Montelukast alternatives: What can I take instead of montelukast?

Compare montelukast alternatives | Leukotriene modifiers | Inhaled corticosteroids | Mast cell stabilizers | Long-acting beta-agonists | Antihistamines | Natural alternatives | How to switch meds

Montelukast is a leukotriene receptor antagonist, which works by blocking the action of inflammatory chemicals called leukotrienes. A healthcare provider may prescribe montelukast to treat asthma and allergies. During exposure to an asthma or allergy trigger, leukotrienes increase the production of mucus, the formation of eosinophils, and the tightening of the airways. Blocking the effects of leukotrienes can help improve symptoms of asthma and seasonal allergies. 

The brand name of montelukast is Singulair, which is manufactured by Merck. It is available as oral granules, chewable tablets, and regular tablets. 

 While montelukast is an effective prescription drug, it may not be right for everyone. For some people, montelukast may not be as effective as other medications. For others, montelukast can cause intolerable side effects. Montelukast also carries a boxed warning that states some people may experience neuropsychiatric events, such as depression, sleeping problems, and suicidal thoughts. 

Other FDA-approved asthma and allergy medications are available. Continue reading to learn about montelukast alternatives and how they work against asthma or allergies.

RELATED: What is montelukast?

What can I take in place of montelukast?

Several options can be used to treat asthma and allergies. Other allergy medicines are often recommended to be used before trying montelukast. Montelukast alternatives include inhaled corticosteroids (ICS), mast cell stabilizers, long-acting beta-agonists, antihistamines, and biologic medications. These options may be preferred over montelukast because of their side-effect profiles and other uses.
It’s important to note that montelukast and its alternatives are meant to be used for long-term control of asthma symptoms. They should not be used for asthma attacks or an acute worsening of asthma symptoms. A healthcare provider will prescribe a short-acting beta-agonist (SABA), such as albuterol, for asthma attacks. 

Other alternatives to montelukast

• Flovent HFA, Flovent Diskus (fluticasone propionate)
• Pulmicort (budesonide)
• Alvesco (ciclesonide)
• Asmanex HFA, Asmanex Twisthaler (mometasone)
• Arnuity Ellipta (fluticasone furoate)
• Breo Ellipta (fluticasone furoate/vilanterol)
• Dulera (mometasone/formoterol)
• Allegra (fexofenadine)
• Theo-24 (theophylline)
• Xopenex (levalbuterol)
• Atrovent HFA (ipratropium)
• Medrol (methylprednisolone)
• Prednisone Intensol (prednisone)
• Fasenra (benralizumab)
• Cinqair (reslizumab)
• Dupixent (dupilumab)

Top 5 montelukast alternatives

Other leukotriene modifiers (such as zafirlukast and zileuton)

Zafirlukast is a leukotriene receptor antagonist that is known by the brand name Accolate. Zileuton, or Zyflo, is a leukotriene synthesis inhibitor, meaning it blocks the production of leukotrienes. Like montelukast, these leukotriene modifiers are available as oral tablets. However, zafirlukast is usually taken twice daily and zileuton is usually taken four times daily. Therefore, they may not be the best alternatives to montelukast in terms of dosage since montelukast only needs to be taken once daily. 

Inhaled corticosteroids (such as budesonide, fluticasone, or beclomethasone)

Inhaled corticosteroids, or ICS, are the treatment of choice for asthma. Corticosteroids work by reducing the immune response and decreasing inflammation in the airways. According to studies, inhaled corticosteroids, such as Flonase, are more effective than leukotriene modifiers for improving lung function in people with asthma. However, inhaled corticosteroids can cause yeast infections in the mouth (oral candidiasis). Steroid inhalers include Pulmicort (budesonide), Arnuity Ellipta (fluticasone furoate), and Qvar (beclomethasone). 

