Why should I take singular at night for asthma?

When reviewing a patient’s medication list I noticed the Singulair (montelukast) prescription instructed her to take one tablet by mouth in the evening. I knew this was the proper way to take this medication because I had seen it come through the pharmacy many times, but I always wondered why it had to be taken in the evening.

In the Rumor vs. Truth section of the Pharmacists Letter evaluating when montelukast should be dosed, they concluded asthma symptoms tend to be worse during the night and early morning hours and that montelukast has a short half-life of about 4-7 hours with blood levels peaking 3-4 hours after a dose.⁴ For these reasons, they concluded that this is why healthcare providers and the prescribing information for montelukast recommends taking it at night in order to match peak drug levels with symptom onset.⁴ A comment was added by a pharmacist from Maryland that leukotriene synthesis occurs more at night than during the day. This would argue that evening dosing would have the most significant benefit on asthma symptoms both during sleep and the next day⁴.  No clinical data could be found supporting this comment. Since the publication from the Pharmacist Letter, there has not been any additional studies or trials conducted to compare morning versus evening dosing of montelukast.
https://info.umkc.edu/pharmtofarm/clinical-question-when-to-take-singulair-montelukast-morning-or-evening/

With the question still slightly up in the air, I would still recommend the use of montelukast in the evening, despite there being no clinical evidence in comparing morning doses versus evening doses in adults with asthma. I say this because from clinical trials comparing placebo versus montelukast, montelukast was always given in the evening showing statistical significant results in reducing asthma symptoms in children and adults.²


https://messageboards.webmd.com/health-conditions/f/asthma/60727/why-should-i-take-singular-at-night-for-asthma

Anti-inflammatory properties of montelukast, a leukotriene receptor antagonist in patients with asthma and nasal polyposis.

Leukotrienes, especially LTC4, are important inflammatory mediators in allergic and nonallergic inflammation of the entire airways. Of particular interest are numerous theories regarding the pathogenesis of aspirin intolerance with subsequent hyperproduction of leukotrienes and inhibition of cyclooxygenase.

OBJECTIVE:

To examine the influence of the cysteinyl-leukotriene receptor antagonist montelukast on clinical symptoms and inflammatory markers in nasal lavage fluid in patients with bronchial asthma and nasal polyps, and determine its dependency on aspirin sensitization.

METHODS:

Twenty-four patients (7 women, 17 men; median age, 55.5 years) with nasal polyps and controlled asthma (n=12 with aspirin intolerance) were treated with 10 mg montelukast once daily for 6 weeks in a blinded, placebo-controlled fashion. The placebo phase was randomly assigned 4 weeks before (n=12) or after treatment (n=12). Symptom score, rhinoendoscopy, rhinomanometry, smears for eosinophils, and nasal lavages for the determination of different mediators were performed.

RESULTS:

Compared to placebo, there were significant improvements in the nasal symptom score and airflow limitation as well as a reduction in the inflammatory mediators in nasal lavage fluid after treatment. Furthermore, reduced eosinophils in nasal smears and peripheral blood were observed 2 and 6 weeks after treatment.

CONCLUSION:

Leukotriene 1 receptor blockade led to a significant decrease in eosinophil inflammation accompanied by a reduction in other mediators such as neurokinin A and substance P in the nasal lavage fluid of patients with nasal polyps and asthma, with or without aspirin intolerance.

https://www.ncbi.nlm.nih.gov/pubmed/21370724

ALCOHOL AND DRUG DETOX

Most of the alcohol detox usually kickstarts 24-hours after evaluation. During this period of time, the patient's vital signs such as the ability to walk, respiration, pulse and blood pressure are used to determine the type of medication that will best suit the individual. There is a gradual reduction in the dosage administered on daily basis. The treatment process lasts for 5 days after which the individual is completely detoxed from alcohol.

There is a general approach that can be adopted in order to detox from benzodiazepines. The patient’s intake is gradually reduced on a daily basis. This detoxing process takes a longer time as compared with that of alcohol. This can last for several months as an outpatient. During this detoxing, the vital signs of the individual are taken on a daily basis throughout the treatment process and the use of non-benzodiazepine medications can be employed in reducing the discomfort associated with withdrawal.

https://www.postpoems.org/authors/artic1904/prose/1066424

Xiaoqin Liu, the lead author, an epidemiologist at the National Center for Register-based Research at Aarhus University in Denmark, revealed that the study is the first look at a wide range of psychiatric disorders, rather than a single psychiatric illness occurring in children who have been exposed to antidepressants in the uterus.
Data generated from this research were in agreement with similar researches conducted in the field. There were some few discrepancies which Liu believed would have been as a result of differences in the sample size and study population, or perhaps they were able to use a modest approach in the present study.
While replying to a mail from Reuters Health, Liu had this to say “We would like to stress that our study does not suggest or support that women with depression discontinue medication during pregnancy.”

http://www.medicalmingle.com/doctor1970/blog/2018/08/05/use_of_antidepressant_during_pregnancy_can_lead_to_higher_risk_of_psychiatric_illness

Today there are more options available for treating alcohol use disorder (AUD) than ever before. Decades of research have led to advances in medications and behavioral therapies to help people recover. Professionally led alcohol treatment now takes place in a variety of settings, including outpatient care that can help many people recover while still living at home.
To learn more about treating AUD, visit the following:


► NIAAA Alcohol Treatment Navigator

This online tool is designed to help consumers find quality treatment for alcohol use disorder (AUD).  

Navigator focuses on evidence-based alcohol treatment, telling you what you need to know about AUD and treatment options, and helping you find the right treatment for you—and near you.

https://www.niaaa.nih.gov/alcohol-health/support-treatment