Asthma & Allergy Medication Comparison Tool
Find Your Best Match
Answer a few questions about your situation to see which asthma or allergy medication might work best for you.
Your Condition
Your Considerations
Quick Takeaways
- Singulair (montelukast) is a onceâdaily oral tablet that blocks leukotrienes, helping control mildâtoâmoderate asthma and seasonal allergies.
- Inhaled corticosteroids (ICS) such as fluticasone and budesonide are usually more potent for persistent asthma but require a device.
- Zafirlukast offers a similar leukotrieneâblocking effect to Singulair, yet itâs taken twice daily and has a higher risk of liver issues.
- Oral antihistamines (cetirizine, loratadine) relieve allergic rhinitis but do not prevent asthma symptoms.
- Choosing the right therapy depends on disease severity, age, dosing preference, cost, and any history of sideâeffects.
When you Singulair compare options, the goal is to find a medication that fits your lifestyle while keeping symptoms in check. Below is a deep dive into how montelukast stacks up against the most common alternatives.
What is Singulair (Montelukast)?
Singulair is a branded oral tablet whose generic name is montelukast. It belongs to the class of leukotriene receptor antagonists (LTRAs), which block the action of inflammatory chemicals called leukotrienes.
How does montelukast work?
Leukotrienes tighten airway muscles, increase mucus production, and attract inflammatory cells. By binding to the cysteinyl leukotriene receptor (CysLT1), montelukast prevents these actions, leading to smoother breathing and less nasal congestion. The effect begins within hours and reaches steady state after a few days of daily use.
Who typically uses Singulair?
Doctors prescribe montelukast for:
- Persistent mildâtoâmoderate asthma in children aged 6months and older.
- Seasonal allergic rhinitis (hay fever) when antihistamines alone arenât enough.
- Exerciseâinduced bronchoconstriction (EIB) as a preventive dose taken an hour before activity.
Because itâs a tablet, itâs a favorite for patients who struggle with inhaler technique or who need a medication that doesnât require a device.
Common alternatives
Below are the main drug families youâll encounter when looking for asthma or allergy relief.
Zafirlukast is another LTRA. It shares the same mechanism as montelukast but must be taken twice daily and has a boxed warning for potential liver injury.
Fluticasone propionate is an inhaled corticosteroid (ICS). It reduces airway inflammation at the source and is considered firstâline for persistent asthma.
Budesonide is another ICS, often delivered via dryâpowder inhaler or nebulizer. It offers a slightly different particle size profile, which can help some patients achieve better lung deposition.
Cetirizine is a secondâgeneration antihistamine. It blocks histamine receptors, providing fast relief for sneezing, itching, and watery eyes, but it does not address the leukotrieneâdriven airway narrowing seen in asthma.
Loratadine works like cetirizine-excellent for nasal congestion and itchy eyes, but insufficient for asthma control.
Rescue inhalers such as salbutamol (known as albuterol in the US) remain essential for acute bronchospasm, regardless of maintenance therapy.
Sideâeffect profile at a glance
| Drug | Common sideâeffects | Serious concerns | Monitoring needed? |
|---|---|---|---|
| Singulair (montelukast) | Headache, abdominal pain, occasional cough | Neuropsychiatric events (mood changes, suicidal thoughts) | Ask about mood changes at each visit |
| Zafirlukast | Nausea, joint pain, dizziness | Liver enzyme elevation, rare hepatitis | Liver function tests every 3â6months |
| Fluticasone (ICS) | Oropharyngeal candidiasis, hoarseness | Potential reduction in bone mineral density with longâterm high doses | Dental hygiene, periodic bone density screening if highâdose >2years |
| Budesonide (ICS) | Throat irritation, cough | Systemic cortisol suppression at high doses | Check morning cortisol if dosage >800Âľg/day |
| Cetirizine (antihistamine) | Transient drowsiness (rare with secondâgen) | None significant | No routine labs needed |
Efficacy and onset of action
In randomized trials, montelukast reduced nighttime awakenings by about 30% compared with placebo in mild asthma. In contrast, lowâdose inhaled steroids can cut exacerbations by up to 50% but take 1-2weeks to reach full effect.
