.g., intranasal corticosteroids) may be safer.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice and local protocols vary. Always verify current prescribing information, contraindications, and drug interactions through official sources such as the FDA-approved label or institutional pharmacy references before prescribing or administering medication.
