General: Montelukast sodium should not be abruptly substituted for inhaled or oral corticosteroids. However, the dose of inhaled corticosteroid may be reduced gradually under medical supervision.
Although a casual relationship with leukotriene receptor antagonism has not been established, caution and appropriate clinical monitoring is recommended when systemic corticosteroid reduction is considered in patients receiving montelukast sodium.
Montelukast sodium should not be used as monotherapy for the treatment and management of exercise-induced asthma. Patients who have exacerbations of asthma after exercise should continue to use their usual regimen of inhaled β-agonists as prophylaxis and should have it available as and when required.
Montelukast sodium does not block bronchoconstrictor response to aspirin or NSAIDs in aspirin-sensitive asthmatic patients. Such patients should continue to avoid aspirin and other NSAIDs.
Caution should be exercised when using montelukast sodium with bronchodilator therapy. When clinical response is apparent, the bronchodilator therapy should be reduced.
Use in pregnancy: Montelukast sodium has not been studied in pregnant women. It should be used during pregnancy only if clearly needed.
Use in lactation: It is not known if montelukast sodium is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when montelukast sodium is given to a nursing mother.