Should you use Singulair for allergies?

Singulair uses | Singulair for allergies | Efficacy | Dosage | Side effects | Cost | Alternatives

Not everyone with allergies finds relief with a daily dose of an antihistamine or nasal spray. If this sounds familiar, it’s possible that those medications did not work because they target histamine pathways while your allergies are due to leukotrienes, another type of common allergic reaction that causes inflammation in the respiratory system.

You can experience both types of allergic response, histamine and leukotriene, but you’ll need two different types of medications if you want to relieve the symptoms of both. That’s where Singulair (montelukast) comes in. 

Singulair can be an effective medication for treating allergies in many people, but it isn’t right for everyone. Here’s what you need to know about how it works, who it works best for, and what else you can take along with it. 

What is Singulair used for?

Singulair is a prescription drug that belongs to a class called leukotriene receptor antagonists. According to University of Missouri Health Care allergist and otolaryngologist Christine Franzese, MD, it’s approved for the treatment of asthma symptoms, including exercise-induced asthma, and common allergies like mold, pollen, pet dander, and dust mites. It is not a rescue medication and should not be used in an attempt to relieve acute bronchospasm or asthma attacks.

How does Singulair work for allergies?

When your body is exposed to an allergen, it releases chemicals that initiate an allergic response. These chemicals are often histamines, but they can be leukotrienes, too. The release of these chemicals causes inflammation in the respiratory system and is responsible for all the itching, sneezing, wheezing, and coughing that happens if you come into contact with something you’re allergic to.  

Singulair targets the pathways that leukotrienes travel along, which stops the chemical from creating an allergic response. If you haven’t found symptom relief with antihistamines—or if they help some of your symptoms, but not all—your provider may prescribe Singulair to be taken alone or in combination with other drugs like oral antihistamines and intranasal steroids.

“There is not a one-size-fits-all treatment plan, so some people may benefit from only Singulair, but some may need other medications to feel better,” Kathleen Dass, MD, an allergist and immunologist privately practicing in Michigan. “It can especially be helpful with pet allergies, stuffy noses, or children who may not be able to tolerate a nose spray.”

How effective is Singulair for allergies?

Singulair has been prescribed for many years as treatment for allergies and asthma, so it has a long track record of safety and efficacy. 

One 2011 review of studies found that montelukast has positive outcomes in the treatment of adult asthma, particularly exercise-induced asthma and asthma associated with allergic rhinitis (aka hay fever), smoking, obesity, and viral illnesses. Meanwhile, a 2014 study suggests that montelukast is beneficial when used alone or in conjunction with other therapies for the treatment of mild to moderate childhood asthma.

Still, it’s important to know under what circumstances Singulair tends to be the most effective. “It seems to work pretty well as an add-on therapy for more moderate and severe asthma, or if you have allergies and asthma,” explains Dr. Franzese. “If you have just allergies but no asthma, it’s not as effective as other medications like nasal steroids and antihistamine pills.”

In other words, if you’re trying to exclusively treat allergies, Singulair isn’t commonly prescribed on its own. However, if you are treating both allergies and asthma or need an additional medication to manage your asthma (along with an inhaler), Singulair can be an effective standalone drug or one used in combination with other therapies. “For my patients who take Singulair, the majority find it to be very helpful,” says Dr. Dass.

It also reduces some of the stigma surrounding asthma, especially in young children, adds Dr. Franzese; in addition to working well for asthma, Singulair makes it easier for some people to treat their asthma since they can take a pill at home instead of carrying an inhaler with them to use at school or work.

Singulair dosage for allergies

Singulair is available in pill form, chewable tablets, and oral granules. In general, adults are prescribed 10 milligrams per day, regardless of why Singulair is being used. That is, the dosages for asthma maintenance, allergies, and exercise-induced asthma—in adults—are all the same. 

Singulair is approved for adults and children:

• 12 months of age and older for prevention and chronic treatment of asthma;
• 6 years of age and older for prevention of exercise-induced asthma;
• 2 years of age and older for seasonal allergies;
• and 6 months of age and older for perennial (year-round) allergies.

