Should you use Singulair for allergies?

In this article:

• What is Singulair?
• Effectiveness for allergies
• FDA warning
• Conditions it treats
• Dosage
• Alternatives
• Cost
• FAQs

In this article

• What is Singulair?
• Effectiveness for allergies
• FDA warning
• Conditions it treats
• Dosage
• Alternatives
• Cost
• FAQs

If you have allergy symptoms, such as itching, sneezing, cough, a runny nose, stuffy nose, or watery eyes, you may be wondering if Singulair (montelukast) can help. Singulair is a prescription medication used to prevent and control asthma (including exercise-induced asthma) and to treat certain types of allergic rhinitis. It belongs to a class of medications called leukotriene receptor antagonists, which work by blocking chemicals that contribute to inflammation and allergy symptoms.

Singulair can help relieve allergy symptoms, but it is not usually a first-choice treatment. The U.S. Food and Drug Administration (FDA) recommends reserving it for people whose allergies have not improved enough with other medications or who cannot tolerate them because of the drug’s potential for serious mental health side effects. Antihistamines and nasal steroid sprays are generally tried first.

So, how well does Singulair work for allergies, how long does it take to work, and what should you know about its side effects and dosage? Here’s what to know.

What is Singulair, and is it an antihistamine or a steroid?

Singulair is not an antihistamine (like Claritin or Zyrtec) or a steroid (like Flonase or prednisone). When your body is exposed to an allergen, your immune system releases chemicals that initiate the allergic response. These chemicals are often histamines, which commonly-known allergy medications work against. But, they can also be leukotrienes. Singulair is a leukotriene receptor blocker, a different drug class. It works by stopping these chemicals from causing symptoms of asthma and allergies.

Unlike many asthma medications, Singulair is not an inhaler. It is available as oral tablets, oral chewable tablets, and oral granules. You typically take Singulair once daily for asthma or allergies, with the exception of exercise-induced bronchoconstriction (EIB), where you take it at least two hours before exercise.

How effective is Singulair for allergies, and how long does it take to work?

Singulair can be effective in reducing allergy symptoms, but it doesn’t work right away. It may start relieving symptoms within one to three days of beginning treatment. In clinical studies, patients reported an improvement in symptoms by the second day of treatment.

Unlike antihistamines, which can be taken as needed for relatively fast allergy relief, Singulair is taken once daily to prevent and control allergy symptoms. However, current FDA guidance recommends that Singulair should only be used for allergic rhinitis when other treatments, such as antihistamines and nasal steroid sprays, have not worked well enough or cannot be tolerated, rather than as a first choice of treatment. That’s because Singulair comes with a boxed warning (also known as a black box warning) because of potential mental health risks.

What is the FDA warning about Singulair?

In 2020, the FDA added a boxed warning (the agency’s strongest safety warning) to Singulair and all other montelukast products because of reports of serious mental health side effects. The FDA had previously warned about mood and behavior changes associated with montelukast, but a review of reported cases led the agency to strengthen the warning.

Reported side effects include changes in mood or behavior, sleep problems, depression, feeling anxious, agitation, and suicidal thoughts or actions. Some side effects occurred while people were taking montelukast and improved after they stopped taking it. In other cases, symptoms began or continued after treatment ended. The FDA says it cannot determine how likely someone is to experience these side effects because people can respond differently to the medication.

For people with allergic rhinitis, the FDA recommends using montelukast only when other medications have not worked well enough or cannot be tolerated. This is because other allergy medications, including antihistamines and nasal steroid sprays, are available and have established safety records. For people taking montelukast for asthma or exercise-induced bronchoconstriction (EIB), healthcare providers should weigh the potential benefits and risks.

Most people tolerate Singulair well, and the more common side effects are generally mild, such as headache, stomach pain, cough, diarrhea, and upper respiratory symptoms like a sore throat or earache. The medication guide lists the following possible mental health side effects:

• Agitation, including aggression or hostility
• Attention problems
• Memory problems
• Bad or vivid dreams
• Depression
• Confusion or disorientation
• Anxiety
• Irritability
• Hallucinations (seeing/hearing things that are not there)
• Obsessive-compulsive symptoms
• Restlessness
• Trouble sleeping
• Sleepwalking
• Stuttering
• Thoughts of suicide
• Tremor (shaking) or uncontrolled muscle movements

If you or your child has changes in mood or behavior while taking Singulair, stop taking the medicine and call your healthcare provider right away. If there is an immediate risk of suicide, call or text the 988 Suicide and Crisis Lifeline or call 911. Rarely, people can have an allergic reaction to Singulair itself. Signs include rash, hives, itching, or swelling of the face, lips, tongue, or throat. Get emergency medical help right away if you have trouble breathing or swelling in the face or throat.

