Montelukast administered in the morning or evening to prevent exercise‐induced bronchoconstriction in children

Abstract

Montelukast is recommended to be taken in the evening. The effectiveness of this drug to prevent exercise-induced bronchoconstriction (EIB) in children was already evaluated. However, there is no information to determine if this effectiveness could vary depending on dosage time. Children (n = 24) with a documented history of EIB performed an exercise challenge test before starting montelukast treatment. Twelve children were randomly allocated to receive the drug in the morning for 2 weeks, and another 12 to receive it in the evening. After this treatment period and after a week of washout, the children were crossed over. An exercise test was repeated after the first and second periods of treatment. Values obtained after morning or evening dosage were compared with pretreatment values for the whole group of children. There was a significant effect of montelukast for protecting against EIB, measured both as percent of maximum fall in forced expired volume in 1 sec (FEV1) (18.9 +/- 9.7, morning, 18.7 +/- 11.3, evening, vs. 27.5 +/- 9.8, pretreatment; P < 0.05) or as area under the curve (156.4 +/- 102.0, morning, 145.4 +/- 130.6, evening, vs. 294.3 +/- 156.5, pretreatment; P < 0.005). There were no statistical differences between taking the drug in the morning or evening. In conclusion, montelukast, taken for 2 weeks, is equally effective in exercise-induced bronchoconstriction when dosing either in the morning or in the evening.

Chronotherapeutics — A chronopharmaceutical approach to drug delivery in the treatment of asthma

“…Montelukast is not marketed as a chronotherapy of NBA; however, various studies have been conducted to compare the effectiveness of its dosing schedule (twice-a-day) and/or its dosing time (once-a-day morning versus once-a-day evening). From the studies it has been assessed that once daily evening dose of montelukast improves NBA [95][96][97][98]. The finding of above discussed studies are helpful in achieving and optimizing therapeutic goals by developing chronotherapy of LT antagonists, delivering the right treatment in the right amount at night and early morning, prior to the time when airway caliber, inflammation, and hyper responsiveness are known to be worse during the 24 h. Zileuton is a new active 5-lipoxygenase inhibitor which has been shown to be clinically effective in the treatment of asthma.…”

Exercise-induced asthma: critical analysis of the protective role of montelukast

“…Once daily dosing at bedtime was chosen based on higher plasma levels at night when the circadian variation for asthma-related airway obstruction tends to be worse59 and when there may be a higher concentration of alveolar-tissue CD4 + lymphocytes 63. Pajaron-Fernandez and colleagues found no statistical difference in exercise challenge results when comparing morning vs evening montelukast dosing in 24 children aged 6–14 years, but showed better outcomes in some children with evening dosing 63.…”

Antileukotrienes in the treatment of asthma and allergic rhinitis

“…Quantidades aumentadas de LT têm sido verificadas na urina desses pacientes após BIE 50 . Embora o manejo ideal seja a profilaxia, o aquecimento e o uso de broncodilatadores antes dos exercícios, o uso de montelucaste apresenta ação rápida em prevenir a BIE 51 , tanto se administrado pela manhã quanto à noite 52 . Além disso, o montelucaste atenua a fase imediata e tardia do BIE 53 e pode atenuar os sintomas das crianças com BIE por longo período de tempo 54 .…”