Inhaled corticosteroids are delivered via inhalation through the mouth and are typically used to treat asthma. Intranasal corticosteroids are delivered through the nose and are often used to treat nasal symptoms of allergic rhinitis. Systemic corticosteroids are taken as tablets or injections and are usually reserved for severe allergic reactions. 

Mast cell stabilizers (such as cromolyn sodium and nedocromil sodium)

Mast cell stabilizers block the release of inflammatory chemicals from mast cells in response to allergens. Cromolyn sodium is known by the brand name Nasalcrom, and it is administered as a nasal spray that can help treat nasal allergy symptoms. Nedocromil sodium is known by the brand name Tilade, and it is FDA approved to treat asthma. Unlike cromolyn sodium, nedocromil sodium is delivered as an inhaler. 

Long-acting beta-agonists (such as formoterol and salmeterol)

Long-acting beta-agonists, also known as LABAs, work to relax the smooth muscles in the airways. These drugs are rarely used alone for asthma. Instead, they are combined with an inhaled corticosteroid for persistent asthma that doesn’t respond to an inhaled corticosteroid alone. Examples of combination ICS-LABA medications include Advair Diskus (fluticasone/salmeterol), Dulera (mometasone/formoterol), and Symbicort (budesonide/formoterol).

Antihistamines (such as loratadine and cetirizine)

Antihistamines work by blocking the effects of histamine, an inflammatory chemical. These drugs are usually taken by mouth and are known for causing drowsiness. However, they are effective for treating symptoms of allergic rhinitis or hay fever. They’re also available as over-the-counter drugs. Some antihistamines are combined with decongestants to relieve nasal congestion. Examples of antihistamines include Claritin (loratadine), Zyrtec (cetirizine), and Allegra (fexofenadine). 

Natural alternatives to montelukast

Natural remedies for asthma, including lifestyle changes, dietary modifications, and vitamins or supplements, are not recommended to replace asthma treatment. Instead, these natural remedies are added on top of drug treatment. Before trying a natural remedy, you should consult with your healthcare professional for medical advice. 

Breathing exercises

Breathing exercises, such as breathing from the nose and diaphragm, may help improve breathing with asthma. Breathing exercises can also help promote relaxation and improve quality of life. Some healthcare providers will recommend a particular breathing exercise in addition to treatment with medication. 

Diet

There is no specific asthma diet that can help relieve symptoms. However, eating the right diet and maintaining a healthy weight may help reduce inflammation and reduce the severity of symptoms. A diet rich in fruit and vegetables, for example, contains antioxidants that may help fight inflammation. It’s also important to stay away from certain foods that may trigger an asthma attack. Food triggers can vary depending on the person.

Vitamins 

Studies have shown that low vitamin D levels are associated with reduced lung function and a diagnosis of asthma. Vitamin D is typically used to improve bone health, although it also has anti-inflammatory effects. Clinical trials have shown that vitamin D may help reduce the risk of asthma attacks. Some experts suggest that vitamin E may also help control asthma as it has antioxidant and anti-inflammatory effects. 

Herbal supplements

Ginger contains compounds called gingerols and shogaols that may help relieve asthma symptoms. While some studies show that ginger can help reduce asthma symptoms, ginger does not help improve the overall function of the lungs. Stinging nettle is another herbal remedy that may help improve the symptoms of asthma. However, more research is needed to determine the full effects of herbal supplements on asthma. 

How to switch to a montelukast alternative

If you’re considering switching to a montelukast alternative, you should consult with a healthcare provider first. Although there’s a very low risk of withdrawal symptoms or rebound asthma symptoms, you should not stop taking montelukast abruptly. Montelukast is a prescription drug that should be monitored by a healthcare provider. Your healthcare provider will be able to assess any potential drug interactions or adverse events with the new treatment. 

Your healthcare provider may recommend that you keep taking montelukast while starting a new drug to allow the new drug to have time to take effect. However, the process for switching to a new drug will depend on which drug montelukast is being switched to. 

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