Asthma attacks symptoms and conditions

Hi
I am in the UK - where any knowledge of side effects related to Yasmin appear to be non-existent. I was prescribed this to treat my endo after having problems with another pill (constant bleeding and mood swings).
Initially it was like a magic pill - immediately improving the mood swings and stopping the constant bleeding. Then after about 4 days I felt so nauseous I wanted to go home from work - this lasted a few days.
A week and half into my first pack, I suffered continuous asthma attacks - with no obvious cause, this developed in hours to spontaneous vomiting along with a hacking cough.nI was prescribed antibiotics for "infections". The symptoms continued until it was unbearable and I was put on anti-vomiting tablets. and changed onto a different antibiotic.
A week later back at the doctors surgery I had a series of tests - awaiting results as I type, as I have very dark urine, stools that are not "normal" (clay or yellow), pain in my stomach, pins and needles, continue to vomit if don't take the anti vomiting tablets. Have now stopped taking Yasmin and await results...
HOw long does everyone appear to improve after stopping taking Yasmin? Also does this sound like I may have a case of hyperkalemia? (I am awaiting results).
Many thank

I am a 36 year old woman, and I have taken Singulair for the past 8 months. I got a lung infection over the winter, and the clinic I went to put me on the 10mg Singulair. It helped my lungs and got me over the worst of the infection, but I never anticipated the side-effects. For several months, I attributed what I was feeling to hormones (like severe PMS) and the stress in my life. I started to have thoughts of death, especially at night. I also began to have a hard time leaving my house. I would have panic attacks, worrying that the window was left open, the stove was left on, and god forbid there was a dark cloud in the sky (I became convinced that a terrible storm would come). Several times, I nearly got in a car accident racing to get home after work. Then, I started to obsess over getting sick. I was convinced that I would get some terrible disease and die soon. The fears and anxiety got worse and worse until one day (a rainy day), I quit my job of twelve years. It was a good job. I was happy with my work, and I made more than enough money. I ended up moving across the country back in with my estranged husband, because here I would not have to work. I could stay home all the time, away from germs and storms and anything else bad. That was three months ago. Still on the Singulair, I began to obsess over death. The panic attacks were so severe that they triggered asthma attacks, and not being able to breathe triggered more anxiety. I stopped sleeping at night. In three months, I've slept four nights. I began to have nightmares that made me wake up screaming and violently lashing out. I had to urinate 5 or 6 times every night. I developed severe stomach pain and nausea. And I had leg pain (actually, I hurt everywhere, severe pain). I had headaches, dizziness, and fatigue. Slowly, I began to realize that it might be the medicine. I started to research, and yesterday, I took my last pill. Since then, I have not had one panic attack. I have not had one asthma attack. I slept last night with no bad dreams. I know what's happened now, and I'm so sad that I lost so much of my life because of this drug. I really had a good life...friends, a home, a great job... Now, I'm very tired. My body is very weak and still hurting. I'm shaky. But I believe in time, those effects, too, will go away. I feel like my body has been through a war. I'm grateful that I didn't kill myself. There were a couple of really bad days when the urge to be violent towards myself was overwhelming. One day, I punched a fence, making my knuckles bleed. I think I could've killed myself, and I know it was Singulair. It's going to be better now. Just as a note: what helped me withdraw without any major worsening of asthma was Advair 250/50 twice a day.

I was on Advair for a few months back in about 2005. I was taking it for asthma. I noticed after about a month of using it that I would have these severe asthma attacks if I came in contact with an irritant. Instead of minor coughing if I was near someone smoking my lungs would practically slam shut and I could not get any air. These were far more reactive and severe than I have had on any other meds or none at all. I stopped taking it, switched back to Flovent and the problem went away. A few months later the FDA announced the black box warning for Advair and that this was a possible severe side effect. They need to be more up front with patients about this risk so they can decide if it is worth using, I wasn't given that option.

I have been on advair for 2 years and am starting to experience headaches that last the entire day. It helps with my breathing difficulties and I am unsure if I can just stop taking the medication. Its really difficult for me right now and I'm starting to feel depressed about it. I'm not sure how I'll get through this.

