Family doctor

USE: Prevention and Treatment of Asthma (including the prevention of day and night time symptoms)

Singulair is a new type of asthma medicine available in New Zealand. Singulair is used in conjunction with other asthma medications to reduce the number of acute asthma attacks when taken regularly.

Singulair is a "Leukotriene (pronounced luke-o-try-een) antagonist". This means that it blocks leukotrienes in the body. Leukotrienes are chemicals which occur naturally in the human body, and like some other chemicals in the body, leukotrienes can affect the breathing passages (airways, bronchi). Leukotrienes are involved in asthma, and seem to have a major involvement in both the acute asthma attacks as well as the hypersensitivity of the airways in longer-term chronic asthma. Leukotrienes can cause effects such as tightening of the airway (bronchoconstriction) and can increase the inflammation and mucous/phlegm in the airway as well.

Because Singulair blocks the action of some of the leukotrienes, this type of medicine can reduce the occurrence of acute asthma attacks when taken regularly. Singulair is also known as montelukast (pronounced monty-loo-cast), and it comes as tablets for adults or children over 6 years of age. Singulair is not a corticosteroid.

It is important to know that Singulair does not work like a blue (reliever) inhaler. Therefore, during an asthma attack a blue inhaler (e.g. Ventolin or Bricanyl) is still used. To take a Singulair tablet during an asthma attack will not work fast enough.

It is also important that the doctor's directions are followed when starting Singulair - other asthma medicines should not be stopped without a doctor's permission.

Used with the brown preventer inhalers (also known as corticosteroids, e.g. Becotide, Flixotide, Pulmicort), Singulair can usually give people with asthma more control over their asthma than the brown preventer inhalers alone. The preventer inhalers are usually continued to be used while using Singulair, but sometimes the doctor may reduce the dose of the preventer inhalers depending on the patient's progress. Occasionally the doctor may stop the preventer inhalers completely, but this must not be done without the doctor's advice, because for many people the preventer inhalers will be very important in keeping them well.

Singulair does not work like prednisone or Betnesol (betamethasone) tablets (called corticosteroids or steroids), and therefore cannot be a substitute for these tablets. If both Singulair and steroid tablets are prescribed, both should be taken. It is important to follow the doctor's directions for the steroid tablets and not stop them without checking with the doctor.

Singulair can improve asthma within one day, and, if prescribed, should be taken every day, both during times when asthma is well-controlled and times when asthma is worsening.

Cautions:

• Not to be used to relieve an acute asthma attack
• Not to be abruptly substituted for preventer inhalers or steroid tablets
• Pregnancy (discuss with doctor)
• Breastfeeding
• Children under 6 years

Side effects:

In studies on asthma patients, Singulair has been compared to placebo (tablets which contain no medicine) and only headache and stomach pain were found to be more common from Singulair tablets than placebo.

Hypersensitivity (allergy) has been reported also, including a skin allergy (red or itchy skin), or anaphylaxis or angioedema (swelling of the face and throat).

Interactions:

Singulair may be used with other medicines routinely used in the prevention and treatment of asthma.

It is not known if Singulair interacts with alcohol, therefore it may be wise not to drink alcohol while taking Singulair, although this is best discussed with your doctor or pharmacist.

Patient information:

• Follow the instructions on the label of the medicine or as directed by your doctor.
• Used for the prevention and treatment of asthma, therefore it must be taken regularly for maximum effect.
• Do not stop taking other asthma medications when using Singulair unless your doctor advises you to. This is especially important with steroid tablets (e.g. prednisone) and brown preventer inhalers (e.g. Becotide, Flixotide, Pulmicort, Respocort).
• The dose is only taken once a day, usually at bedtime - do not take more than the doctor recommends.
• The 10mg tablet is recommended for people 15 years old and over (one tablet at bedtime).
• The 5mg chewable cherry-flavoured tablet is recommended for children six to 14 years of age (one tablet at bedtime).
• Store the tablets away from moisture and light, at room temperature.
• Singulair is only available on a doctor's prescription, and is not currently funded by the New Zealand Government so will need to be paid for by the patient, and it is unlikely to be covered by health insurance. One month's supply could cost around $110.