Prescribing hormonal therapy to asthmatic children greatly worries parents, because with prolonged use of steroid drugs, addiction develops to them. This is due to the fact that there is no point in the adrenal glands synthesizing their own hormones if they come from outside. As a result, the function of endocrine cells gradually decreases, and ultimately the hormonally active tissue atrophies irrevocably. In addition, steroids have a lot of side effects that lead to another pathology.
So is there really no alternative medicine that alleviates the condition of a child doomed to hide from allergens and avoid physical activity all his life? Such a drug exists, it is Singular, but the instructions for its use are so difficult for the average person to understand that the help of a qualified physician is required to explain it. And I, as a doctor with the highest qualification category, offer you this help.
Release form
"Singulair" for children are chewable tablets, for adolescents and adults - coated tablets . No other dosage forms are produced. They were made to be chewed so that the absorption of the active substance began already in the child’s oral cavity, because the oral mucosa has a powerful absorption capacity. In addition, they were provided with sweetener, coloring and cherry flavoring so that young patients would not refuse the medicine.
All tablets are packaged in coins of 7 pieces. For different age categories, different dosages of the drug and different quantities in 1 package are provided:
- chewable tablets with 4 mg of active ingredient, 1, 2 or 4 coins per pack, with a shelf life of 2 years;
- chewable tablets with 5 mg of active ingredient, 2 or 4 coins per pack, with a shelf life of 2 years;
- coated tablets with 10 mg of active substance, 2 or 4 coins per pack, with a shelf life of 3 years.
What is this substance?
Contraindications
- Phenylketonuria;
- A rare form of hereditary galactose intolerance, congenital lactase deficiency or glucose-galactose malabsorption (for film-coated tablets);
- Children's age: up to 2 years (chewable tablets 4 mg); up to 6 years (chewable tablets 5 mg and film-coated tablets);
- Hypersensitivity to the components of the drug.
During pregnancy and during the breastfeeding period, the use of Singulair is permissible only in cases where the expected effect of therapy for the mother significantly exceeds the possible risk for the developing fetus or infant.
Composition and principle of action
To understand the mechanism of the effect produced by the drug, it is advisable to familiarize yourself with some aspects of the allergic reaction.
An allergen that enters the body comes into contact with the receptors of immune cells - leukocytes, macrophages, mast cells. In response to the “treacherous invasion,” complex chemical reactions occur inside these cells, the product of which are highly active substances – leukotrienes. They enter the bloodstream and activate target cells, resulting in:
- spasm of smooth muscles (primarily the bronchi and gastrointestinal tract);
- release of plasma beyond the vascular wall;
- reduction of the pulmonary parenchyma.
In simple words, tissue edema develops, bronchial secretion increases, the lumen of the bronchial tree narrows and the respiratory surface of the lungs decreases. As a result, the child suffocates and “drowns” in his own phlegm. It is worth noting that these reactions develop more slowly than under the influence of another allergic mediator - histamine, but last much longer.
Now let's get back to the active ingredient of Singulair. This is montelukast sodium, which initially blocks leukotriene receptors on target cells, breaking the chain of allergic reactions. Already in the upper part of the gastrointestinal tract, it is completely absorbed, and, upon entering the blood, binds to proteins and spreads throughout the tissues. 3 hours after administration, its maximum concentration is observed in the blood. After another 2-3 hours, its content in the body is halved as a result of decay and intensive excretion.
Maximum relaxation of the bronchial muscles lasts 2 hours . In addition to bronchodilation, antileukotriene inhibits bronchial secretion and reduces the permeability of vascular walls, preventing edema. The drug does not penetrate the blood-brain barrier, which means it does not enter the central nervous system. It is completely processed by the liver, its metabolites enter the bile, then into the intestines and are completely excreted.
Pharmacology
When ingested, the active component of the drug “Singulair” has a depressing effect on CysLT1 receptors. This allows you to influence the mediators that accompany inflammatory processes. These same mediators are associated with increased activity of the bronchi, which is characteristic of asthma. Correct use of the drug allows you to reduce the volume of secretions generated in the bronchi.
