Montelukast has a boxed warning for serious neuropsychiatric events, including agitation, depression, sleep disturbance, and suicidal thoughts or behavior. The child and caregivers should monitor for new behavioral or mood symptoms, stop montelukast, and contact the prescriber if they occur. Montelukast is not a rescue medication, missed doses are not doubled, and urine discoloration or gingival enlargement do not indicate benefit.
In-depth explanation
Clinical reasoning
Leukotriene receptor blockade helps prevent asthma symptoms but does not rapidly reverse acute bronchospasm. Neuropsychiatric changes can emerge during therapy and require prompt action.
Decision rule
Teach the boxed warning, preserve access to a rescue inhaler, and distinguish preventive therapy from acute symptom relief.
For study reference only. Always follow current clinical guidelines and your institution’s protocols.