Comparison of Montelukast and Pseudoephedrine in the Treatment of Allergic Rhinitis

Abstract

To compare montelukast sodium and pseudoephedrine hydrochloride in the treatment of seasonal allergic rhinitis. Design: A 2-week, parallel, randomized, double-blind study with rolling enrollment. Setting: Tertiary care medical center. Patients: A total of 58 adult subjects with ragweed allergic rhinitis as documented by positive findings on a skin test to ragweed and history of symptoms during previous seasons. Interventions: After recording their own baseline nasal symptoms, nasal peak inspiratory flow (NPIF), and diurnal and nocturnal rhinoconjunctivitis quality of life (QOL) scores, subjects were randomized to receive daily morning oral doses of either pseudoephedrine hydrochloride (240 mg) or montelukast sodium (10 mg) for 2 weeks. They recorded their nasal symptoms and NPIF twice daily during this time, and at the end of the study, they completed another QOL questionnaire and 2 tolerability profiles. Main Outcome Measures: Nasal symptoms, NPIF, QOL scores, and tolerability profiles. Results: Both active treatments resulted in significant improvements from baseline in all symptoms of allergic rhinitis as well as in all the domains of the QOL questionnaires. When changes from baseline were compared between treatments, there were no significant differences except in the symptom of nasal congestion, for which pseudoephedrine was more effective than montelukast. Both treatments resulted in a significant increase in NPIF over baseline with no significant difference between treatments. Both drugs were well tolerated with no differences in the tolerability profiles between treatments. Conclusions: Pseudoephedrine and montelukast are equivalent in improving symptoms and QOL and increasing nasal airflow in patients with seasonal allergic rhinitis. The lack of the usual adverse effects in the pseudoephedrine group is ascribed to morning dosing.

Peak nasal inspiratory flow evaluation as an objective method of measuring nasal airflow

“…In the literature, authors usually adopt a cutting point of 120 l/min for symptomatic individuals, and sensitivity and specificity higher than 75% 7 . Mucha et al 12 have already used the NIPF as an instrument in the assessment and treatment of individuals with allergic rhinitis, thus showing its usefulness in patients with this disease. Bhatia et al 15 also utilized the NIPF as the only assessment method for nasal patency improvement in seasonal rhinitis, comparing the treatment between desloratadine and intranasal budesonide.…”

Benefits, limits and danger of ephedrine and pseudoephedrine as nasal decongestants

“…These results in common cold have been backed up by other randomized double-blind studies of associated H1 antihistamines and pseudoephedrine in allergic rhinitis [17][18][19][20][21][22]. Grosclaude et al [17] found that the association of an H1 antihistamine (cetirizine 5 mg) and pseudoephedrine (120 mg) for 15 days did not improve nasal congestion more than pseudoephedrine (120 mg) alone but did improve other symptoms.…”

“…In allergic rhinitis with moderate asthma, Nathan et al [21] found efficacy compared to placebo for 4 weeks' associated H1 antihistamine (cetirizine 5 mg) and pseudoephedrine (120 mg). And finally, Mucha et al [22] found 15 days' oral pseudoephedrine (240 mg) to be more effective against nasal congestion than an oral leukotriene receptor antagonist (montelukast 10 mg). [26] 1 Angina pectoris Manini et al [27] 1 Myocardial infarction Pederson et al [28] 1 Myocardial infarction Lopez Lois et al [29] 1 Myoclonia and trembling Roberge et al [30] 1 Psychosis and ataxia Sotullo C.A.…”

More Evolution of the Evidence in Asthma Disease Management-SMART Versus GOAL Clinical Trials Debate the Cost-Benefit of LABA While the Value of Leukotriene Modifiers, Particularly Montelukast, Is Uncertain

“…There was no difference in the outcome measures of nasal peak inspiratory flow and diurnal and nocturnal rhinoconjunctivitis quality-of-life scores. 35 Not only was there no difference between these 2 drugs in 3 measures of effectiveness, pseudoephedrine was superior to montelukast in the symptoms of nasal congestion, and no difference was found between the 2 drugs in tolerability.…”