Michael Marcus MD Ped Pulmonary DrMDK
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Male: In the morning, Today’s show, a lot of ads, for a thing called Singulair yet we do use at medicine, not because of the ads. Why would they use a drug called Singulair and what is its advantages in the treatment of asthma? Dr. Marcus: Singulair is a medication in the class called leukotriene modifiers. It is a class of medication which is very important in helping treat both asthma as well as allergies. Singulair blocks a chemical which the body releases called leukotrienes and this chemical is responsible for many of the symptoms that we have seen in patients with asthma including the wheezing, the coughing, as well as the runny nose and congestion that patients with allergies has. By taking Singulair on a once a day basis, we block this chemical in the body thereby preventing the wheezing as well as preventing a lot of the allergy symptoms that our patients may have. Male: In itself and many times, can you just keep the kid well controlled by using it by itself in some patients, is that true? Dr. Marcus: It seems to be very true. There is a group of patients who have been shown to respond very well to Singulair, where it can be used as a single medication to control both asthma and allergy symptoms. What we generally do is we start patients on Singulair and give them a trial of one to two weeks to see if they are in this group that respond well to the medication. And if they do respond well, then we maintain them on this medication throughout their high risk allergy season. Once the season is over, we reassess whether we want to continue them on medication beyond that point in time. If they are not a responder, we then stop the Singulair and move them on to another alternative. Male: Sometimes we even use it in combination with things like Pulmicort, is that true? Dr. Marcus: It is true. The new guidelines have come out which tell us that when we treat patients with asthma, we frequently need to use combination therapy. In the mildest form of disease, we can start with a single drug, either a Singulair or an inhaled corticosteroid. However, if the patient does not get a complete response to the first drug, it is common to add the second drug and perhaps even a third drug if they continue to have a poor response until stepping-up therapy is an important approach in caring for patients with asthma. Male: What is the most common side effect from Singulair that you have found? Dr. Marcus: Singulair is probably one of the safest drugs that have hit the market in recent years. The only side effect that I have seen with Singulair is headache. And the headache that you get with Singulair is stopped the minute you stop the medication, so it doesn’t seem to be common side effect. There are another group of side effects that have been listed in the packaging and I certainly recommend patients to read these so that they know what to look for. But from a practical point of view my own experience is that headache is the one side effect that can occasionally occur. Male: What is the youngest age group that you could give Singulair that is approved by the Food and Drug Administration? Dr. Marcus: Singulair is clearly approved down to two years of age and off label, we have used it even younger than that on occasion but we really shouldn’t be using it younger than that without the proper expertise of a physician experience in using the medication. Male: And it comes in many forms, chewable, regular tablet and like a granular type of thing? Dr. Marcus: Yes. It is very nice that the Singulair has several different options to deliver it depending upon the patient’s ability to chew or swallow. There is a small pill which can be swallowed hole. There is another poll that can be chewed and then swallowed and for the youngest children, it even comes in a power packet, the granules. These granules can be placed in a teaspoon of apple sauce or ice cream or pudding so that they can go down easily without having the child be

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