Leukotriene Receptor Antagonists
Key Points
- Montelukast blocks leukotriene receptors to reduce airway inflammation and prevent asthma symptoms.
- This class is for long-term control, not rapid rescue during acute asthma attacks.
- Main indications include asthma prevention, exercise-induced bronchospasm prevention, and allergic rhinitis.
- Boxed warning: serious neuropsychiatric effects, including suicidal ideation.
- Effect is delayed; therapeutic benefit may take about 3-7 days.
Mechanism of Action
Leukotriene receptor antagonists inhibit leukotriene signaling in the airways. Blocking this inflammatory pathway decreases airway inflammation and reduces frequency of bronchospasm episodes.
Indications
- Long-term control of asthma and reduction of asthma-attack frequency.
- Prevention of exercise-induced bronchospasm.
- Management of allergic rhinitis symptoms.
Nursing Considerations
- Not a quick-relief medication for acute asthma attacks.
- Available as granules, chewable tablets, and standard tablets.
- Pediatric use: can be used in children 12 months and older per product criteria.
- For exercise-induced symptoms, administer at least 2 hours before exercise.
- Avoid using as first-line therapy for mild asthma when conventional treatment is effective, due to neuropsychiatric risk profile.
Boxed Warning: Neuropsychiatric Effects
Serious mental health adverse effects can occur, including suicidal ideation. Screen for mood and behavior changes and escalate concerns immediately.
Side Effects and Adverse Effects
- Headache
- Cough
- Nasal congestion
- Nausea
- Hepatotoxicity
- Suicidal ideation and other serious mental-health effects
Health Teaching
- Take the medication at the same time each day.
- Do not stop therapy without discussing with the prescribing clinician.
- Teach clients and family to report new agitation, mood change, sleep disturbance, depression, or suicidal thoughts immediately.
- Reinforce that rescue inhalers (not montelukast) are used for sudden asthma symptoms.
Related Concepts
- asthma-action-plan-and-exacerbation-management - Long-term controller role within zone-based management.
- bronchodilators - Rescue and bronchodilation therapy compared with anti-inflammatory controller therapy.
- corticosteroids - Alternative or adjunct anti-inflammatory maintenance therapy.
- upper-respiratory-tract-infection - Differential context for congestion and cough symptoms.