Have you observed adverse mental health side effects in patients who start montelukast?

A female patient with anxiety but no history of depression or suicidal tendencies developed suicidal ideation with intrusive thoughts while taking montelukast. These were resolved within days of stopping the medication. I also treated a child brought in by his parents for extreme and sometimes viole...

I've had parents describe these neuropsychiatric side effects to me since my fellowship in the early 2000s. This was 15 years before the FDA placed the Black Box warning. This is an unpredictable side effect, and I rarely have started patients on montelukast since 2020. That's aside from the fact th...

Never suicidal ideation, but mood changes and vivid dreams causing sleep disturbance.

I have seen this with multiple pediatric patients who experienced significant behavior changes, mood swings, and problems with sleep which resolved when montelukast was discontinued. I always discuss the side effects and black box warning prior to prescribing it and tell them to notify my office and...

I have not had anyone admit to suicidal ideation. Most elderly patients feel sleepy and are advised to take it at bedtime. Few admit to getting agitated and discontinue it. I do counsel patients routinely and may avoid it in established major depressive disorder since the pcp, psychiatrist, or the e...

Always discuss and counsel before prescribing, but have not experienced any patient exhibiting the suicidality side effect.