I have been on Singulair longer than I can recall... at least 10 years, maybe longer. My 7 year old son has been on it since he was probably 12 months old. Neither one of us have had any problem reported here. No depression, no sleeplessness (until I weaned him from naps, he slept up to 13 hours a day), no leg cramps, nothing. We are two of the happiest, most well adjusted people you could know. And, best of all, we haven't had any asthma attacks. Bottom line, different drugs react differently in different people. Don't let the post here stop you from trying a medication that for some could mean the difference between life and death depending on how asthmatic they are. As with any drug recommended by your doctor, try it. If you experience adverse reactions, stop it ASAP. It's that simple.

Hey all. I have had asthmatic bronchitis for about 6-7 weeks now and I have never had asthma or bronchitis before. It started off as a normal flu for 3 days with fever. Then when the flu went away, I started having trouble breathing and shortness of breath. It felt like I ran a marathon walking to the bathroom. I never had that before. The doctor told me it was bronchitis. All tests were fine. I was taking azithromycin (took 3 paks of them) and that was the only thing that made me feel normal, but it did not get rid of the infection. Then I was placed on cipro and steroids. Now I'm not on any antibiotics. I'm taking prednisone and just started the advair inhaler. I was having asthma attacks that I never had before. Very scary. Did anyone have asthmatic bronchitis before??? What did you do to get over it and how long??? Please help!!!

Hey all. I have had asthmatic bronchitis for about 6 weeks now and I have never had asthma or bronchitis before. It started off as a normal flu for 3 days with fever. Then when the flu went away, I started having trouble breathing and shortness of breath. I never had that before. The doctor told me it was bronchitis. All tests were fine. I was taking azithromycin (took 3 paks of them) and that was the only thing that made me feel normal, but it did not get rid of the infection. Then I was placed on cipro and steroids. Now I'm not on any antibiotics. I'm taking steroids and just started the advair inhaler. I was having asthma attacks and everything. Very scary. I was just wondering how long it took you to get over it and what you did to get over it. I have been to so many doctors and had so many tests done. It's affecting my life. I won't leave the house due to fear of having another asthma attack. I just hope I feel normal again soon, please.

I started taking Advair a few years ago because my doctor suggested it. I noticed after taking for a bit and then stiopping, I would get ill and have bronchitis. After a few episodes of this, I started taking it regularly. I was supposed to be taking it 2x a day but only took it at night. After about a few months of regualry taking it at night, I forgot to take it one evening and woke up in the middle of the night with the worst attack ever. I started testing this with on and off uses of the advair to see what the relationship was and one for one, if I did not take the medication, I had an attack. I believe that the regular use of Advair caused my body to become dependant on it. I wish I had never taken it in the first place. I am now having asthma attacks 1 to 2 times a day and before Advair, once every 3 months or so.

Hi - I was on advair for a couple of weeks after a horrible bout of asthmatic bronchitis. I now have this constant pressure under my rib cage that will not go away. I was wondering if any one else has experienced this while on or after stopping advair. Thanks and happy holidays!

I was surprised to hear that Merc, the maker of singulair update their side effects 4 times in one year to include depression, anxiety, suicide, and suicidal thoughts. It was prescribed to me cos of my allergies and asthma. I never really took singulair on a daily basis because it made me feel so tired and out of it. So i would only take it when my allergies were very very bad, like having a bad sneezing fit or nose would be runny non stop which would be at least 1 to 2 times a month. My asthma wasn't really that bad, i would get it when my allergies would act up like i mentioned before. When the fires in California were going on my asthma started acting up because of all the ash in the air. I was having asthma attacks every day. Since singulair works great for asthma i started to take it everyday and noticed my asthma went away. The first couple days were fine..and after two weeks i started noticing i was becoming anxious and irritable. Also depression sunk in...So i wondered what was causing it. I wasn't going trhough any major life changes. So i looked up singuliar side effects and noticed the four new side effects that i mentioned above...I stopped taking the pills to see what would happen and i felt emotionally better but the asthma came back..id rather suck on my inhaler then be anxious and depressed.

