Montelukast (Paediatric)

How it works

It selectively blocks the cysteinyl leukotriene CysLT1 receptor, reducing leukotriene-driven airway inflammation, bronchoconstriction and mucus secretion.

Prescribing in practice

• The most important paediatric concern is the risk of neuropsychiatric reactions (including sleep disturbance, nightmares, agitation, depression and behavioural change), which the MHRA has highlighted; families should be warned to watch for these and stop the drug if they occur.
• It is a preventer, not a reliever, and does not treat acute attacks, so reliever inhaler use must continue.
• It is given once daily, usually in the evening, with formulation (granules/chewable) chosen to suit the child's age.

Monitoring

Monitor asthma control and, importantly, for any new behavioural or mood changes and sleep disturbance.

Counselling the patient

• Tell the team about any nightmares, sleep problems, mood changes, agitation or unusual behaviour.
• This is a daily preventer and will not relieve a sudden attack; keep using the reliever inhaler.
• Granules can be given directly or mixed with a small amount of soft food for younger children.

Evidence & guidelines

The MHRA has issued reminders about the risk of neuropsychiatric reactions with montelukast, and NICE asthma guidance positions it as add-on preventer therapy.