Montelukast — पूरा Clinical Guide (कब, कैसे, किसलिए, डोज़, टेस्ट, डायट & सावधानियाँ)
Montelukast (LTRA) का MBBS/MD स्तर पर विस्तृत सार — mechanism, indications, adult/pediatric dosing, pathology tests, interactions, supportive medicines और dietary सलाह सहित।
Contents — Quick Jump
क्या है (Definition) • कैसे काम करता है (MOA) • कब उपयोग करें (When to use) • किस-किस बीमारियों में • डोज़/दिया कैसे जाए • पैथोलॉजी टेस्ट • सहायक दवाइयाँ • आहार/परहेज • साइड इफेक्ट्स/सावधानियाँ • FAQ
क्या है — Definition
Montelukast sodium एक oral leukotriene receptor antagonist (LTRA) है। यह cysteinyl leukotriene (LTC4/LTD4/LTE4) के प्रभावों को रोककर airway bronchoconstriction, mucus secretion और leukocyte recruitment को कम करता है।
Brand example: Singulair (ब्रांड के अनुसार अलग)।
Mechanism of action & Pathogenesis (क्यों और कैसे काम करती है)
Allergic/inflammatory stimulus पर leukotrienes (Arachidonic acid pathway के downstream mediators) बनते हैं। ये CysLT1 रिसेप्टर पर कार्य करके:
- ब्रोंकोकंस्ट्रिक्शन बढ़ाते हैं
- ब्रोंकियल सॉमथ मसल hyperreactivity को बढ़ाते हैं
- एडिमा/वेस्कुलर परमीएबिलिटी बढ़ाते हैं
- इंसुल्यूशन: eosinophil recruitment बढ़ाते हैं
Montelukast CysLT1 receptor को competitive रूप से ब्लॉक करके इन प्रभावों को रोकता है — long-term airway inflammation और nocturnal symptoms में सुधार होता है।
कब इस्तेमाल होता है — Clinical Indications (When to use)
Primary roles:
- Chronic asthma (maintenance) — especially as add-on to inhaled corticosteroid (ICS) in mild–moderate disease or as alternative when ICS not tolerated/acceptable.
- Exercise-induced bronchospasm (EIB) — prophylactic benefit.
- Allergic rhinitis — adjunct to intranasal steroid/antihistamine or monotherapy in selected patients.
- Aspirin-exacerbated respiratory disease (AERD) — leukotriene-driven disease phenotype benefits from LTRA.
- Off-label/adjunct: atopic dermatitis support, chronic cough with leukotriene component (case-by-case).
Montelukast is not for acute bronchospasm — use rescue inhaler (SABA) for acute attacks.
किस-किस बीमारियों के लिए उपयोगी — Disease List
- Persistent asthma (mild persistent / as add-on)
- Exercise-induced bronchospasm
- Allergic rhinitis (seasonal / perennial)
- Aspirin-exacerbated respiratory disease (Samter’s triad)
- Selected cases of atopic dermatitis (adjunctive)
- Cough-variant asthma (with specialist assessment)
नीचे हर स्थिति में किस तरह उपयोग होता है उस पर dosing/approach दिया गया है।
डोज़, कैसे दें और कितने दिनों तक — Dosing & Administration
Adult
10 mg once daily (oral tablet), preferably in the evening.
Children (age wise)
- 6 months to 5 years: 4 mg once daily (oral granules/chewable as per product) — product specific.
- 6–14 years: 5 mg chewable tablet once daily.
- ≥15 years: 10 mg once daily (adult dose).
How to give (practical)
- Oral once daily — evening timing aligns with nocturnal leukotriene activity and may reduce night-time symptoms.
- Granules may be given directly in mouth or mixed with a spoonful of cold soft food (e.g., applesauce) and should be consumed within 15 minutes.
- Not indicated for immediate relief of acute bronchospasm — keep rescue inhaler (Salbutamol) handy.
Duration
Maintenance therapy — months to years based on control. For seasonal allergic rhinitis, use through season or as advised. Always reassess control every 3 months and step-down when appropriate (per guidelines).
कौन-से पैथोलॉजी टेस्ट जरूरत पड़ सकती है (Baseline & Monitoring)
- Spirometry / Peak flow: baseline and periodic assessment of lung function (FEV1).
- Allergy testing: skin prick or specific IgE — to identify triggers.
- CBC: eosinophil counts if suspicion of eosinophilic phenotype or Churg-Strauss presentation.
- Liver function tests (LFT): baseline in some settings / if symptoms suggest hepatic dysfunction on therapy (rare reports).
