Asthma patients symptoms and conditions

I was giving prednisone for only 5 days (not sure about dose, but it tapered to one pill on the last day) for a bronchitis induced severe asthma attack. I have only had asthma twice in my 50 years, both times associated with a bad case of bronchitis. The "doc in the box" reduced his original dosage due to the 3 corisone injections I recently had in my spine. After reading these posts I feel grateful I wasn't on a higher, longer term dose. I have some of the same side effects listed here including uncontrollable appetite, fat gain around the middle, water weight gain, constantly having to urinate, superhuman energy, heart palpitations, and approximately two weeks after finishing, I began to get a mustache (hairs that were previously white became brown over a two week period). I have read on the internet and been told by my pharmacist that this is temporary. I have also read and been told that the 2mg estradiol I take every day since my hysterectomy causes the body to retain and not rid itself of the steroids as it normally would (estrogen is actually listed as drug interaction with prednisone). The doctor in the box apparently just ignored this interaction and prescribed it anyway. However the main reason I am posting is a very strange possible side effect that occurred approximately 1 week after my final dose. I was awakened in the middle of the night with SEVERE pain (felt like bone pain, not muscle) in my right knee that lasted until morning. By mid morning it was gone. The next night I had the same experience but in both knees. It lasted about 5 more days, gradually tapering in intensity, and then just went away. I do have severe arthritis in my lumbar and cervical spine, having had surgeries to repair injuries from a snowmobiling accident. I have normal arthritis elsewhere for a 50 year old, but have NEVER had issues with my knees. Has anyone had this strange symptom? None of my doctors (internist, rheumatologist, physiatrist - who gave me the injections and prescribed physical therapy for my spine) had any explanation. The only explanation I have is the prednisone because I had taken the Z-pac (antibiotic) with no side effects several times in the past. Weird!

Incidentally, I am off the prednisone for about 5 weeks, am still hungry all the time, still fat, still bloated. Unfortunately the extra energy is gone. Best of luck to everyone on this strange drug. My heart sincerely goes out to all of you on long term therapy. God bless.

I was diagnosed with asthma as a child. In late teens it seemed to not be problem, however after 50, I started developing symptoms of asthma again as evidenced from COPD tests. I am currently using Advair 250/50 since 55 yo.

One symptom, that I have not seen addressed here is that of "slow healing" after injuries. I injured my back awhile ago, and it seemed like 2 years before most of my symptoms were gone. To this day I still feel lingering effects. Then I scraped my shinbone. It seemed like it took forever to heal, and now there is an ugly red/purple scar where the minor scrape was.

I had never taken so long to heal before, and read that this was a problem with taking Advair. I never figured my asthma was that serious in the first place, so I simply cut back on the Advair to once/day or less as it seems still to keep my breathing OK. Sometimes, after a few days of not taking Advair, I feel some minor difficulty with breathing.

Now that I am 63, and so concerned about "slow healing", which I attribute to Advair, I have asked my Dr. to perhaps take me off Advair and simply take Albuterol when needed. Then I read that Asthma patients should only use Albuterol if that is sufficient to control symptoms and to advance to Advair to control more severe symptoms. Another article says that Albuterol does not heal Asthma, only assists with sudden onset of breathing difficulties and that I may still damage my lungs if I do not take Advair.

I remain at a loss as to what is best: Taking Albuterol when needed (perhaps a few to several times/week) or as I was doing before, contrary to recommended dosage, of 1-2 times/day. Fortunately my Dr. goes along with my changes, but tells me if symptoms get worse, she will put me on Advair 2X's/Day (which I probably will ignore dosage because of healing side effects, and use once/day or less).

I will report back later after trying Albuterol for time without the use of Advair at all.

i have been on prednisone for 5 years off and on and he moon face is there the hair loss the weight i really want to come off it so bad the asthma is a big issue in my life i wish they would come out with a better drug for us asthma patients the withdrawals i have been going through are the hair loss i use to have long thick beautiful hair thin face smaller body i am hoping some day i will get it all back
hopeful

A smaller recent study from Spain showing a genetic component of montelukast efficacy.