One thing that’s unique about Singulair is that dosages aren’t based on weight, like many other drugs. Instead, they’re based on age; anyone age 15 years or older can take the adult dose of 10 milligrams daily, while children ages 2 years through 5 years are given 4 milligrams daily and children between the ages of 6 and 14 are given 5 milligrams daily. 

The unique qualities of Singulair don’t stop there. Unlike common antihistamines, like Claritin, Singulair doesn’t start working right away. It can take a while before you start noticing its effects. “I generally recommend patients take it for at least one month because it doesn’t act in the immediate phases [of an allergic response],” explains Dr. Franzese. “It works more in the delayed phases, 48 to 72 hours later, so you should really give it a week or two [before determining if it’s helping you].”

It’s also important to consider the timing of your Singulair dosage, both experts say. If you’re using it for exercise-induced bronchoconstriction, Dr. Franzese recommends taking it about four to five hours before performing the activity that triggers you—but in most other cases, it’s often recommended that you take your dosage at night. “Singulair is taken at night because it can cause fatigue or drowsiness in some patients,” says Dr. Dass. “I always advise my patients [to take it at bedtime so] they can sleep off the drowsiness and fatigue.”

RELATED: Non-drowsy Benadryl: What are your options?

Side effects of Singulair

One thing you should note about Singulair is that it has the potential to cause more serious or severe adverse effects than other common allergy medications. However, those side effects are pretty rare. Neuropsychiatric side effects of Singulair include:

• Depression 
• Anxiety
• Behavioral changes
• Fatigue or drowsiness
• Suicidal ideation
• Vivid dreams

Again, these serious side effects are not common. The U.S. Food and Drug Administration (FDA) requires the drug to include a black box warning about the mental health side effects it can cause. “I’m comfortable prescribing it, but I always tell people about the side effects,” says Dr. Franzese. “Rarely, I’ll have someone decide not to take it [because of the possible risks], but most people take it and agree to monitor for those side effects.” 

If you experience mood changes or suicidal thoughts, reach out to your healthcare provider or a suicide prevention hotline right away. Be sure your family and any caregivers know to look out for mood and behavior changes, as well.

In addition to neuropsychiatric side effects, Singulair has common side effects, such as:

• Stomach pain and nausea
• Headache
• Runny or stuffy nose
• Sinus pain
• Fever
• Sore throat
• Cough 

It’s unlikely that taking Singulair will make your allergies worse, but since some of the drug’s physical side effects mimic common allergy symptoms, it may certainly feel that way. Allergic reactions to the drug itself appear to be quite rare. Seek medical attention right away if you start to develop hives, have difficulty breathing, or have swelling around the face, lips, tongue, or throat, after taking Singulair. Singulair is not known to cause weight gain. 

Who should not take Singulair

Singulair has been studied with use in many populations, and seems to be safe for most children and adults. That said, some people should avoid taking Singulair, such as:

• People with a history of neuropsychiatric events
• People with PKU, or phenylketonuria 

Women who are pregnant, planning to become pregnant, or are breastfeeding, should consult their healthcare provider before taking Singulair.

Before taking Singulair, be sure to discuss all medications (Rx and OTC) and vitamins or supplements you’re taking with your pharmacist. 

How much does Singulair cost?

Without insurance, Singulair typically costs nearly $300 for a month’s supply. It’s expensive because it’s a brand name. The generic version, montelukast, is more commonly prescribed and significantly less pricey. 

If your Singulair prescription isn’t covered by your insurance plan, don’t assume that means you can’t take it. SingleCare’s prescription discount card may make the medication more affordable for you. Get a free prescription discount card or ask your pharmacist to check for available discounts when you bring in your prescription to the pharmacy.

Alternatives to Singulair for allergies

Singulair can be taken with many other over-the-counter or prescription drugs that treat allergies, including antihistamines like Claritin, Allegra, or Zyrtec, and intranasal steroid sprays such as Flonase or Nasacort. Antihistamine pills, nasal sprays, and eye drops were the most commonly used allergy medicines among survey takers in SingleCare’s allergy survey.

While Singulair is largely a safe and effective drug, it might not be the right choice for you. If you only have allergies and not asthma, Singulair may not work as well as a traditional antihistamine like Allegra. But if you have allergic asthma, or if you know you need to treat your body’s leukotriene response versus its histamine response, then Singulair may be more likely to target your symptoms than drugs.

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