·        Patient need to take this medication at the same time of each day. If they are taking this medication for asthma or for both asthma and allergies, should take their dose in the evening.

·        If they are taking montelukast to prevent only allergies, should take their dose either in the morning or the evening.

·        If patient are taking this medication to prevent breathing problems during exercise, should take the dose at least 2 hours before exercise. 

NOTE:

There have been no clinical trials evaluating the relative efficacy of morning versus evening dosing. Also, no difference in pharmacokinetics was noted between morning and evening dosing.

Shouldn’t take more than one dose in 24 hours. Should not take a dose before exercise if they are already taking this medication daily for asthma or allergies.

Patient usually prescribed to take montelukast once a day.

For the treatment of Asthma, it's taken at night because asthma symptoms tend to be worse at night. Administration of montelukast at evening ensures that maximal plasma concentrations of the drug coincide with the early morning maximal airway narrowing.

Montelukast typically starts to work after the first dose, but it can take up to a week for some people to notice a change in their symptoms.

Unlike antihistamines, montelukast can't be taken as needed. It typically needs about 3 to 7 days. 

This medication must be used regularly to be effective. It does not work right away and should not be used to relieve sudden asthma attacks or breathing problems. 

There is strong evidence to suggest that leukotrienes are also involved in decreasing persistent cough following viral or whooping cough infection. Montelukast may therefore also help settle persistent coughs in these settings.

Collectively, these data suggest that long-term treatment with montelukast is safe and improves COPD control in elderly patients with moderate to severe COPD.

Neuropsychiatric disorders as side effects of montelukast were more frequently reported for children than for adults. Infants and children seem to be more prone to sleep disturbances, whereas adolescents present symptoms of depression/anxiety and psychotic reactions more often.

https://www.webmd.com/drugs/2/drug-6478-8277/montelukast-oral/montelukast-oral/details

https://www.drugs.com/mtm/montelukast.html

https://www.nhs.uk/medicines/montelukast/

https://pubmed.ncbi.nlm.nih.gov/16429427/

https://clinicaltrials.gov/ct2/show/NCT01279668

https://pubmed.ncbi.nlm.nih.gov/14971876/

https://www.fda.gov/drugs/drug-safety-and-availability/fda-requires-boxed-warning-about-serious-mental-health-side-effects-asthma-and-allergy-drug

Note: For informational purposes only. Consult your textbook for advising your patients.