Prescribing of montelukast (leukotriene receptor antagonist)

Polypharmacy icon of two pills

If asthma control remains suboptimal after the addition of an inhaled LABA to low-dose ICS then either:

Montelukast can be used as an additional add on therapy for asthma in adults. If control remains suboptimal after the addition of an inhaled LABA to low-dose ICS then either:

  • increase the dose of inhaled corticosteroids to medium dose

or

  • consider adding a leukotriene receptor antagonist6

Therapeutic indicator

Number of montelukast doses prescribed per 1000 list size of population

 

 

This chart highlights prescribing of montelukast, which shows a variance in NHS Boards across Scotland. Overall prescribing appears to have increased. Montelukast should be reviewed four to eight weeks following initiation33 to ensure that there has been a response to therapy and that it is still required.

The Medicines and Healthcare products Regulatory agency (MHRA) issued a reminder regarding the known risks of neuropsychiatric reactions with montelukast.34

A recent EU Review35 of montelukast confirmed the known risks and that the magnitude was unchanged. The review highlighted that there had been some delays in recognising that neuropsychiatric reactions were a potential side effect to montelukast. Consider the benefits and risks of continued prescribing should these side effects occur.

 

The numerical data for NTI graphs can also be viewed here.

The most up to date national therapeutic indicator data is available here.