As a result, the swelling of the airways becomes weaker. In general, this has a positive effect on the condition of the mucous membrane covering the respiratory tract. Proper use of the medication can reduce the frequency and number of attacks. The disease progresses more easily. Always try to carefully read the instructions for use of Singular for children/adults.
On the first day after the active component enters the human body, the bronchodilator effect increases, which is then maintained for a long period of time sufficiently pronounced so that the asthmatic’s condition stabilizes. The greatest positive effect is observed if persistent asthma is diagnosed, and bronchodilators do not sufficiently control the patient’s condition.
Indications
"Singular" is prescribed:
- to prevent the development of attacks of bronchial asthma, especially before upcoming physical activity or with increased sensitivity to salicylates;
- in case of intolerance or ineffectiveness of glucocorticosteroids in the treatment of bronchial asthma;
- for the treatment of hormone-dependent asthma with long interictal periods;
- in complex therapy of severe allergic rhinitis.
Combine wisely
"Singular" can be safely used with many medications developed for patients with bronchial asthma suffering from rhinitis caused by allergies. The drug is combined with both preventive medications and medications used for long-term treatment of these disorders. Compatibility does not depend on the dosage form of the drug "Singulair".
If the patient has been treated with corticosteroids in the form of aerosols, the manufacturer recommends switching to Singulair smoothly, under the supervision of the attending physician. A sudden change in treatment strategy can provoke negative reactions in the body. It is not recommended to change one type of medication to another at your own request, without the recommendation of a doctor and his attentive attitude to the situation.
The product is designed as a base for long-term therapy. Self-medication with its use can lead to unpredictable reactions. In case of an acute infectious process, the drug can be used when a doctor assesses the patient’s condition. In such a situation, combination with other medications chosen by a specialist based on the specifics of the disease is usually practiced.
Special Instructions
- Since the therapeutic effect of antileukotriene develops gradually - during the first day, it is not used to stop an attack. In emergency cases, standard drugs are used to eliminate bronchial obstruction.
- However, once a course of treatment with Singular is started, it is not canceled if the pathology worsens or attacks develop.
- Depending on the course of the disease, the doctor can gradually (but not sharply!) reduce the dosage of inhaled and oral glucocorticosteroids without changing the frequency of administration and dosage of Singulair.
Analogues of Singulair
The following analogues of Singulair are sold in pharmacies:
- Vanseir;
- Glemont;
- Lucast;
- Milukant;
- Moncasta;
- Montel;
- Single;
- Tevalukast.
All drugs have their own nuances of use. Analogues of Singulair should not be used without the appointment of a specialist. All of the above funds are quite expensive. But the price of Singulair analogues is noticeably lower than the drug described. Of these, Vanseir and Tevalukast are considered the most affordable.
Single or Singular – which is better?
Singlen is one of the most popular analogues of Singular. The last drug is too expensive for many, so they try to look for substitutes for it. Questions “Singlon or Singular – which is better?” can often be found on forums. Those who have tried both products write that they did not notice any difference. At the same time, Singlon is half the price.
Doctors report that there is still a difference in effectiveness and in most cases it is better to take Singulair, but if you need to replace it, then it is advisable to start taking Singlon.
At what age is it allowed to take
The drug is approved for use from 2 years of age. This is due to the fact that the diagnosis of bronchial asthma at an earlier age is rarely made, and if there are isolated cases, they are not yet treated with hormones.
The instructions are divided into the following patient groups:
- from 2 to 5 years;
- from 6 to 14 years;
- over 15 years old.
I’ll immediately warn you about your question: why not “from 5 to 14” and not “over 14”, because it turns out to be a failure of 1 year? Because only full age is taken into account for children. That is, if a child is 5 years and 11.5 months old, then he is still considered to be 5 years old (the same is the case with 14 years old).
When is it not recommended?
