Montelukast Powerful Action, and its Uses in Urdu

Introduction

Montelukast is a medication primarily used to manage and prevent symptoms of asthma and allergic rhinitis. It belongs to a class of medicines called leukotriene receptor antagonists.

Montelukast is a prescription medication that works by blocking leukotrienes, chemicals in the body that contribute to inflammation, bronchoconstriction, and mucus production. By blocking the action of leukotrienes, Montelukast helps in reducing the frequency and intensity of asthma attacks and alleviates symptoms of allergic rhinitis.

Mechanism of Action

Montelukast works by targeting and blocking specific receptors in the body known as leukotriene receptors. Leukotrienes are lipid compounds that play a crucial role in the inflammatory response associated with asthma and allergies. By inhibiting these receptors, Montelukast reduces inflammation, prevents bronchoconstriction, and decreases mucus production, leading to an overall improvement in respiratory function.

Montelukast Uses

Montelukast is prescribed by doctors for the following health conditions:

Asthma

Montelukast is primarily prescribed for the management of asthma. It helps in reducing the number and severity of asthma attacks by improving lung function and decreasing inflammation in the airways. It is typically used as a long-term control medication, rather than for immediate relief of acute asthma attacks.

Allergic Rhinitis

Allergic rhinitis, commonly known as hay fever, is another condition effectively treated by Montelukast. It alleviates symptoms such as sneezing, runny nose, nasal congestion, and itching. Montelukast is particularly beneficial for individuals who do not respond well to antihistamines or corticosteroids.

Exercise-Induced Bronchoconstriction

Exercise-induced bronchoconstriction (EIB) is a condition where physical exertion triggers airway constriction, leading to difficulty breathing. Montelukast can be used to prevent EIB, making it a valuable option for athletes and physically active individuals.

Montelukast Uses in Urdu

دمہ

یہ بنیادی طور پر دمہ کے انتظام کے لیے تجویز کیا جاتا ہے۔ یہ پھیپھڑوں کے کام کو بہتر بنا کر اور ایئر ویز میں سوزش کو کم کرکے دمہ کے حملوں کی تعداد اور شدت کو کم کرنے میں مدد کرتا ہے۔ یہ عام طور پر دمہ کے شدید حملوں کی فوری امداد کے بجائے ایک طویل مدتی کنٹرول دوا کے طور پر استعمال ہوتی ہے۔

الرجی (گھاس بخار)

الرجک ناک کی سوزش، جسے عام طور پر گھاس بخار کے نام سے جانا جاتا ہے، ایک اور حالت ہے جس کا اس دوا سے مؤثر طریقے سے علاج کیا جاتا ہے۔ یہ چھینک، ناک بہنا، ناک بند ہونا اور خارش جیسی علامات کو دور کرتا ہے۔ مونٹیلوکاسٹ خاص طور پر ان افراد کے لیے فائدہ مند ہے جو اینٹی ہسٹامائنز یا کورٹیکوسٹیرائڈز کے لیے اچھا ردعمل نہیں دیتے۔

ورزش سے متاثرہ برونکو کنسٹرکشن

ورزش کی وجہ سے برونکو کنسٹرکشن ایک ایسی حالت ہے جہاں جسمانی مشقت سے سانس لینے میں دشواری ہوتی ہے، جس سے سانس لینے میں دشواری ہوتی ہے۔ اس کا استعمال ورزش کی حوصلہ افزائی سے ہونے والی برونکو کنسٹرکشن کو روکنے کے لیے کیا جاتا ہے، جو اسے کھلاڑیوں اور جسمانی طور پر فعال افراد کے لیے ایک قابل قدر آپشن بناتا ہے۔

Dosage and Administration

Montelukast is available in tablet form, including regular tablets, chewable tablets, and granules. The dosage varies based on the age and condition of the patient:

• Adults and teenagers (ages 15 and up): Take 10 mg once a day in the evening.
• Children (6 to 14 years): 5 mg chewable tablet once daily in the evening.
• Children (2 to 5 years): 4 mg chewable tablet or granules once daily in the evening.

To prevent exercise-induced bronchoconstriction, a single dose should be taken at least 2 hours before exercise. It should not be used again within 24 hours if taken for this purpose.

Benefits of Montelukast

Montelukast offers several benefits for individuals suffering from asthma and allergic rhinitis:

• Improved Breathing: By reducing airway inflammation and constriction, this drug helps patients breathe more easily.
• Reduced Symptoms: It effectively minimizes symptoms such as wheezing, coughing, and nasal congestion.
• Convenience: As a once-daily medication, Montelukast is convenient for patients, enhancing adherence to the treatment regimen.
• Prevention of Symptoms: It helps in preventing asthma attacks and allergic reactions, thereby improving the quality of life.
• Non-Sedative: Unlike some antihistamines, it does not cause drowsiness, making it suitable for daytime use.

Approval and Usage Statistics

In 1998, the US FDA authorized the use of montelukast for medicinal purposes. It is available as a generic medication. In 2021, it ranked as the fourteenth most commonly prescribed medication in the United States, with over 30 million prescriptions.

Potential Side Effects

Like all medications, Montelukast may cause side effects, although not everyone experiences them. Common side effects include:

• Headache
• Abdominal pain
• Cough
• Diarrhea
• Fever

Less common but more serious side effects can include:

• Mood changes (e.g., agitation, aggression, depression)
• Suicidal thoughts or actions
• Tremors
• Allergic reactions (e.g., rash, swelling, anaphylaxis)

In case of any serious adverse effects, it’s imperative to promptly seek medical attention.