1: Respir Med. 2008 Jun;102(6):857-61. Epub 2008 Mar 12. Links
ALOX5 promoter genotype and response to montelukast in moderate persistent asthma.Telleria JJ, Blanco-Quiros A, Varillas D, Armentia A, Fernandez-Carvajal I, Jesus Alonso M, Diez I.
Institute of Biology and Molecular Genetics (IBGM/CSIC), University of Valladolid, Valladolid, Spain; Department of Pediatrics, University of Valladolid, Valladolid, Spain.

BACKGROUND: It was hypothesized that asthmatic patients with mutant alleles in the leukotriene pathway should not respond to leukotriene receptor antagonists and the concept of a tailored treatment is increasingly supported. METHODS: Sixty-one patients (mean age 24.9 years, range 14-52) with moderate persistent asthma were clinical and immunological assess prior and after a 6-month treatment with montelukast. Tandem repeat polymorphisms were genotyped in the promoter (-147 to -176) of 5-lipoxygenase gene (ALOX5). RESULTS: Thirty-two patients (52.5%) were homozygous for the five repeats allele; 17 (27.9%) were heterozygous (4/5 repeats) and 12 (19.7%) were homozygous for 4/4 repeats. After the montelukast treatment decrease number of asthma exacerbations, improvement of FEV(1) and decreased use of beta(2) agonists was observed in patients with 5/5 or 4/5 repeats. Conversely, the patients with 4/4 repeats genotype did not modify these data after treatment. CONCLUSIONS: It was confirmed that ALOX5 promoter polymorphisms have a clear influence in montelukast response in atopic moderate persistent asthma patients. The genetic study could identify those patients most likely to respond to montelukast.

PMID: 18339529

http://www.ncbi.nlm.nih.gov/pubmed/18339529

FYI: Go to

http://www.drugs.com/fda/singulair-montelukast-12368.html

Singulair (montelukast)
March 27, 2008
Audience: Pulmonologists, respiratory therapists, other healthcare professionals, patients
FDA informed healthcare professionals and patients of the Agency's investigation of the possible association between the use of Singulair and behavior/mood changes, suicidality (suicidal thinking and behavior) and suicide. Singulair is a leukotriene receptor antagonist used to treat asthma and the symptoms of allergic rhinitis, and to prevent exercise-induced asthma. Patients should not stop taking Singulair before talking to their doctor if they have questions about the new information. Healthcare professionals and caregivers should monitor patients taking Singulair for suicidality (suicidal thinking and behavior) and changes in behavior and mood.

This early communication is in keeping with FDA’s commitment to inform the public about its ongoing safety reviews of drugs. Due to the complexity of the analyzes, FDA anticipates that it may take up to 9 months to complete the ongoing evaluations. As soon as this review is complete, FDA will communicate the conclusions and recommendations to the public.

Latest FDA MedWatch Alerts...

Unfortunately my lawyer told me that they do not want to take our case because of the lack of evidence that Singulair has caused our daughters problems. :(

Does anyone out there have a pending class action lawsuit that We may be able to get in on? I have tons of proof that Singulair has caused our daughters problems and loss of almost 5 years of her elementary school career!

My phone number is *** and my email is ****** if You email me please put "Singulair" in Your subject line so I know it pertains to this posting.

Thank You in advance,
Chuck & Brenda
Jamestown New York

I was just asked by Dr. ???, if these European reports lead to change in product information in these countries. I did post that I thought that we should try to find that out. I don't have access to that information. But I do see that the Netherlands did require that depression be added to the product information. It doesn't say the date but Merck agreed.

Artie wanted to tell us about the blood brain barrier. Where are you Artie?

The report says:

In three of the cases a positive dechallenge was seen.The fact that the patients (except for one) did not suffer from depressive symptoms before they started montelukast, the short latency, and recovery after withdrawal of the drug all strengthen our hypothesis that depressive symptoms are an ADR related to the use of montelukast. According to the Marketing Authorisation Holder of montelukast, depression will be added to the product information.

Mechanism: The mechanism of montelukast-induced depressive symptoms is unknown. However, montelukast has earlier been associated with adverse drug reactions such as abnormal dreaming, nightmares, hallucinations, agitation with aggressive behavior, irritability and restlessness, which suggests that montelukast can penetrate the blood brain barrier and exert an effect in the brain .

From the Netherlands 2006.

This is the html version of the file http://www.lareb.nl/documents/kwb_2006_4_montel.pdf.

