Montelukast & Neuropsychiatric Adverse Events

MONTELUKAST & NEUROPSYCHIATRIC ADVERSE EVENTS

Neuropsychiatric Adverse Events from Non-Psychiatric Medications

BY DR. HARVINDER SINGH

Montelukast is indicated for the treatment of:

  1. Prophylaxis and chronic treatment of asthma (adults and pediatric patients 12 months of age and older).
  2. Prevention of exercise-induced bronchoconstriction (15 years of age and older).
  3. Allergic rhinitis (seasonal allergic rhinitis in adults and pediatric patients 2 years of age and older, and perennial allergic rhinitis in adults and pediatric patients 6 months of age and older).

On March 4, 2020, FDA strengthened existing warnings about serious behavior and mood-related changes with montelukast.

Our course chapter will discuss the details of montelukast’s neuropsychiatric adverse events in the following sections:

  1. Neuropsychiatric side effects reported with the use of Montelukast.
  2. Mechanism Underlying Neuropsychiatric Side Effects.
  3. Is History of Psychiatric Disorder a Risk Factor?
  4. When to Avoid Montelukast Use?
  5. Reserve Montelukast Use for which medical conditions?
  6. Clinical Recommendations.
  7. Do Neuropsychiatric Symptoms resolve on Montelukast Discontinuation?

Reference:

  • FDA Drug Safety Information: FDA requires Boxed Warning about serious mental health side effects for asthma and allergy drug montelukast (Singulair); advises restricting use for allergic rhinitis. (FDA Communication)
  • Singulair Package Insert (PDF)

LECTURE SERIES:

NON-PSYCHIATRIC MEDICATIONS: NEUROPSYCHIATRIC ADVERSE EVENTS

(1) STEROIDS

  • What is the dose equivalency among steroids?
  • What doses of steroids are known for cause these psychiatric symptoms?
  • How long does it take from initiation of steroid to development of neuropsychiatric manifestations?
  • How long does it take for patient to recover?
  • How do you manage these neuropsychiatric symptoms?

(2) INTERFERON

  • Does prophylactic treatment with antidepressant prevent future episodes of depression?
  • Does type of Interferon (PEG Interferon a2a and 2b) affects this prophylactic SSRI response?
  • Which SSRI should be considered for prophylactic treatment?
  • Which risk factors are predictive variables of major depression episode during interferon treatment.

(3) LEVETIRACETAM

  • Behavioral symptoms associated with Levetiracetam.
  • Risk factors.
  • Treatment options.

(4) ISOTRETINOIN

  • Behavioral symptoms associated with Isotretinoin.
  • Management options.

(5) FLUOROQUINOLONES

  • Serious central nervous system side effects.
  • Risk factors.
  • Clinical tips.

(6) MEFLOQUINE

  • Neurological and psychiatric side effects
  • Clinical recommendations.

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