Neuropsychiatric Events Associated with Leukotriene-Modifying Agents: A Systematic Review

Law, Sharon W.Y.; Wong, Angel; Anand, Shweta; Wong, Ian Chi Kei; Chan, Esther W.

doi:10.1007/s40264-017-0607-1

Cited by 36 publications

(27 citation statements)

References 40 publications

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“…We received 46 reports of psychiatric ADRs associated with montelukast in children. Behavioural problems as an ADR have been described 28. In a recent review of both Dutch and international pharmacovigilance databases, strong statistical associations were found between montelukast and depression, aggression, suicidal ideation and abnormal behaviour 29.…”

Section: Discussionmentioning

confidence: 99%

Psychiatric adverse drug reactions in the paediatric population

2020

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ObjectiveDue to lack of information on drug use in children, many drugs are used off-label in paediatrics. Increased knowledge of adverse drug reactions (ADRs) would enable a better risk–benefit analysis. Our aim was to characterise drugs causing psychiatric ADRs in children by conducting a descriptive study based on pharmacovigilance reports.DesignReports submitted to the Netherlands Pharmacovigilance Centre Lareb from 2003 to 2016 were used to investigate drugs causing psychiatric ADRs in the Dutch paediatric population. These data were corrected for drug utilisation in order to correct the number of reports for the number of users of a drug.Main outcome measuresORs were calculated as a measure of disproportionality for drug–ADR associations for three different age groups. Significant drug–ADR associations were checked if it was labelled in the product information.ResultsLareb received 918 reports of psychiatric ADRs, which constitute 15% of the reports of ADRs in children. Drugs used for the treatment of ADHD (methylphenidate and atomoxetine) and drugs used for the treatment of asthma (montelukast and fluticasone) were the most frequently reported. However, psychiatric ADRs were also reported for less often prescribed medications such as oxybutynin and isotretinoin.ConclusionsReal-world data on psychiatric ADRs in the Dutch paediatric population show a consistent pattern with what is known from drug labels and the literature. Reports of psychiatric ADRs should be taken seriously because of the impact on medication adherence and the well-being of the child and its family.

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Section: Discussionmentioning

confidence: 99%

Psychiatric adverse drug reactions in the paediatric population

2020

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“…Interestingly, after a 12-week trial with either corticosteroids or oral montelukast, similar reductions in apnea-hypopnea index emerged in patients with mild OSA [75]. However, the neuropsychiatric side-effects of montelukast have possibly tilted the equipoise regarding this therapeutic option for OSA [76,77].…”

Section: Montelukastmentioning

confidence: 98%

Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision

Gozal

Tan

Kheirandish‐Gozal

2020

JCM

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Treatment approaches to pediatric obstructive sleep apnea (OSA) have remarkably evolved over the last two decades. From an a priori assumption that surgical removal of enlarged upper airway lymphadenoid tissues (T&A) was curative in the vast majority of patients as the recommended first-line treatment for pediatric OSA, residual respiratory abnormalities are frequent. Children likely to manifest persistent OSA after T&A include those with severe OSA, obese or older children, those with concurrent asthma or allergic rhinitis, children with predisposing oropharyngeal or maxillomandibular factors, and patients with underlying medical conditions. Furthermore, selection anti-inflammatory therapy or orthodontic interventions may be preferable in milder cases. The treatment options for residual OSA after T&A encompass a large spectrum of approaches, which may be complementary, and clearly require multidisciplinary cooperation. Among these, continuous positive airway pressure (CPAP), combined anti-inflammatory agents, rapid maxillary expansion, and myofunctional therapy are all part of the armamentarium, albeit with currently low-grade evidence supporting their efficacy. In this context, there is urgent need for prospective evidence that will readily identify the correct candidate for a specific intervention, and thus enable some degree of scientifically based precision in the current one approach fits all model of pediatric OSA medical care.

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“…Infants are more prone to drug-associated sleep disturbances; children present most often with symptoms of depression and anxiety; and adolescents are more prone to symptoms of depression, anxiety, and suicidal behavior. [314][315][316][317] Unexpectedly, a worldwide review of Individual Case Safety Reports associated with montelukast determined that completed suicides were reported more frequently for children than for adolescents or the total population. 316 Most studies are low-quality evidence, (eg, case reports or observational studies), mainly in children and adolescents; high-quality epidemiological studies are needed to evaluate the association and quantify the risk of neuropsychiatric adverse events, not only in children and adolescents, but also in adults.…”

Section: Oral Leukotriene Receptor Antagonistsmentioning

confidence: 99%