When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be instructed that:

Rationale: A. Weight gain is not a documented or common side effect associated with the use of leukotriene receptor antagonists like montelukast. Unlike systemic corticosteroids, which can cause fluid retention and metabolic changes, montelukast does not interfere with adiposity or appetite regulation. Instructing patients to watch for weight gain would be medically inaccurate and could lead to unnecessary anxiety about the medication's effects. B. Lethargy and hypersomnia are not typical adverse reactions for this class of medication; in fact, the opposite is more frequently reported. Montelukast is more likely to cause sleep disturbances or vivid dreams rather than excessive sleepiness or a lack of energy. Providing instructions about lethargy would misguide the patient and could mask other potential clinical issues that might be occurring during their treatment. C. The FDA has issued a boxed warning for montelukast because it is associated with serious neuropsychiatric events, including agitation, aggression, depression, sleep disturbances, and suicidal thoughts. It is critical for providers to educate patients and parents to monitor for any sudden changes in mood or behavior while on this therapy. If these symptoms emerge, the medication should be discontinued immediately and the healthcare provider should be contacted. D. Montelukast is a chronic controller medication and should not be used as a rescue agent or have its dose increased during an acute asthma exacerbation. The dosage remains constant as part of the daily management plan to prevent inflammation. Increasing the dose during an attack does not provide rapid bronchodilation and only increases the risk of side effects without offering acute respiratory relief for the patient.