Can Singulair treat asthma and allergies?

Asthma and allergic rhinitis often go hand in hand. Many people with asthma also have hay fever or year-round nasal allergies, and allergen exposure can trigger both nasal symptoms and asthma flares. Because Singulair is approved for both conditions, it’s sometimes considered for people who have both, since one daily medication can target both sets of symptoms.

That said, the FDA’s guidance still applies. The agency’s recommendation to reserve montelukast for allergic rhinitis when other treatments fail or aren’t tolerated doesn’t disappear because someone also has asthma. Instead, your healthcare provider will weigh the potential benefits against the mental health risks in light of your full health profile, including how well your asthma is controlled and how you’ve responded to other allergy treatments.

If you have both conditions, talk with your provider about which combination of medications makes the most sense for you. Don’t stop or change any asthma medication without their guidance. Singulair is meant to prevent asthma symptoms over time, not to stop an asthma attack that has already started, so keep your rescue inhaler with you if your provider has prescribed one.

What is the dosage for Singulair?

If your healthcare team prescribes Singulair, they will tell you the appropriate dose for your age and condition. Typical dosing is:

• Asthma: once daily in the evening for patients 12 months and older
• Prevention of EIB: one tablet at least two hours before exercise for patients 6 years and older
• Allergies: once daily (for seasonal allergies: patients 2 years and older, for perennial allergic rhinitis: patients 6 months and older)

What’s unique about Singulair is the dose isn’t based on weight, like many other drugs. It is based on age. The dose by age is as follows:

• 6–23 months: 1 packet of 4 mg oral granules
• 2–5 years: 1 packet of 4 mg oral granules or one 4 mg chewable tablet
• 6–14 years: 1, 5 mg chewable tablet
• 15 years and older: 1, 10 mg oral tablet

Are there alternatives to Singulair?

Yes, there are many first-line alternatives to Singulair for allergies, including:

• Antihistamines, such as Claritin or Xyzal
• Nasal steroid sprays, like Flonase or Nasacort
• Antihistamine nasal sprays, such as Astepro (azelastine)
• Antihistamine/steroid combination nasal sprays, such as Dymista
• Antihistamine eye drops, like Zatidor or Pataday

It’s likely your provider will recommend one of these medications first, before trying Singulair. Always check with your healthcare provider before switching medications.

How much does Singulair cost?

Without insurance or discounts, brand-name Singulair can be quite costly. The typical price for 90, 10 mg tablets of brand-name Singulair is about $1,125. The good news, though, is that generic montelukast is widely available and significantly less expensive than Singulair. Without insurance, the typical price for 90, 10 mg tablets of generic montelukast is about $396, which is much less than the brand. However, if you use a free SingleCare discount, you can pay as low as $9 at Kroger or Harris Teeter for 90, 10 mg tablets of generic montelukast. What’s more, you can use the SingleCare discount on your first prescription and refills.

Frequently asked questions

Is Singulair the same as an antihistamine like Claritin or Zyrtec?

Singulair is not an antihistamine. It is in a class of drugs called leukotriene receptor antagonists. For allergies, it is only recommended for use when other medications, such as antihistamines or nasal steroids, have not been effective or cannot be tolerated.

What does the FDA boxed warning on Singulair mean for someone taking it for allergies?

Because of the mental health risks, healthcare providers generally reserve Singulair for allergies when other medications, such as antihistamines or nasal steroids, have not provided adequate relief or cannot be tolerated. If you are taking Singulair for allergies, it usually means that other allergy medications have not worked well enough or you could not tolerate them. While taking Singulair, you should be alert to changes in mood, behavior, and thinking. If any of these symptoms occur, stop taking Singulair and call your healthcare provider right away.

How long does it take for Singulair to start working for allergy symptoms?

Singulair may start reducing allergy symptoms within a few days. In one clinical study, people reported a reduction in symptoms by the second day of treatment.