- Clinical scores: Asthma Control Test (ACT), rescue inhaler frequency.
सहायक दवाएँ (Supportive Medicines & Combinations)
- Inhaled corticosteroids (ICS): cornerstone controller — fluticasone, budesonide (see: Fluticasone Guide).
- Short-acting β2-agonists (SABA): salbutamol for rescue (see: Salbutamol).
- Antihistamines: for rhinitis/urticaria adjunct — levocetirizine, cetirizine, fexofenadine (internal links: Levocetirizine, Cetirizine, Fexofenadine).
- Leukotriene modifiers + Intranasal steroid/antihistamine: for difficult rhinitis control.
- Biologics / Omalizumab: for severe allergic asthma/chronic urticaria — specialist referral.
आहार व जीवनशैली — क्या खाएँ और क्या बचाएँ (Recommended & Avoid)
General advice for asthma/allergic patients
- Trigger avoidance: dust mite control (encasings), avoid smoke & pollution, pet dander minimization.
- Maintain healthy weight — obesity worsens asthma control.
- Regular moderate exercise with pre-exercise prophylaxis if EIB.
Recommended foods
- Fresh fruits and vegetables — antioxidant support (e.g., guava — see: Guava).
- Omega-3 rich foods (fatty fish, flaxseed) — may reduce inflammation.
- Maintain adequate Vitamin D — deficiency correction may improve control (reference: Complete Nutrition Guide).
- Protein rich diet for general health (eggs, legumes, dairy if tolerated) — biotin/Vit D support (see: Biotin).
Foods / practices to avoid
- Known food allergens for the patient (shellfish, peanuts, dairy etc.).
- Excessive alcohol and smoking.
- Poorly stored fish (risk of scombroid) and high histamine foods if histamine-intolerance suspected.
Safety, Side-effects & Precautions
Common side-effects
- Headache
- Abdominal pain, dyspepsia
- Upper respiratory infection symptoms (reported)
Important warnings — Neuropsychiatric events
Montelukast has been associated with neuropsychiatric events in a minority of patients: sleep disturbances, vivid dreams, agitation, anxiety, depression, behavioral changes and rare reports of suicidal ideation. Counsel patients and caregivers; if such symptoms develop, stop drug and seek immediate evaluation.
Rare / serious
- Churg–Strauss syndrome (eosinophilic granulomatosis with polyangiitis) reported in patients who reduce systemic steroids — monitor eosinophils and systemic vasculitic symptoms.
- Hypersensitivity reactions (rare).
Pregnancy & breastfeeding
Data limited; montelukast used in pregnancy in some cases. Decision should be individualized — uncontrolled maternal asthma can harm fetus; manage after risk–benefit discussion with obstetrician.
Renal / Hepatic impairment
No routine dose adjustment for mild–moderate disease; caution in severe hepatic impairment and seek specialist advice.
Drug interactions
- Montelukast metabolized by CYP pathways (CYP3A4, CYP2C9) — potent enzyme inducers (e.g., phenobarbital) may reduce montelukast exposure.
- Monitor interaction potential with psychiatric drugs if neuropsychiatric events suspected.
FAQ — अक्सर पूछे जाने वाले प्रश्न
Q: Montelukast कब दिया जाता है?
A: Chronic asthma के maintenance में (especially as add-on to ICS), exercise-induced bronchospasm prophylaxis, allergic rhinitis और aspirin-exacerbated respiratory disease में।
Q: क्या Montelukast acute asthma attack में काम करेगा?
A: नहीं — acute attack के लिए short-acting bronchodilator (salbutamol) और emergency measures चाहिए। Montelukast preventive controller है।
Q: कितना समय लेने पर असर दिखेगा?
A: कुछ मरीजों में 24 घंटे के भीतर symptomatic improvement दिख सकता है; controller effect typically over days–weeks; assess control over 4–12 सप्ताह।
Q: Neuropsychiatric symptoms आए तो क्या करें?
A: तुरंत दवा बंद करें और clinician/psychiatrist से संपर्क करें। Caregivers को mood/behavior changes पर नजर रखने को कहें।
Q: क्या बच्चे ले सकते हैं?
A: हाँ — age-specific formulations and doses उपलब्ध हैं; pediatrician की सलाह जरूरी।
Clinical Pearls (नोट्स) — Practitioner tips
- Montelukast is useful in leukotriene-driven phenotypes (AERD, EIB); consider trial in selected patients.
- Always continue inhaled corticosteroids where indicated; do not replace ICS routinely with montelukast.
- Counsel patients about psychiatric warning signs at initiation and during follow-up.
- Reassess control regularly; step-up or step-down therapy per guideline.