Neuropsychiatric Risks of Montelukast

Introduction to Risks

The American Academy of Allergy, Asthma, and Immunology recommends that prescribers carefully evaluate risks versus benefits before initiating montelukast treatment, particularly given that alternative therapies are more effective and lack serious psychiatric risks 1

The American College of Allergy, Asthma, and Immunology suggests that montelukast should be reserved for specific scenarios only, such as patients with both asthma and allergic rhinitis who refuse or cannot tolerate intranasal/inhaled corticosteroids 2
The European Respiratory Society recommends that patients with current or prior psychiatric illness should be monitored particularly closely when taking montelukast, as they may be at higher risk of neuropsychiatric events 1

The American Academy of Pediatrics recommends that treatment with montelukast should be stopped immediately upon occurrence of any neuropsychiatric side effects, and that there is no role for continued monitoring while symptomatic 2
The American College of Allergy, Asthma, and Immunology suggests that montelukast should not be prescribed as first-line for isolated allergic rhinitis, as this violates guideline recommendations and exposes patients to unnecessary psychiatric risk 3