Singulair: Targeted Leukotriene Inhibition for Asthma and Allergy Control
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Synonyms
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Singulair (montelukast sodium) is a prescription leukotriene receptor antagonist (LTRA) specifically formulated for the prophylactic and chronic treatment of asthma, and for the relief of symptoms of allergic rhinitis. It represents a cornerstone in maintenance therapy for reversible airway obstruction, offering a non-steroidal mechanism that complements traditional inhaled corticosteroids. By selectively blocking cysteinyl leukotriene (CysLT) receptors, it mitigates the bronchoconstriction and inflammatory processes central to asthma pathophysiology and allergic response. This oral medication provides a convenient, once-daily dosing option for both adult and pediatric populations, supporting long-term disease management and improved quality of life.
Features
- Active pharmaceutical ingredient: Montelukast sodium
- Available in 4mg chewable, 5mg chewable, and 10mg film-coated tablet formulations
- Selective and competitive antagonist of the CysLT1 receptor
- Once-daily oral administration, typically in the evening
- Demonstrated efficacy in exercise-induced bronchoconstriction (EIB)
- Suitable for patients as young as 12 months (for asthma) and 2 years (for allergic rhinitis)
- Not indicated for the relief of acute asthma attacks
Benefits
- Reduces airway inflammation and bronchoconstriction through targeted leukotriene pathway inhibition
- Decreases frequency and severity of asthma exacerbations when used as maintenance therapy
- Provides symptomatic relief for perennial and seasonal allergic rhinitis, including reduction in nasal congestion, sneezing, and rhinorrhea
- Offers protection against exercise-induced bronchoconstriction when taken at least 2 hours prior to physical activity
- Serves as add-on therapy when inhaled corticosteroids alone provide inadequate asthma control
- Convenient oral dosing may improve adherence compared to inhaled regimens, particularly in pediatric populations
Common use
Singulair is principally indicated for the prophylaxis and chronic treatment of asthma in adults and pediatric patients 12 months of age and older. It is not a bronchodilator and should not be used for the immediate relief of acute asthma attacks. Additionally, it is approved for the relief of symptoms of allergic rhinitis (seasonal and perennial) in patients aged 2 years and older. For exercise-induced bronchoconstriction, it is indicated in patients 6 years of age and older for prevention when taken at least 2 hours before exercise. Clinical use often involves combination with inhaled corticosteroids for additive anti-inflammatory effects in moderate to severe persistent asthma.
Dosage and direction
Administration should follow healthcare provider instructions precisely. For asthma and allergic rhinitis: Adults and adolescents 15 years and older: one 10mg tablet daily. Pediatric patients 6 to 14 years: one 5mg chewable tablet daily. Pediatric patients 2 to 5 years: one 4mg chewable tablet or one 4mg oral granule packet daily. Pediatric patients 12 to 23 months (for asthma only): one 4mg granule packet daily. For exercise-induced bronchoconstriction: Patients 15 years and older: one 10mg tablet at least 2 hours before exercise; patients 6 to 14 years: one 5mg chewable tablet at least 2 hours before exercise. Do not take an additional dose within 24 hours. Tablets should be taken whole or chewed completely; granules may be administered directly in the mouth or mixed with a spoonful of cold or room temperature soft food.
Precautions
Patients should be monitored for neuropsychiatric events including agitation, aggression, depression, sleep disturbances, and suicidal ideation. These have been reported in patients taking Singulair; healthcare providers should reassess benefits and risks if such symptoms occur. Not for use in acute asthma attacks. Patients should have access to rescue medication. Caution advised in patients with phenylketonuria (chewable tablets contain aspartame). Systemic eosinophilia, sometimes presenting with clinical features of vasculitis consistent with Churg-Strauss syndrome, has been reported rarely, typically in association with the reduction of oral corticosteroid therapy. Pregnancy Category B: use only if clearly needed. Not studied in nursing women; caution advised.
Contraindications
Hypersensitivity to montelukast or any component of the formulation. Not indicated for the treatment of acute asthma attacks. Should not be used as monotherapy for the treatment and management of exercise-induced bronchospasm in patients with concomitant asthma; these patients should continue to use their inhaled corticosteroids. Not recommended in patients with severe hepatic impairment (no dose adjustment recommended for mild to moderate impairment).
Possible side effect
Common adverse reactions (≥1% and greater than placebo) include: upper respiratory infection, fever, headache, pharyngitis, cough, abdominal pain, diarrhea, otitis media, influenza, rhinorrhea, sinusitis, otitis. Serious side effects requiring immediate medical attention may include: increased eosinophils, rash, pulmonary symptoms, cardiac issues, or neuropsychiatric events (agitation, aggressive behavior, anxiety, depression, bad/vivid dreams, hallucinations, insomnia, irritability, restlessness, suicidal thinking and behavior, tremor). Allergic reactions including swelling, hives, and rash have been reported.
Drug interaction
Clinically significant drug interactions are limited. Montelukast is metabolized by CYP450 isoenzymes; potent CYP2C8 inducers (e.g., rifampin) may decrease montelukast concentrations. Phenobarbital may decrease montelukast AUC. No dosage adjustment is recommended with coadministration of these agents, but clinical response should be monitored. No clinically important interactions observed with theophylline, prednisone, prednisolone, oral contraceptives, terfenadine, digoxin, or warfarin.
Missed dose
Take the missed dose as soon as remembered. However, if it is almost time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one. Maintain the prescribed once-daily regimen.
Overdose
Experience in adults and children with doses up to 1000mg/day has been reported without clinically adverse events. In chronic asthma studies, montelukast has been administered at doses up to 200mg/day to patients for 22 weeks with no increase in adverse events. There is no specific antidote for montelukast overdose. Treatment should be symptomatic and supportive. Consider standard measures to eliminate any unabsorbed drug.
Storage
Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F). Keep in original container with dessicant to protect from moisture and light. Keep tightly closed. Granules must be used within 15 minutes of opening the packet; do not store opened packets. Keep all medications out of reach of children and pets.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Singulair is a prescription medication that must be used under the supervision of a qualified healthcare professional. Individual patient response may vary. Always follow the specific instructions provided by your prescribing physician and refer to the official prescribing information for complete details on indications, dosing, warnings, and precautions. Do not initiate or discontinue therapy without consulting your healthcare provider.
Reviews
Clinical studies demonstrate that montelukast significantly improves asthma control days and reduces beta-agonist use compared to placebo. In pediatric populations, it shows particular benefit for viral-induced wheezing phenotypes. — Journal of Allergy and Clinical Immunology
As add-on therapy to inhaled corticosteroids, montelukast provides statistically significant improvement in FEV1 and reduction in exacerbation rates. Its oral bioavailability offers advantages for adherence in certain patient subsets. — American Journal of Respiratory and Critical Care Medicine
While effective for allergic rhinitis symptoms, montelukast is generally considered second-line to intranasal corticosteroids for monotherapy. However, it provides valuable option for patients with concomitant asthma. — Annals of Allergy, Asthma & Immunology