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Montelukast and zafirlukast are cysteinyl leukotriene receptor antagonists indicated to prevent and treat chronic asthma. Leukotrienes are eicosanoid inflammatory mediators derived from arachidonic acid. Neither montelukast nor zafirlukast has a role as rescue medication during an acute asthmatic attack. This activity will highlight the mechanism of action, adverse event profile, and monitoring pertinent for interprofessional team members in managing patients with asthma and related conditions with leukotriene receptor antagonists. Objectives: Explain the mechanism of action of leukotriene receptor antagonists. Describe the potential adverse effects of leukotriene receptor antagonists. Review the appropriate monitoring for patients using leukotriene receptor antagonists. Summarize interprofessional team strategies for improving care coordination and communication to advance the treatment of asthma with leukotriene receptor antagonists and improve outcomes. Access free multiple choice questions on this topic.

Both montelukast and zafirlukast have a wide margin of safety. Patients who took an overdose had no adverse symptoms, an uneventful course of recovery, or a rash and upset stomach.[25][26] When overdosed, remove unabsorbed drugs using active charcoal and institute supportive therapy, if needed.

Several adverse drug reactions were reported to the Netherlands pharmacovigilance center Lareb and the WHO global individual case safety report database. The most common adverse effect in the whole population was depression, and in children under the age of 19 years, it was aggression.[18] Suicidal ideation, abnormal behavior, nightmares, headaches, insomnia, and anxiety have been reported in patients treated with montelukast. Nightmares may occur and frighten children. Aggression and abnormal behavior of children may cause concerns from their parents and teachers. Insomnia in adults may impact the safety of the patients and others. Asthma is a chronic lung disease. Even in patients with a well-established medication regimen, acute asthma exacerbations may occur. Understanding the risk factors for exacerbation-prone asthma is critical for preventing potentially fatal acute asthma attacks.[27][28] Both African Americans and Hispanics have a higher incidence of exacerbations. Poor compliance with medication due to patients’ poor access to healthcare and inadequate education and knowledge about the disease put the patients at great risk of acute exacerbations. Other potentially modifiable risk factors include uncontrolled allergies, upper respiratory viral infections, obesity, smoking, and gastroesophageal reflux disease.[29][30][31][32] An interprofessional approach that includes all healthcare team members, including physicians (MDs and DOs), mid-level practitioners (NPs and PAs), specialists, nurses, pharmacists, and respiratory therapists, may reduce acute asthma attacks by taking control of these risk factors. The interprofessional healthcare team should educate their patients or parents and monitor the incidence of adverse drug effects. Using the interprofessional team approach to patient care in general and using leukotriene receptor antagonists in patients who will benefit from such medical therapy. [Level 5]