Precautions and Contraindications

Before starting Montelukast, it is essential to consider certain precautions:

• Hypersensitivity: Individuals with known hypersensitivity to Montelukast or any of its components should avoid using this medication.
• Psychiatric Disorders: Patients with a history of psychiatric disorders should use this drug with caution due to the potential for mood changes and other psychological effects.
• Liver Function: This medication is metabolized in the liver, so patients with liver impairment should use it cautiously and under close medical supervision.

Drug Interactions

Montelukast can interact with other medications, which may affect its efficacy or increase the risk of adverse effects. Some notable interactions include:

• Phenobarbital: This medication can reduce the effectiveness of Montelukast by increasing its metabolism.
• Rifampin: Like phenobarbital, rifampin can also decrease the plasma concentration of Montelukast.
• Warfarin: While Montelukast does not significantly affect the anticoagulant effect of warfarin, close monitoring of INR levels is recommended.

To prevent any interactions, always let your healthcare provider know about all of the medications and supplements you take.

Use in Specific Populations

Pregnancy and Lactation

Montelukast is classified as a pregnancy category B drug, indicating that there is no evidence of harm to the fetus in animal studies, but adequate and well-controlled studies in pregnant women are lacking. Therefore, it should only be used during pregnancy if needed.

There is limited data on the excretion of Montelukast in human milk. Caution should be exercised when administering Montelukast to nursing mothers.

Pediatrics

It is approved for use in children aged 6 months and older for the treatment of allergic rhinitis and 12 months and older for asthma. The chewable tablets and granule formulations make it easier for pediatric use.

Geriatrics

There is no need for dose adjustment in elderly patients, but it is always important to monitor for any increased sensitivity or adverse reactions in this population.

FDA Investigation

Initial Review and Findings (2009)

In June 2009, the U.S. Food and Drug Administration (FDA) completed a review of the potential neuropsychiatric side effects associated with leukotriene modulator drugs, including Montelukast. Clinical trials indicated only an increased risk of insomnia, but post-marketing surveillance revealed a possible link to more severe neuropsychiatric side effects such as suicidal behavior, agitation, aggression, anxiousness, dream abnormalities, hallucinations, depression, irritability, restlessness, and tremors.

Pediatric Advisory Committee Review (2019)

In September 2019, the Pediatric Advisory Committee and the Drug Safety and Risk Management Advisory Committee convened to conduct a pediatric-focused safety review of neuropsychiatric events linked to Montelukast.

Boxed Warning Requirement (2020)

By March 2020, in response to an increase in reported neuropsychiatric events, the FDA mandated a boxed warning for Montelukast to highlight the risk of these events. The warning advises healthcare providers to avoid prescribing Montelukast to patients with mild symptoms, particularly those with allergic rhinitis since there are many other safe and effective medications available for managing this condition.

Data Analysis and Findings

The FDA’s analysis compared self-reported case data and found no statistically significant increase in the risk of new-onset neuropsychiatric disorders associated with Montelukast compared to inhaled corticosteroids.

The analysis further indicated that there were no significant risks among various demographic groups, including males, females, patients aged 12 years and older, and those with a psychiatric history.

Interestingly, the data suggested that Montelukast use was significantly associated with a decreased risk of treated outpatient depressive disorder, including among patients with a psychiatric history, adolescents (12 to 17 years), adults (18 years and older), and across both genders. “Treated outpatient depressive disorder” refers to patients who sought treatment specifically for depressive disorders in outpatient psychiatric settings.

Montelukast vs. Other Asthma Medications

Montelukast is one of several medications available for asthma management. Here’s how it compares to some common alternatives:

• Inhaled Corticosteroids (ICS): ICS are the cornerstone of asthma treatment. They are effective in reducing inflammation but may have side effects such as oral thrush. Montelukast can be used in conjunction with ICS for better control.
• Short-Acting Beta-Agonists (SABAs): SABAs, like albuterol, are used for quick relief of acute symptoms. Montelukast is not suitable for immediate relief but is effective for long-term control.
• Long-Acting Beta-Agonists (LABAs): LABAs are often combined with ICS for long-term control. Montelukast can be an alternative for patients who cannot tolerate LABAs.
• Theophylline: An older medication with a narrow therapeutic window and potential for serious side effects, theophylline is less commonly used today. Montelukast offers a safer profile with fewer side effects.

Brands in Pakistan

Montelukast is sold under various brands names some popular brands include:

• Myteka is manufactured by Hilton Pharma.
• Aireez is manufactured by Pharmevo Pharmaceuticals.
• Aerokast is manufactured by Barrett Hodgson Pakistan (Pvt.) Ltd
• Beasy is manufactured by Bosch Pharmaceuticals company.
• MNTK  is manufactured by Macter International Ltd.
• Montika is manufactured by Sami Pharmaceutical.
• Freehale is manufactured by High-Q Pharma.
• Asthiven is manufactured by Scilife Pharma (Pvt) Ltd.

Conclusion

Montelukast is a versatile and effective medication for managing asthma and allergic rhinitis. Its ability to block leukotrienes makes it a valuable tool in controlling inflammatory responses associated with these conditions. While generally well-tolerated, patients need to be aware of potential side effects and interactions with other medications. As research continues, its role in treating other conditions may expand, offering hope for broader therapeutic applications.

By understanding the mechanisms, benefits, and considerations associated with this medicine, patients, and healthcare providers can make informed decisions to optimize treatment outcomes. Always consult with a healthcare professional before starting or adjusting any medication regimen.