Montelukast adverse effects

Neuropsychiatric Neuropsychiatric side-effects of montelukast have been discussed extensively previously [SEDA-35, 320]. A review of French, Swedish, Spanish, and North American pharmacovigilance registries included 851 psychiatric adverse effects [83 ]. The neuropsychiatric side-effects represented 20% of all adverse effects attributed to montelukast. The most frequently occurring neuropsychiatric side-effects among them were sleep disorders, behavioral disorders, depression, and suicidality, which included suicidal ideation, suicidal attempts, and suicides. 

A case series of four males between 8 and 14 years old receiving montelukast with neuropsychiatric adverse effects was presented Side-effects included headache, behavioral changes, aggressiveness, autolytic ideation and night... 

The adverse effect profile of roflmnilast has been described previously. However, new data became available recently. A systematic review smnmarised the available data on adverse effects and drug reactions of roflmnilast. This systematic review was based on six clinical trials with a total population of 9102 COPD patients, with the study duration ranging between 24 and 52 weeks [89 ]. Roflmnilast is metabolised by CYP 3A4, CYP 2C19 and CYP 1A2. Inhibitors of these enzymes such as erythromycin or ketoconazole were shown to increase the activity and half-life of roflumilast. In contrast, drugs that induced these enzymes, like rifampicin, had the opposite effect, reducing the activity and half-life of roflumilast. Roflumilast did not significantly interact with montelukast, budesonide, or antacids. 

Aypak C, Turedi O Solmaz N, Yikilkan H, GorpeUoglu S. Arare adverse effect of montelukast treatment ecchymosis. Respir Care September... 

Administration of zafirlukast and aspirin increases plasma levels of zafirlukast, When zafirlukast is administered with warfarin, there is an increased effect of the anti coagulant. Administration of zafirlukast and theophylline or erythromycin may result in a decreased level of zafirlukast. Administration of montelukast with other drugs has not revealed any adverse responses. Administration of montelukast with aspirin and NSAIDs is avoided in patients with known aspirin sensitivity. Administration of zileuton with propranolol increases the activity or the propranolol with theophylline increases serum theophylline levels and with warfarin may increase prothrombin time (PT). A prothrombin blood test should be done regularly in the event dosages of warfarin need to be decreased. 

A further review of three randomized controlled trials showed no evidence of a negative effect of montelukast on emotional wellbeing, using quality of life rather than indices of depression [107 ]. However, the studies that were included in these reviews were not originally designed to assess suicidahty or behavior-related adverse events. The authors also pointed out that sufferers of asthma and atopy have a higher than usual incidence of psychological morbidity, and that such reports are not unexpected. 

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