Neuropsychiatric reactions with the use of montelukast

Ekhart, Corine; Hunsel, Florence van; Sellick, Vanessa; Vries, Tjalling de

doi:10.1136/bmj-2021-067554

Cited by 5 publications

(4 citation statements)

References 11 publications

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“…However, there are studies have reported that montelukast may cause some neuropsychiatric side effects [ 19 , 20 ]. Although side effects associated with the use of montelukast are rare and usually mild, they can be worrisome for patients and their families and may negatively affect their quality of life [ 21 ]. There are assumptions that the neuropsychiatric effects of the drug develop when it crosses the blood–brain barrier and blocks leukotriene receptors in the brain [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Neuropsychiatric Effects of Montelukast–Levocetirizine Combination Therapy in Children with Asthma and Allergic Rhinitis

Altaş

Öz

et al. 2023

Children

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Drug-induced neuropsychiatric effects are important for disease management. We aim to evaluate the neuropsychiatric effects of montelukast–levocetirizine combination therapy in children. This descriptive study was conducted with children aged 2–5 years, diagnosed with asthma and allergic rhinitis, who began to receive montelukast and levocetirizine combination therapy. The respiratory and asthma control test for children (TRACK), Rhino Conjunctivitis Scoring System (RCSS), and common neuropsychiatric effects (irritable behavior, hallucinations, headaches, nightmares, sleep disorders, behavioral and mood disorder, restlessness, depression) were ascertained by the questionnaire applied before and 4 weeks after the treatment. Parents answered on behalf of their children. The most common finding before and after treatment was irritable behavior. While irritable behavior was observed in 82.4% (n = 56) of children before the treatment, this percentage was 63.2% (n = 43) after the treatment (p = 0.004). The percentage of children who developed at least one neuropsychiatric symptom after treatment was 22.1% (n = 15). There was no significant effect of age, gender, RCSS, TRACK, or allergy test positivity on the development of neuropsychiatric symptoms (p > 0.05). According to the results, at least one neuropsychiatric finding developed in approximately one in five children. Identifying risk factors will enable more careful treatment or consideration of alternative treatments for children at higher risk in the clinical follow-up period.

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Section: Introductionmentioning

confidence: 99%

Evaluation of Neuropsychiatric Effects of Montelukast–Levocetirizine Combination Therapy in Children with Asthma and Allergic Rhinitis

Altaş

Öz

et al. 2023

Children

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“…Almost nothing is known about the involvement of LTs in the pathogenesis of mental illness. Post-marketing reports and pharmacovigilance studies suggested that the use of LTMAs, and MTK, in particular, may be associated with the development of various adverse neuropsychiatric events (ANPEs), such as depression, aggression, suicidal ideation, anxiousness, hallucinations, sleep disturbances, irritability, tremors, and restlessness ( 32 , 64 – 74 ). For example, a recent large retrospective, propensity score-matched cohort study by Paljarvi et al ( 73 ) demonstrated that MTK treatment was associated with increased incidence of ANPEs among patients with asthma and allergic rhinitis.…”

Section: Introductionmentioning

confidence: 99%

Montelukast induces beneficial behavioral outcomes and reduces inflammation in male and female rats

et al. 2022

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BackgroundAccumulative data links inflammation and immune dysregulation to the pathophysiology of mental disorders; little is known regarding leukotrienes’ (LTs) involvement in this process. Circumstantial evidence suggests that treatment with leukotriene modifying agents (LTMAs) such as montelukast (MTK) may induce adverse neuropsychiatric events. Further methodic evaluation is warranted.ObjectiveThis study aims to examine behavioral effects, as well as inflammatory mediator levels of chronic MTK treatment in male and female rats.MethodsDepression-like phenotypes were induced by exposing male and female rats to a chronic unpredictable mild stress (CUMS) protocol for four weeks. Thereafter, rats were treated (intraperitoneally) once daily, for two weeks, with either vehicle (dimethyl sulfoxide 0.2 ml/rat) or 20 mg/kg MTK. Following treatment protocols, behavioral tests were conducted and brain regions were evaluated for inflammatory mediators including tumor necrosis factor (TNF)-α, interleukin (IL)-6 and prostaglandin (PG) E2.ResultsOverall, MTK did not invoke negative behavioral phenotypes (except for an aggression-inducing effect in males). Numerous positive behavioral outcomes were observed, including reduction in aggressive behavior in females and reduced manic/hyperactive-like behavior and increased sucrose consumption (suggestive of antidepressant-like effect) in males. Furthermore, in control males, MTK increased IL-6 levels in the hypothalamus and TNF-α in the frontal cortex, while in control females it generated a robust anti-inflammatory effect. In females that were subjected to CUMS, MTK caused a prominent reduction in TNF-α and IL-6 in brain regions, whereas in CUMS-subjected males its effects were inconsistent.ConclusionContrary to prior postulations, MTK may be associated with select beneficial behavioral outcomes. Additionally, MTK differentially affects male vs. female rats in respect to brain inflammatory mediators, plausibly explaining the dissimilar behavioral phenotypes of sexes under MTK treatment.

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“…And how should clinicians think about montelukast? The best advice I encountered was a BMJ paper by Ekhart et al (2022). After summarizing basic information about the drug, its regulatory history, and what is known about its adverse effects, the investigators underscored the importance of evaluating potential risks and benefits, informing and educating patients, and monitoring patients for neuropsychiatric changes.…”

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confidence: 99%

Much ado about montelukast: A side‐effects saga

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2024

Psychopharmacology Update

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Our coverage of emerging findings in psychopharmacology is generally limited to what gets published in the refereed scientific literature. Occasionally, however, something appears in the lay media that we think Update readers will benefit from knowing about. A recent such “something” was an article published in the New York Times under the alarming title “The F.D.A. [Food and Drug Administration] Warned an Asthma Drug Could Induce Despair. Many Were Never Told” (Jewett & Mueller, 2024). Broad coverage of this by other media outlets ensued.

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Neuropsychiatric reactions with the use of montelukast

Cited by 5 publications

References 11 publications

Evaluation of Neuropsychiatric Effects of Montelukast–Levocetirizine Combination Therapy in Children with Asthma and Allergic Rhinitis

Evaluation of Neuropsychiatric Effects of Montelukast–Levocetirizine Combination Therapy in Children with Asthma and Allergic Rhinitis

Montelukast induces beneficial behavioral outcomes and reduces inflammation in male and female rats

Much ado about montelukast: A side‐effects saga

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