Zafirlukast shows similar efficacy to montelukast when dosed twice daily, yet adherence drops because of the extra pill burden. Antihistamines excel at rapid symptom relief for hay fever (often within 30minutes) but do not improve lung function.
For patients who need quick protection before exercise, a single 10mg dose of montelukast taken one hour prior is as effective as a shortâacting βâagonist in reducing postâexercise bronchoconstriction.
Cost and convenience
In NewZealand, a 30âday supply of generic montelukast costs roughly NZD25, while brandâname Singulair is about NZD45. Inhaled steroids like fluticasone cost around NZD55 for a monthâs worth of inhaler, plus the initial purchase of the device.
Oral antihistamines are the cheapest-often under NZD15 for a month-but you still need an inhaler for rescue therapy. The convenience of a onceâdaily pill can tip the balance for busy families or older adults who find inhalers tricky.
How to choose the right option for you
- Mild intermittent asthma, good inhaler technique: Start with a lowâdose inhaled corticosteroid or a shortâacting βâagonist as needed. Add montelukast only if symptoms persist at night.
- Exerciseâinduced bronchoconstriction: Montelukast taken an hour before activity works well, especially when a rescue inhaler isnât convenient.
- Concurrent allergic rhinitis: Combine montelukast with an oral antihistamine for dual relief, or choose a nasal steroid spray for rhinitis and keep an inhaled steroid for asthma.
- Adherence concerns (multiple daily doses): Prefer onceâdaily oral agents (montelukast) over twiceâdaily zafirlukast or inhalers that require technique.
- Liver disease or abnormal liver enzymes: Avoid zafirlukast; montelukast is safer for the liver.
- History of mood disorders: Discuss the neuropsychiatric warning with your prescriber; consider an inhaled steroid instead.
Always review your medication list with a pharmacist or nurse, especially if youâre on multiple asthma controllers.
Switching or combining therapies safely
If youâre moving from an inhaled steroid to montelukast, taper the steroid over 1-2weeks to avoid rebound inflammation. When adding montelukast to an existing inhaled steroid, no dose adjustment is needed-just monitor for overlapping sideâeffects.
Combination therapy (ICS+LTRA) is common in moderate asthma. Studies show a reduction in nighttime symptoms by an extra 15% compared with an inhaled steroid alone.
Never replace a rescue inhaler with an oral controller; keep a shortâacting βâagonist (like salbutamol) on hand for sudden attacks.
Frequently Asked Questions
Frequently Asked Questions
Can I take Singulair and an antihistamine together?
Yes. Montelukast and secondâgeneration antihistamines such as cetirizine work via different pathways, so using them together often gives better control of both asthma and hay fever without added risk.
Is montelukast safe for children under 2 years?
The tablet is approved for children 6months and older for asthma prevention. The chewable form is used for kids 2years and up. Always follow the pediatric dosing chart.
What should I do if I experience mood changes while on Singulair?
Contact your prescriber immediately. They may pause the medication, switch to an inhaled steroid, or refer you to a mentalâhealth professional. Do not stop abruptly without guidance.
How quickly does montelukast start working before exercise?
Take a 10mg tablet about one hour before the activity. Most users notice less coughing and wheezing during and after exercise.
Is a generic version as effective as Singulair?
Yes. Generic montelukast contains the same active ingredient and has been shown in bioâequivalence studies to provide identical clinical outcomes.
Next steps
1ď¸âŁ Review your current symptom diary - note nighttime awakenings, rescue inhaler use, and allergy triggers.
2ď¸âŁ Bring that diary to your next appointment and discuss whether a leukotriene antagonist, an inhaled steroid, or a combination best fits your pattern.
3ď¸âŁ If cost is a major factor, ask about the generic version of montelukast or bulkâorder programs offered by local pharmacies in Wellington.
4ď¸âŁ Set a reminder to check mood, liver function (if using zafirlukast), or oral hygiene (if using inhaled steroids) at your regular checkâups.
Choosing the right controller is a personal decision, but with the facts laid out you can have a clear conversation with your prescriber and avoid trialâandâerror that wastes time and money.
Winnie Chan
October 13, 2025 AT 18:53