Respiratory/Leukotriene receptor antagonist

Montelukast (LTRA)

also: leukotriene receptor antagonist · LTRA

Overview

Oral add-on in asthma — useful with an allergic/exercise component. The neuropsychiatric warning is a recent MHRA point.

Mechanism

Antagonist at the cysteinyl-leukotriene-1 receptor → blocks leukotriene-mediated bronchoconstriction and inflammation. Oral (useful when inhaler adherence is poor).

Indications

Asthma add-on (per NG245 ladder)
Exercise-induced / allergic rhinitis–associated asthma

Adverse effects

Neuropsychiatric effects (sleep disturbance, mood/behaviour change, nightmares)serious

MHRA warning — counsel patients/parents.

Headache, GI upsetcommon

Churg-Strauss / eosinophilic granulomatosis (rare)common

Cautions & contraindications

Monitor for mood/behaviour changepaediatric

Neuropsychiatric effects (esp. children).

Interactions

Monitoring & kinetics

Mood/behaviour; asthma control

Oral, evening. Add-on per the asthma ladder.

Choosing it

true

Source: NICE NG245 — Asthma · BNF — Montelukast