Montiget Special Precautions

Acute asthma attacks: Montelukast is not indicated for use in the reversal of bronchospasm in acute asthma attacks, including status asthmaticus. Continue therapy during acute exacerbations of asthma. Advise patients to have appropriate rescue medication available.
CNS effects: Neuropsychiatric events have been reported in adults, adolescent, and pediatric patients taking leukotriene modifiers. Agitation, aggressive behavior or hostility, anxiousness, depression, disorientation, disturbance in attention, dream abnormalities, hallucinations, insomnia, irritability, memory impairment, restlessness, somnambulism, suicidal thinking and behavior (including suicide) and tremor have been reported postmarketing. 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.
Eosinophilic conditions: Patients receiving montelukast may present with systemic eosinophilia, eosinophilic pneumonia, or clinical features of vasculitis consistent with Churg-Strauss syndrome, a condition that is often treated with systemic corticosteroid therapy. These events usually, but not always, have been associated with the reduction of oral steroid therapy. Be alert to eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, and/or neuropathy in patients.
Concurrent corticosteroids: While the dose of inhaled corticosteroid may be reduced gradually under medical supervision, do not abruptly substituted montelukast for inhaled or oral corticosteroids.
Aspirin sensitivity: Inform patients with known aspirin sensitivity that they should continue avoidance of aspirin or anti-inflammatory drugs (NSAIDs) while taking montelukast. Although montelukast is effective in improving airway function in asthmatic patients with documented aspirin sensitivity, it has not been shown to truncate bronchoconstrictor response to aspirin and other NSAIDs drugs in aspirin-sensitive asthmatic patients.