Montelukast treatment for asthma raises risk of a neuropsychiatric event

Michael G Burke, MD

Children who are prescribed montelukast for managing their asthma are nearly twice as likely to experience a neuropsychiatric event as asthmatic children who are taking other asthma maintenance medications. Canadian investigators based this finding, which controlled for sociodemographic factors and measures of asthma severity and treatment, on analysis of data from 2004 to 2015 related to a group of asthmatic children aged from 5 to 18 years old.

Each of the 898 study children with asthma who experienced a neuropsychiatric event was matched to a maximum of 4 controls who had no neuropsychiatric events. The most common events were anxiety (48.6%) and sleep disturbance (26.1%), almost half of which arose within 90 days of the most recently dispensed asthma maintenance prescription.

In addition to being more likely to have been exposed to montelukast in the previous year, children who experienced an event also had significantly more ED visits and hospitalizations for asthma during this period and were more likely to have a dispensed prescription for systemic corticosteroids and other asthma maintenance medications (Glockler-Lauf SD, et al. J Pediatr. 2019;209;176-182).

Thoughts from Dr. Burke

These findings won’t stop me from using this medication in a child who needs it, but if a child with asthma who is on montelukast develops anxiety or another neuropsychiatric conditions, I’ll consider stopping it.