My daughter is 7 and was just put on Singular as a preventive medication for croup which she gets when she has an infection. She is not on a daily inhaler nor does she have asthma attacks at school. I asked the doctor for an alternative to the pulmicort breathing treatments b/c the prolonged use of this caused her to have dental issues (8 cavities) and he gave her singular. I am concerned of the side effects in the reviews of this medication but I need some relief for my child. She has been on the medication only 1 day is frequent urination a side effect and can it come on that quick? If there is another medication that doesn't have the side effects apparently singular has please let me know.

My 8 yr old has been on singulair since May. I never put two and two together until reading these posts. He has been having anxiety at night..crying and looking terrified saying he can't stop the scary thoughts in his head. Tonight I felt so bad for him...because I can't make it go away. I am hoping with tonight being the last night on singulair he will not have such a hard time at night. He also says it's very hard to get to sleep at night. Poor kid. I also know he's a sensitive kid but it seems a bit overboard in the last few months....like getting upset and just not knowing how to handle his emotions so he just shuts down. Please message me if you've had similar experiences. I'm calling his dr. on Monday to figure out some other options if there is any. My son started with a cough in March and finally took him to see the dr. in May and she heard wheezing and started him on singulair and then added zyrtec. I know they control his coughing (wheezing...slight asthma) because if we miss a dose he coughs all day the next day. I'm a bit scared to go off it...but hope it stops the anxiety and moodiness. He had his first asthma attack last week too...and I wasn't prepared as we never have had to use the inhaler...so I didn't have it with us. Anyway, hoping he doesn't get too bad taking him off...and I hope he is able to control the scary thoughts by going off of it too.

ive only been using the proair inhaler for a few days and my chest pains are increasing to the point where it hurts to even breathe. im sick also, so i cant cough or anything. it hurts so bad that i cant lay down to sleep because the pain is worse when i lay down. i don't know why. its 430am and im up because of the pain this inhaler is causing me. i recommend it not be given to patients.

My daughter was on Advair, Singulair, and Zyrtec to control her severe asthma and allergies. We were so thankful that these medications kept her from having to be hospitalized 2-3 times a year for uncontrollable asthma attacks. About six months after she began taking these medications she began to have headaches, she had difficulty sleeping, she was irritable, she had stomach pains, leg cramps,and eventually depression and social withdrawal. She went from an outgoing and happy teenager to a bitter and angry person. In 2003 she committed suicide. Six months after her death reports started to surface about the link between singulair and depression and suicide. Perhaps for my daughter it was a combination of the three drugs. Whatever you do be cautious and do your research before taking any allergy or asthma medication. Go to the Singulair website and you will be astounded by what you read. Please try to get the word out about these medications.

I just started the Singular and it has helped my asthma a lot. I can't tell about the coughing because I also started it while I had a cold. But now and then even before I took singluar I would cough. Sometimes coughs are produced from various types of airborne things, many different types of things. I have a mold aggreviated asthma so that could be why its helping my instead of causing me to go nuts like it does for some. But it doesn't sound like a very good drug for children. It seems as though none of the posts coming from children taken Singular are positive. But so far it's helping me. I made it through the day without grabbing for my inhaler which was a great relief for once.

After never having asthma in my life I was put on Advair 100/50 at 34 ...
I have been on it for a little over a year but I have been reading these side effects and wanted to try and ween myself off this stuff. I cut back to 1 per day then 1 every other day and now I am down to 1 per week. Hopefully I am going to be off it soon. The side effects are real with the weight problems people are having with this stuff .... My question is does anyone else have the feeling in their throat like there is an obstruction or a lump? or like something is stuck in the back of their throat?? Does this go away ?