In some cases, you can use Singular only very carefully, under the supervision of your doctor, or even better to refrain from using the medication and find a replacement for it. Instructions for use of 5-, 10-milligram Singular for children/adults mention the following groups of people:
- children under six years of age;
- persons who cannot tolerate the components of the drug;
- pregnant women;
- women during lactation;
- patients with phenylketonuria.
Instructions for use and dosage
Tablets are given to babies outside of meals (1 hour before or 2 hours after), at any time of the day when it is convenient for the little patient. It is more physiological to take them at night, when the bronchopulmonary system is most functional, and the likelihood of an attack is higher than during the day.
- In the first age category (from 2 to 5 years), chewable Singulair 4 mg is prescribed, according to the instructions for children, 1 time per day.
- In the second age category (from 6 to 14 years), chewable Singulair is also prescribed once a day, but, according to the instructions for children, this time in a dosage of 5 mg.
- In the third age category (over 15 years old), coated Singular tablets containing 10 mg of active substance are used, according to the instructions for children - also once a day.
Antileukotriene is a drug with cumulative action. That is, to achieve a lasting therapeutic effect, it should be taken for at least 1 month. Knowing the timing of the onset of exacerbation, you can calculate the time to start taking it. For example, if a child’s season of exacerbation of bronchial asthma or allergic rhinitis starts at the end of September, then to prevent attacks and alleviate the course of the disease, antileukotriene should be started at the end of August.
The average duration of the course is 90 days, but the final duration is set by the pediatrician, depending on the clinical picture. It is possible to repeat the course of treatment after a certain period of time, and this is also decided by the doctor.
Negative effects: what to be prepared for?
According to the instructions for use of Singular for children/adults, you may encounter a number of side effects. Some of them are recorded in a large percentage of cases. Patients complain of:
- cough;
- runny nose;
- headache;
- nausea;
- sore throat;
- abdominal pain;
- allergies.
Laboratory tests show that liver transaminases are activated.
In some cases, infection of the respiratory system is possible. The upper paths are the first to suffer.
Some patients experienced bleeding when using the medication. There are known cases of intolerance, explained by the individual characteristics of the body. This can lead to anaphylaxis. With a frequency of less than one case in ten thousand, those who practiced treatment with Singulair may experience liver damage - eosinophilic infiltration.
Some patients complain of a change in character under the influence of the medication: they become irritable and aggressive. There may be manifestations of hostility, sometimes agitation. In some cases, side effects include tachycardia, a headache, and very rarely convulsions. Many patients complained that during treatment with Singular they constantly wanted to sleep. Extremely rare, but still cases of hepatitis have been recorded.
Overdose
In essence, an overdose is manifested by an increase in side effects, and the most often observed in practice:
- dyspeptic disorders in the form of thirst, discomfort and abdominal pain, nausea, single vomiting not associated with food intake;
- disturbances in the functioning of the nervous system in the form of psychomotor agitation or lethargy and drowsiness, headaches.
An antidote has not been invented for the drug, so if signs of overdose occur, symptomatic treatment is used.
Rare, but apt: unpleasant side effects
If an allergic reaction develops when using Singular, not only relatively safe urticaria is possible, but also angioedema, which poses a danger to the health and life of the patient.
Patients undergoing treatment with this drug are more prone to the appearance of hematomas and erythemas. The skin may break out in a rash or become itchy. Some patients have bleeding from the nose and develop a pulmonary form of eosinophilia. The following side effects may occur from the gastrointestinal tract:
- stool disorder;
- pancreatitis;
- dyspepsia;
- nausea, vomiting.
Some patients complain of pain, aching sensations in muscles and joints, turning into cramps (extremely rare). In younger children, therapy is sometimes accompanied by urinary incontinence. At any age, patients treated with Singulair sometimes complain of fatigue, general weakness, asthenic syndrome and swelling.
Interaction with other drugs
Treatment of bronchial asthma and prolonged allergic rhinitis involves the complex use of drugs from different pharmacological groups. Therefore, it will not hurt to find out about the interaction of Singular with other drugs.
