Be cautious with montelukast (Singulair) — know the black box warning

What to Do

Be aware that montelukast (Singulair) carries an FDA black box warning for neuropsychiatric side effects. For allergic rhinitis, it should only be used when other treatments have failed.

Why It Works

Montelukast blocks leukotrienes — inflammatory chemicals that cause airway swelling. It is FDA-approved for allergic rhinitis and asthma. However, of 19,000+ adverse event reports, over 10,000 involved psychiatric symptoms including aggression, depression, insomnia, and suicidal ideation. The FDA restricts its use to cases where safer alternatives have failed.

Tips

• Multiple safer alternatives exist for allergic rhinitis (nasal corticosteroids, antihistamines)
• If prescribed, monitor closely for mood or behavioral changes, especially in children
• More justified when a patient has both allergies and asthma
• Discuss the risk-benefit ratio thoroughly with your doctor before starting