I rinsed my mouth and brushed my teeth after every use .... so I am not sure if this will go away with lower use or not

I have taken 100/50 Advair off and on for several years and hadn't noticed any problems. Three weeks ago I was switched to 250/50 strength Advair following a bad cold which I believe had become bronchitis but my NEW doctor believed was an asthma attack. I don't have asthma "attacks". I just have asthma which is always under control except for when I am exposed to smoke. Even then it isn't that bad. I just use a puff or two on my inhaler and I am good to go. So, I don't think I even needed to be put on the 250/50 strength! Right away, even with careful rinsing, I started to develop a sore throat. I had a constant cough, had to constantly clear my throat to try to speak and it hurt to talk. Within two weeks, besides the throat and congestion problems, I felt miserable as if I had a severe case of influenza: major headache, sinus and teeth pain, joint pains, severe fatigue, chills, burning eyes and blurry vision. I also developed an itchy red rash on my buttock and felt as though I was beginning to get a UTI. Because I felt so lousy, I told myself I didn't have to take the Advair which I knew would just make my throat feel worse. So, I went a whole weekend without the Advair and I started to feel better. Then on Monday morning, I took the Advair (which immediately made my throat hurt) and later went to see the new doctor in the afternoon. (We didn't discuss Advair because I hadn't made the connection and, obviously, he didn't either.) The doctor said I was negative for a UTI and thought my rash was cellulitis. He prescribed an oral antibiotic. I haven't taken any Advair since Monday a.m. because I read about its side effects on the Internet on Monday evening. My throat feels better. It is so good not to be constantly coughing and clearing my throat! The rash didn't respond to the antibiotic, but it did respond to the anti-yeast infection skin cream I decided to use on it. Unfortunately, the antibiotics DID give me a vaginal yeast infection and now I am also treating that! I am wondering if there is a connection between my skin yeast infection and the 250/50 Advair or if Advair just causes thrush (a mouth yeast infection)? Also, my eyes still burn and I still get blurry vision. Could I have a yeast infection in my eyes? I'm wondering because I have read on the Internet that steroids--just like antibiotics--can cause yeast infections. If so, then maybe thrush is not the only type of yeast infection that 250/50 Advair could cause?

My son age 3 was diagnosed with asthma about a year ago. Since then he has been sick constantly. Most recently his doctor has prescribed Singulair. He is aggressively pushing it on us. I stated my concerns to him, and he said there is nothing wrong with the drug.. he gets all the news letters.. and all the things I listed was the first time he heard anything.. I asked for his to refer us to a specialist and he wont.. I cant find anyone for a second opinion..My son needs medicine- at night i cant leave his side cause of his breathing.. The doctor wont suggest any alternate and I am stuck. I keep reading about all the people who are not taking singulair anymore- what what are they taking? I am completely lost here!

Thank you Massmomof3 for updating us. I noticed postings started on here as far back as 2003. Is there anyone that posted back then that still visits this board. Would love to hear your updates.

I have come to the conclusion that our pediatricians, allergists and various other doctors, have been brainwashed by the drug reps,possibly even bribed. My friend took her son off of Singulair almost a month ago when I told her about all of this. He already suffers from a learning disability, but she feels that his ability has improved along with his disposition and complaints of various aches and pains. She took him for his usual appointment at his allergist and told him what she had done and why and he literally YELLED at her, calling her a fool and demanded that she put him back on it. She stood her ground and refused and now is under the impression that her son will be dismissed as a patient from that practice. That won't be a problem. From what I read and what I hear, a lot of doctors are dismissing the whole deal. They can't be bothered with finding out for themselves, what the truth really is. No, they might miss out on the "perks" from the drug reps, like free samples of the deadly drug, or free pens, or a chance at a vacation in the Bahamas, and the list goes on. The drug reps are a hazard. They lack education on the drugs that they are "dealing", and if they HAVE been educated and are still promoting it,
they are no better than the crack dealers in the alley.

