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:
- Prophylaxis and chronic treatment of asthma (adults and pediatric patients 12 months of age and older).
- Prevention of exercise-induced bronchoconstriction (15 years of age and older).
- 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:
- Neuropsychiatric side effects reported with the use of Montelukast.
- Mechanism Underlying Neuropsychiatric Side Effects.
- Is History of Psychiatric Disorder a Risk Factor?
- When to Avoid Montelukast Use?
- Reserve Montelukast Use for which medical conditions?
- Clinical Recommendations.
- 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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