Muloz Special Precautions

Montelukast is not indicated for use in the relief of bronchospasm in acute asthma attacks, including status asthmaticus. Continue therapy during acute exacerbations of asthma. Advise patients to have appropriate rescue medication available. Patients receiving Montelukast should be provided with and instructed in the use of a short-acting, inhaled β₂-adrenergic bronchodilator as supplement therapy for acute asthma symptoms.
While the dose of concomitant inhaled corticosteroids may be reduced gradually under medical supervision. Montelukast should not be abruptly substituted for oral or inhaled corticosteroids.
Neuropsychiatric events have been reported in adult, adolescent, and pediatric patients taking Montelukast. Be alert for neuropsychiatric events and instruct patients to report the occurrence of these changes. Carefully evaluate the risks and benefits of continuing treatment if such events occur.
In rare cases, patients on therapy with anti-asthma agents including Montelukast may present with systemic eosinophilia, sometimes presenting with clinical features of vasculitis consistent with Churg-Strauss syndrome, a condition which is often treated with systemic corticosteroid therapy. Although a causal relationship with leukotriene receptor antagonism has not been established, physicians should be alert to eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, and/or neuropathy presenting in their patients. Patients who develop these symptoms should be reassessed and their treatment regimens evaluated.