Montelukast for allergic rhinitis

Montelukast is a leukotriene receptor antagonist that is usually only used in combination with an antihistamine and an intranasal corticosteroid. It may have a role in patients with intermittent allergic rhinitis that occurs seasonally who also have asthma, because it is beneficial for both conditions. In children with asthma, it may be first-line therapy before intranasal corticosteroids. Montelukast can be trialled in patients who do not respond adequately to other treatments; however, progressing to allergen immunotherapy is more likely to be effective in these patients.

If considered appropriate, use:

Neuropsychiatric adverse effects (eg behavioural changes, depression, suicidality) have been reported in all age groups taking montelukast. Adverse effects are generally mild and may be coincidental; however, symptoms may be serious and continue if treatment is not stopped. Advise patients, parents and carers to be alert for changes in behaviour and new psychiatric symptoms. Stop treatment if these effects occur. In some cases, symptoms may persist after stopping treatment; patients should be monitored and provided supportive care until symptoms resolve. See the Australian Therapeutic Goods Administration (TGA) safety alert for more information.