II. Preparations
- Zafirlukast (Accolate)
- Montelukast (Singulair)
- Zileuton (Zyflo)
III. Mechanism
- Attenuates bronchoconstriction and inflammation
- Leukotriene Receptor Antagonists
- Zafirlukast (Accolate)
- Montelukast (Singulair)
- Leukotriene Synthesis Inhibitor
- Zileuton (Zyflo)
IV. Indication: Adjunctive in Asthma and Allergic Rhinitis
V. Dosing: Zafirlukast (Accolate)
- Leukotriene Receptor Antagonist
- Avoid at mealtime
- Take 1 hour before or 2 hours after meals
- Dose
- Age >11 years old: 20 mg orally twice daily
- Child 7-11 years old: 10 mg orally twice daily
VI. Dosing: Montelukast (Singulair)
- Leukotriene Receptor Antagonist
- Dose
- Adults: 10 mg orally at bedtime
- Child age 6 to 14 years: 5 mg orally at bedtime
- Child age 2-5 years: 4 mg orally at bedtime
VII. Dosing: Zileuton (Zyflo)
- Leukotriene Synthesis Inhibitor
- Indicated only in age 12 and over
- Dosing
- Dose: 600 mg orally four times daily
- Risks
- Hepatotoxicity in 5% (Monitor liver enzymes q3 months)
- Drug Interactions: Warfarin, Theophylline, Propranolol
- Expensive ($273 per month)
VIII. Efficacy
- Modestly effective for maintenance management
- Inhaled Steroids are preferred over Leukotriene agents
- Used as adjunctive therapy in Asthma
- Benefit may be limited to patients with the 5-LO and LTC4 polymorphisms
IX. Adverse Effects
- Montelukast is associated with increased risk of Major Depression and Suicide
- Multiple P450 Drug Interactions
- Potentiates Warfarin
- Potentiates Theophylline
- Potentiates Propranolol
- Some association with Churg-Strauss Syndrome
- Systemic Eosinophilic Vasculitis
- Vasculitic rash
- Pulmonary and cardiac conditions
- Hepatotoxicity with Zileuton (Zyflo)
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Related Studies
| zafirlukast (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ZAFIRLUKAST 10 MG TABLET | Generic | $0.87 each |
| ZAFIRLUKAST 20 MG TABLET | Generic | $0.91 each |
| montelukast (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| MONTELUKAST SOD 10 MG TABLET | Generic | $0.06 each |
| MONTELUKAST SOD 4 MG GRANULES | Generic | $0.95 each |
| MONTELUKAST SOD 4 MG TAB CHEW | Generic | $0.09 each |
| MONTELUKAST SOD 5 MG TAB CHEW | Generic | $0.08 each |
| singulair (on 1/14/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| SINGULAIR 10 MG TABLET | Generic | $0.06 each |
| zileuton (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ZILEUTON ER 600 MG TABLET | Generic | $10.02 each |