Psychiatric Adverse Effects of Montelukast-A Nationwide Cohort Study.

Abstract

BACKGROUND:

Recent observational studies suggest that the leukotriene receptor antagonist montelukast may have neuropsychiatric adverse effects; however, results are conflicting.

OBJECTIVE:

To assess whether montelukast exposure in adults with asthma is associated with onset of neuropsychiatric adverse events using data from the Danish nationwide health registers.

METHODS:

Individuals 18 years old or older with either 1 or more prescription redemption of inhaled corticosteroids or with at least 1 hospital contact with asthma as the main diagnosis between January 1, 2011, and December 31, 2018, were included. Montelukast exposure was assessed as a time-dependent variable. The 2 outcomes of interest were use of neuropsychiatric medicine including antidepressants, antipsychotics, anxiolytics, lithium, and medication used for attention-deficit/hyperactivity disorder (outcome 1), and hospital contacts with a neuropsychiatric diagnosis (outcome 2), within 90 days of exposure to montelukast.

RESULTS:

Initiation of montelukast was significantly associated with outcome 1: use of neuropsychiatric medicine (hazard ratio [95% confidence interval]) 1.14 [1.08-1.20]; P < .0001). In the assessment of outcome 2: hospital contacts with a neuropsychiatric diagnosis, a significant risk associated with montelukast initiation was found only in the youngest age groups (hazard ratio [95% confidence interval] 1.28 [1.12-1.47], P < .001 and 1.16 [1.02-1.31]; P < .05, for age group 18-29 y and 30-44 y, respectively). Age-stratified analyses showed that the risk of both outcomes increased with decreasing age, with the highest risk seen in patients aged 18 to 29 years.

CONCLUSIONS:

Among younger individuals, montelukast use was significantly associated with an increased risk of neuropsychiatric events such as use of neuropsychiatric medicine and hospital treatment. Clinicians should increase awareness of such adverse effects when prescribing montelukast.

• Authors: Alexander Jordan, Louise Lindhardt Toennesen, Josefin Eklöf, Pradeesh Sivapalan, Howraman Meteran, Klaus Bønnelykke, Charlotte Suppli Ulrik, Jens-Ulrik Stæhr Jensen
• Journal: The journal of allergy and clinical immunology. In practice (J Allergy Clin Immunol Pract) Vol. 11 Issue 7 Pg. 2096-2103.e1 (07 2023) ISSN: 2213-2201 [Electronic] United States
• PMID: 36948487 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2023 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Chemical References

• montelukast
• Leukotriene Antagonists
• Acetates
• Quinolines
• Anti-Asthmatic Agents

Topics

• Adult
• Humans
• Adolescent
• Young Adult
• Cohort Studies
• Asthma (drug therapy)
• Leukotriene Antagonists (adverse effects)
• Acetates (adverse effects)
• Quinolines (adverse effects)
• Drug-Related Side Effects and Adverse Reactions (drug therapy)
• Anti-Asthmatic Agents (adverse effects)