- One of the most prescribed groups of medications for bronchial asthma and allergic rhinitis are antihistamines. They go well with Singular, but the effect of some is potentiated by it. This enhances the effect of the histamine receptor blocker Loratadine, so the regimen for taking it is being reviewed. But Fenistil drops or Suprastin antihistamine tablets do not interact with antileukotriene, and they are combined without caution in the treatment of year-round allergic rhinitis.
- Singulair is not prescribed together with Phenobarbital, which reduces the effectiveness of the drug in question by 40%. In the case of simultaneous treatment of bronchial asthma / allergic rhinitis and diseases with increased nervous excitability, an individual therapeutic regimen is selected.
The instructions do not indicate other drug interactions.
What if there is too much?
An overdose of Singulair can lead to quite unpleasant consequences, so it is important to use the tablets correctly, following the recommendations of the manufacturer and the attending physician. Research, clinical trials, as well as reviews from patients who have used the drug contain references to the feeling of thirst, gag reflex, and overexcitation that accompany poisoning of the body. Your head and stomach may hurt. Many people who have experienced an overdose have complained of a craving for sleep.
There is no specific antidote. In case of poisoning of the body, it is necessary to carry out symptomatic therapy.
Reviews
In addition to explaining the instructions for use, I would like to offer several real reviews of Singular for children, which was used in dosages of 4 mg and 5 mg for different types of allergies.
- Nadezhda: We treated our daughter for paroxysmal cough in different departments, using a variety of drugs. It was eventually discovered that she had allergies. Significant improvement was achieved with Prednisolone, Berodual and Pulmicort inhalations, after which a 4-month course of Singulair was prescribed. The drug clearly improved the child's condition. A lot of time has passed since the end of the course, and the attacks have become more frequent again. We will definitely take a repeat course!
- Svetlana: My child is 3.5 years old. I fell ill with a strange dry cough, worse at night, and a never-ending runny nose. At first I treated myself, studying the instructions on the Internet and in the pharmacy. Did not help. At an appointment at the clinic, the pediatrician prescribed Singular. We did not postpone treatment, since while still in line outside the office we collected a whole bunch of positive reviews. It helped us too. The only drawback is the high price.
- Albina: The price is high, but we are talking about the most precious thing - a child, and a sick one at that! My daughter is 4 years old and inherited asthma from her husband. Both take Singular. And he really helps them. We tried to switch to cheaper analogues, but after several nightmares, we returned to the previous course. It's better to pay more but not have such side effects!
- Miroslava: Due to allergic rhinitis, the child’s hearing began to deteriorate. The audiologist and allergist in consultation prescribed Singulair, since they found the diagnosis and liked it, there were no problems with taking it. Exacerbations of rhinitis have become rare, we take courses infrequently. But I would like the country to pay for such expensive medicines.
- Yulia: My son is being checked by an allergist for allergic rhinitis. At our next appointment, we were prescribed a 2-month course of Singulair. I immediately bought 2 packs of 28 tablets. After a week of taking it, a cough began, the snot became thick, a rash appeared, and the next day the temperature also rose. The doctor canceled the medicine, and the money for it was thrown away.
What can I replace it with?
It must be said that there are relatively few reviews about the Singular tool in the Russian-speaking sector of the Internet. Presumably, this is explained by the difference in price (the instructions for use of Singular for children are in general similar to the instructions for other chewable tablets) in comparison with analogues. On average, medications that have a similar effect cost about 500 rubles per pack in Russian pharmacies. Most popular titles:
- "Montelukast";
- "Montelast";
- "Singlon".
Of course, the instructions for using Singular and analogues may differ, as well as the main active substance. It is strictly not recommended to replace the drug recommended by the doctor with a cheaper one at will, since cases of individual intolerance are possible, and the patient’s condition will only get worse. This is especially true if the medication is selected for the treatment of a child.
However, if you want to save money, then you can avoid unnecessary risk if the replacement is agreed upon with your doctor. Reviews of Singular analogues (the instructions for using these drugs are usually no more complicated - either chew tablets or use an inhaler) are generally positive; patients who have undergone therapy note the high effectiveness of the drugs.