I was diagnosed with allergy induced asthma in my freshman year of high school. I was given Advair for a couple of weeks to help deal with a major attack I experienced. After seeing an allergy-asthma specialist I was told to continue with the Advair until I could get my AIA under control. I was also placed on Singulair, Flonase, MaxAir AutoHaler (for emergencies), Acuneb (also for emergencies) and I was already on Zyrtec and an eye drop Patanol. At the time my Zyrtec and the Astelin I was on were not enough to treat both the allergies and asthma. I also began taking allergy shots. I was an athlete playing fast pitch softball, conditioning P.E. including weight lifting and running, and I was also doing aerobics in my regular P.E. class. I swam often, was an active outdoors man, rode horses, and ate a fairly healthy diet. I could not figure out why I weighed 145 lbs at 5'2. My doctor said I was healthy and that I shouldn't worry about my weight but now that I am a 19 year old 5'3 weighing 130 lbs I realize that my weight gain was not normal. Although I do not play softball right now, I practice belly dancing and yoga. I often go hiking, running and swimming and I walk about 30 minutes a day to get to and from classes at LSU. I worked hard to keep a healthy diet, and exercise often so that I would not gain the dreaded freshman 15. It took me two years to get down to 130 lbs and I never attributed my weight gain and inability to lose weight to my Advair until I was off it for almost a year and then had to start taking it again to deal with a flare up. In less than two weeks I had gained almost 10 lbs and was feeling miserable.After I got to college, I would often go for runs to help keep myself in shape. I got to the point where I had to quit running because I was always short of breath and I would have severe asthma attacks. I was on all of the above mentioned medications and often on Prednisone for sinus infections. I also experienced the dry cough and the tightness of chest. I experienced almost daily headaches -some were attributed to stress but I am not sure if the Advair caused the others. I was also very groggy, dizzy, and EXTREMELY moody. I disliked the way I was feeling while I was on Advair and took myself off it earlier than I was recommended. Since then I have been feeling a lot better and I am able to control my occasional flare ups with zyrtec and flonase and occasionally singulair if I feel my asthma acting up. I got dizzy easily for a few weeks after I took myself I was not told by my doctor that I needed to rinse my mouth out to avoid thrush, nor was I told about the possible weight gain and some of the other side effects. I am going to stop taking Advair unless I absolutely need it and I am not going to stay on it for long, especially if I start feeling like I was before.

One of the most important questions we should be asking as parents is:

How does Singulair - a leukotriene receptor antagonist (blocks the receptors) affect the normal function of the mast cell?

The mast cell is the FRONT LINE DEFENSE against invading micro-organisms. When Singulair was invented, there was limited knowledge regarding the mechanisms by which the mast cell performed it's function. In my opinion, the focus was very narrow - those interested zeroed in on how the leukotriene receptor performed a role in the cause of asthma attacks and how ashma attacks could be prevented. Well, that's good preventing asthma attacks. But what happens to the mast cell if that receptor is blocked on a long term basis. I am not suggesting that blocking the receptor is bad but what if the long term effect is different than what we are are lead to believe-which is this is a safe medication with no known long term effects. What if the leukotriene receptor was just blocked short term a week or two to allow the body to clean up the mess from the last attack?

I seriously question what is going on with all of these infections. Are they related to crippling the mast cell? Parents should be allowed to question. If Merck doesn't want to answer questions regarding what happens to the mast cell (including are the numbers of mast cell decreased on Singulair), then something really BIG is missing. If by any chance (unknown at the moment) that the mast cell is significantly changed and therapy by montelukast is proper on a short but not long term basis, so freakin' what if Singulair is not a huge money maker any more.

Parents deserve every answer possible when decisions regarding their child's growth and development is on the line. I hope that we get some answers.

