Alternative Options to Montelukast and Concerns Regarding Discontinuation
Hello, I have a friend, a 36-year-old male, who was initially prescribed a medication called Alsove-DM, which contains Acebrophylline (200 mg), Desloratadine (5 mg), and Montelukast (10 mg), by a pulmonologist for a duration of five months. Recently, he switched to another medication called Montair FX, which includes Montelukast (10 mg) and Fexofenadine (120 mg), following a prescription from his general practitioner in mid-June. He has been taking Alsove-DM once nightly and has been on Montair FX for the last two months, taking one tablet during the daytime. While researching today, he stumbled upon information indicating that Montelukast carries a black box warning issued by the FDA regarding serious neuropsychiatric side effects. This warning applies to both of the medications he has been prescribed, leaving him quite alarmed since neither physician had advised him of these risks prior to prescribing this drug. He is now feeling quite anxious about the situation. Here are some questions he has: 1. Are there any risks of addiction associated with these medications? How can one identify if they have developed an addiction? 2. If he misses a dose or abruptly ceases taking the medication, might he experience psychological withdrawal symptoms? The information available online seems quite vague on this matter. 3. Are there safer alternatives available for long-term management of his condition? 4. Is there anything else he should be aware of relating to these medications? Thank you!
Answers (1)
8/8/2025, 1:20:50 PM
OpenHealth AI
It's understandable that your friend is feeling anxious after discovering alarming information about Montelukast, especially given the potential side effects and the change in his medication. Here's a structured overview addressing his concerns:
Main Points:
- Addiction Risks: While Montelukast and similar medications are not associated with addiction, the psychological impact can be a concern.
- Withdrawal Symptoms: Abrupt discontinuation typically doesn’t lead to withdrawal but might result in a return of symptoms.
- Alternative Treatments: Several safer options exist for long-term management of respiratory conditions.
- Important Considerations: Understanding risks, monitoring side effects, and regular consultations with healthcare providers are crucial.
Explanation:
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Addiction Risks: Montelukast and related medications (like desloratadine and fexofenadine) are not classified as addictive substances. Addiction usually involves a compulsion to use a drug, tolerance, and withdrawal symptoms, which are generally not applicable here. Signs of psychological dependence could include anxiety about missed doses, feeling unable to function without the medication, or using it for non-prescribed reasons.
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Withdrawal Symptoms: If your friend misses a dose, he is not likely to experience withdrawal symptoms like he would with narcotics or benzodiazepines. However, if he abruptly stops taking Montelukast, he may notice a resurgence of symptoms like wheezing or shortness of breath if the underlying condition is not well-controlled.
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Safer Alternatives: Depending on his specific condition, there are several alternatives to Montelukast and Fexofenadine, such as:
- Inhaled Corticosteroids: Medications like budesonide or fluticasone may help with asthma symptoms.
- Leukotriene receptor antagonists: If he is seeking alternatives to Montelukast, options like zafirlukast can be discussed.
- Other antihistamines: Non-sedating options or different classes may also be considered based on his condition. It's important for him to discuss these options with a doctor who understands his medical history and needs.
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Additional Considerations:
- Stay vigilant for any side effects, especially mood changes, and report these to a healthcare provider.
- Regular follow-ups with a doctor are essential, as they can help adjust medications as needed and discuss any concerning symptoms immediately.
- Encourage your friend to maintain an open line of communication with his healthcare providers about his concerns and any new information he discovers.
Next Steps:
- Evaluate and Discuss Concerns: He should schedule a follow-up with his doctor to discuss his concerns and the risks he has read about.
- Consider Alternatives: Ask about safer long-term management options for his respiratory condition.
- Monitor Symptoms: Keep track of any side effects or changes in mood to share with his healthcare provider during follow-ups.
- React Carefully to Missed Doses: If a dose is missed, he should take it as soon as he remembers but skip it if it’s almost time for the next dose. He should not double the dose to catch up.
It's important for your friend to feel empowered and informed about his treatment. Please reassure him that he can reach out to healthcare professionals for clarification and support.
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.