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Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
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Dose selection and dosing interval determination for LTRA use in asthma.

L Hendeles1

  • 1Department of Pharmacy Practice, University of Florida, Gainesville, FL 32610-0486, USA.

Postgraduate Medicine
|August 12, 2009
PubMed
Summary

Montelukast is effective and safe at a 10-mg daily dose for asthma. Higher zafirlukast doses improved efficacy but increased liver enzyme risk, with specific dosing for pediatric asthma patients.

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Area of Science:

  • Pharmacology
  • Pulmonology
  • Clinical Therapeutics

Background:

  • Leukotriene receptor antagonists (LTRAs) are crucial in asthma management.
  • Optimizing dosage and administration of montelukast and zafirlukast is essential for patient outcomes.

Purpose of the Study:

  • To determine optimal dosing and intervals for montelukast and zafirlukast in adult and pediatric asthma patients.
  • To evaluate the safety and efficacy profiles of different LTRA dosages and administration routes.

Main Methods:

  • Bronchoprovocation challenges (exercise, leukotriene D4) were used to establish initial dosing.
  • Dose-ranging studies, pharmacokinetic analyses, and safety assessments were conducted.
  • Pediatric efficacy and tolerability were evaluated for specific age groups.

Main Results:

  • A once-daily 10-mg dose of montelukast was found effective and safe for adults; higher doses offered no additional benefit.
  • Higher zafirlukast doses increased efficacy but also elevated liver enzymes; food and drug interactions were noted.
  • Montelukast chewable tablets (5-mg and 4-mg) were effective and well-tolerated in pediatric age groups (6-14 and 2-5 years, respectively).
  • Zafirlukast 10-mg film-coated tablets were approved for children aged 7-11 years, requiring twice-daily administration on an empty stomach.

Conclusions:

  • Montelukast demonstrates a favorable safety and efficacy profile with a simple once-daily 10-mg adult dose.
  • Zafirlukast's efficacy is dose-dependent, but higher doses carry increased risks, necessitating careful administration, especially in children.
  • Specific pediatric formulations and dosing regimens for both montelukast and zafirlukast ensure therapeutic effectiveness across different age groups.