Of course, what was there in 2002 were new questions-not necessarily answers about the mast cell. Did anybody apply this to Singulair studies?
May 2002

From Journal of Clinical Investigation

Pattern recognition receptors on mast cells
The Toll-like receptors (TLRs) fit the definition of pattern-recognition molecules, which were originally postulated to allow the innate immune system to detect the 'molecular signatures' of various infectious agents. Although the innate immune system has no memory, it shows a degree of specificity, in part because the various TLRs recognize different sets of pathogen-associated molecules. Dermal mast cells are usually associated, not with the innate immune system, but with atopic dermatitis, but Supajatura et al. have found that these cells also express TLRs. They report here that TLR4, which binds the gram-negative product lipopolysaccharide (LPS), and TLR2, which binds peptidoglycan (PGN) from gram-positive organisms like Staphylococcus aureus, induce distinct mast cell responses. Staphylococcus is known to exacerbate allergic dermatitis, but it has generally been thought to act by inducing antibacterial IgE's, which trigger mast cell degranulation by stimulating the IgE receptor. Interestingly, the authors show that the interaction between PGN and TLR2 can provoke mast cell degranulation directly, sidestepping the need for IgE receptor engagement.

I have communicated directly with Leslie Hendeles, a leading professor of pharmacology and pediatrics at the University of Florida who's direct quote to me was:
"In response to your last comment, I thing Singulair has modest efficacy, and if we take all of our patients off this drug, THEY WON'T SUFFER. This is NOT an important drug for pediatric asthma, as are inhaled corticosteroids."

Ironically, this is the same individual who was quoted in an ABC news article as saying:
"We have hundreds of children on Singulair and have never heard parents make complaints about psychiatric side effects. Moreover, there is no mechanism for this reaction … We will be telling our patients not to worry about this."

WAKE UP EVERYONE...THIS IS AN ADMITTEDLY OVERPRESECRIBED DRUG THAT HAS WORKED WELL FOR MANY, BUT HAS ALSO RUINED MANY LIVES.

The manner in which this drug is casually overprescribed by so many doctors is freakish. I firmly believe that this drug has caused countless misdiagnoses such as ADHD, Bipolar disorder and others. IT FUELS A GOOD PART OF THE ECONOMY TO PUT SO MANY PEOPLE ON THESE DRUGS. I BELIEVE THE PHARM INDUSTRY IS VERY CALCULATED IN THIS MANNER.

Question what your doctors tell you.
See my other posts under matthewct1. I dealt with a situation where my 5 yr. old son was on the road to being diagnosed with ADHD which couldn't have been further from the truth. Singulair changed him. Since he's been off Singulair everyone (teachers, pediatrician, family, etc.) unanimously agree that he does not show the ADHD symptoms like he did on Singulair.

My son is off singulair for two weeks now and is showing improvements. He was on it for 7 years and at the beginning we blamed it on steriods, even though his dose was low. When he went off the steroids, the behavior didn't stop. I questioned the allerist if the singulair could be doing it, but was told no, it doesn't have those side effects. I don't blame the doctors because they weren't given the info. He was extremely emotional, cried for no reason, had no confidence, didn't like himself. We on more than one occasion have told his older sister that when he hits his teenage years we would have to watch him for suicide, as his reaction to problems was sooo out of whack! He was on motrin for headaches 4-5 days a week(blamed it on sinusses). Unexplained stomachaches. These symptoms came on over years, not right away. I have always thought that the steroids had done damage because he took them when he was so young. Until the news reports hit, and I started reading other people's stories and doing the "OMG, that's my kid!", I never put the problems on singulair. I was still skeptical, but took him off. His symptoms immediately got 100x's worse for a week. But funny thing is, his headaches are gone, his stomachaches are gone and he seems much less emotional. The strangest thing is, EVERY night, he comes in to kiss us good night 7 or 8 times, and sometimes by the 7th time he is crying and can't explain why. This has been going on for YEARS, EVERYNIGHT, never a break. It stopped! Just stopped cold 7 days ago. Comes in once, says goodnight, leaves and falls asleep. I know this isn't a coincidence. After years of wondering what's wrong with my kid, now I feel like I've been poisoning my him for 7 years. I'm not skeptical anymore.

Update about my post about the Chinese researchers who reported leukoteine receptors in the brain. There were a few people who misunderstood what I was trying to say to you. I was trying to say that yes it is possible or at least not impossible that Singulair does interfere with brain function in some people because at least one group of researchers found leukoteine receptors in the brain.

