Montelukast Safety in End-Stage Renal Disease

Pharmacokinetic Considerations

• Montelukast is highly protein-bound (>99.9%), making it unlikely to be significantly removed by dialysis, similar to other highly protein-bound medications 1

Safety Monitoring in ESRD

• ESRD patients are at heightened risk for adverse drug reactions due to polypharmacy, multiple comorbidities, and altered pharmacokinetics, making medication reconciliation critical 2
• Medication reconciliation should be performed at every care transition for ESRD patients taking montelukast, particularly when moving between hospital, dialysis unit, and rehabilitation settings 2

Practical Clinical Application

• Unlike many medications that require dose reduction or interval adjustment in ESRD, montelukast maintains its standard daily dosing regimen 3
• No therapeutic drug monitoring is required for montelukast in ESRD patients, unlike medications such as cycloserine or aminoglycosides that necessitate serum concentration monitoring 3, 4