I located an article where a professor at Emory was quoted as saying that psychiatric side effects could be possible if leukoteine receptors exist in the brain. That is what I was trying to say without getting myself in trouble for giving misinformation. There is quite a bit more that I would like to say but I cannot find proof as of yet but I am working on it.

Merck’s Singulair likely to see prescription drop-off only in high-risk populations
By Beth Herskovits and Gayatri Iyer in New York

Published: March 28 2008 19:52 | Last updated: March 28 2008 19:52

This article is provided to FT.com readers by Pharmawire—a news service focused on providing insight into the most price sensitive issues in the global pharmaceutical market. www.pharmawire.com
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Merck’s asthma and allergy drug Singulair may see a decline in prescriptions due to recent concerns about suicidality, but the drop will not be precipitous, physicians told Pharmawire.

The warning will likely cause the biggest prescription fall-off among patients with a personal or family history of depression, or patients with mild disease, they add. The drug is taken daily to prevent asthma attacks and allergies, or as needed for exercise-induced asthma.

”Both my kids are on Singulair - and I’m not going to take them off it,” said Dr Lawrence Ciesemier, an allergist and immunologist who practices Kirksville, Missouri. ”It was a surprise to me that this data came out.”

Dr Gregg Santilli, an allergist and immunologist in private practice at AirCare in Plano, Texas, noted that he has prescribed Singulair - a drug he helped launch - for 10 years without seeing any suicides. ”Apparently this is an extremely rare event,” he said. ”This drug has certainly not been linked in a causative way to this.”

”The real question is whether the is greater than what’s seen in the general population,” said Dr Jay Portnoy, president of the American College of Allergy, Asthma and Immunology. ”It’s still an extremely safe and effective medication.”

The FDA announced yesterday that it is ”considering” regulatory action after post-marketing reports seemed to link the asthma and allergy blockbuster to suicidal thoughts and action. Officials said in a statement that they are undertaking a nine-month review of Singulair and three other leukotriene modifying medications: AstraZeneca’s Accolate and Dey’s Zyflo and Zyflo CR.

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HERE IS THE PART ABOUT THE LEUKOTRIENE RECEPTORS IN THE BRAIN

Dr Douglas Bremner, director of Emory’s Clinical Neuroscience Research Unit, noted that drugs can cause psychiatric effects when the targeted receptor also exists in the brain. But he added that it’s unclear whether the brain has leukotriene receptors.

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He noted that despite the updated label, the side effects ”sort of flew below the radar.” However, he painted a grimmer picture of the effect on the market, saying this would affect Singular sales badly. People are likely to stop taking it, he added.

Over the past year, Merck has updated its safety label to include reports of tremors, depression, suicidality, and anxiousness, the FDA said.

But Dr George Philip, senior director in clinical research for Merck, noted that none of the reports of suicidality came out of clinical studies. He added that post-marketing reports can be ”sketchy” and ”not well-defined” - making it more difficult to determine whether the drug caused the change in behavior.

Asked about whether certain high-risk patients should avoid Singulair, he said, ”It may be part of the dialogue moving forward. These are still unanswered questions.”

He added that other allergy drugs have also been linked to suicide, including Pfizer’s Zyrtec.

Santilli noted that he would consider each patient’s individual risk factors - and the severity of their asthma - before making any treatment changes. GlaxoSmithKline’s Advair has a black box warning linking it to an increased risk of asthma-related death, he said, and Zyflo patients must be monitored for liver toxicity.

”Every drug has risks and benefits,” he said. ”Singulair seemed to be a very clean, very safe drug.”

Ciesemier agreed. ”I prescribe Singulair daily,” he said, but conceded that ”maybe this wouldn’t be the first choice” for patients with a history of suicidality.

Patients who are taking the drug for allergies, a less serious condition, might be more likely to switch to an antihistamine, Santilli noted.

Singulair earned USD 4.3bn last year, growing 19%, and is the bestselling respiratory product on the US market, according to the company. Merck has a market cap of USD 96.57bn.

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