Page 1
Nederlands Bijwerkingen Centrum LarebMei 2007Montelukast and depressive symptomsIntroductionMontelukast (Singulair®)is a leukotriene receptor antagonist available on the Dutchmarket since 1998. It is indicated for the treatment ofasthma as combination therapy forpatients with light to moderate forms of chronic asthma which cannot be adequately controlledby inhalation corticosteroids and short-acting ß-agonists. For asthma patients for whommontelukast is indicated as asthma treatment it can also relieve symptoms of seasonal allergicrhinitis. Montelukast is also indicated in asthma prevention, if exercise-inducedbronchoconstriction is the main factor

Reports On September 20, 2006 the database of the Netherlands Pharmacovigilance Centre Lareb contained four reports of depressive reactions associated with theuse of montelukast.Patient A is a female aged 55 who used montelukast 10 mg once daily for asthma associated with COPD. Concomitant medication included ipratropiumbromideinhalation, salmeterol inhalation, fluticasone inhalation, acetylcysteine, budesonide nose spray and desloratadine. Two weeks after montelukast therapy was initiated the patient experienced nightmares, a depressive symptoms, fatigue and increased dyspnoea. When montelukast was withdrawn, the first three symptoms resolved. It is not known if the dyspnoea resolved. The reporting pneumonologist stated that the increased dyspnoea also could be a sign of progressing COPD. Patient B, reported by a pneumonologist, is a female aged 39 who used montelukast 10 mg once daily for asthma. Concomitant medication included salmeterol/fluticasone inhalation, mebeverine and psyllium seed. One week afterstarting montelukast treatment the patient experienced chest discomfort, malaise,depressive symptoms and dizziness. Montelukast was withdrawn, patient outcomeis unknown. Patient C, reported by a pharmacist, is a male aged 46 who used montelukast 10mg once daily for asthma. Concomitant medication included omeprazole,salbutamol inhalation and budesonide/formoterol inhalation. Six days after starting montelukast treatment the patient got in a depressed state. The patient continued to use montelukast for four weeks but the depression did not resolve. When montelukast was withdrawn, the patient recovered. Patient D, reported by a pharmacist, is a female aged 59 who used montelukast 10mg once daily for mild to moderate asthma. Concomitant medication included mometasone nose spray, salmeterol/fluticason inhalation, oxazepam and paroxetine. Three days after starting treatment with montelukast the patient experienced insomnia and aggravation of her depression. When montelukast was withdrawn the symptoms resolved.

Page 2
Nederlands Bijwerkingen Centrum LarebMei 2007 Other sources of information drugs are known to cause depressive symptoms. However montelukasthas not been associated with depressive symptoms earlier . A Medline searchbased on the MeSH terms montelukast, leukotriens, depressive disorder and mood disorders did not yield any relevant publication. DatabasesOn September 20, 2006 the database of the Netherlands Pharmacovigilance Centre Lareb contained four reports of depression associated with the use ofmontelukast (ROR 2.1 95% CI 0.8 - 5.7). The same day the database of the WHO contained 3466 reports on montelukast, 43 of these concerned depression (ROR1.2 95% CI 0.9 – 1.6)MechanismThe mechanism of montelukast-induced depressive symptoms is unknown.However montelukast has earlier been associated with adverse drug reactions such as abnormal dreaming, nightmares, hallucinations, agitation with aggressive behavior, irritability and restlessness, which suggests that montelukast can penetrate the blood brain barrier and exert an effect in the brain .Discussion and conclusionLareb received four reports of depressive symptoms in patients using montelukast.Possible confounding includes that asthma itself has been associated with the development of depression . Inhalated corticosteroids can also exert effects onthe central nervous system. Fluticason in combination with salmeterol which isused by patients A, B and D, is associated with hyperactivity and irritability where as budesonide, which is used by patient C also has been associated with depression . The latency of montelukast-induced depressive symptoms variesfrom 3-14 days. In three of the cases a positive dechallenge was seen.The fact that the patients (except for one) did not suffer from depressive symptomsbefore they started montelukast, the short latency, and recovery after withdrawal ofthe drug all strengthen our hypothesis that depressive symptoms are an ADRrelated to the use of montelukast. According to the Marketing Authorisation Holderof montelukast, depression will be added to the product information.

I noticed a lot of postings about weight gain on Singulair, which is nowhere listed by Merck as a possible side effect. My 15 y.o. daughter experienced sudden weight gain at the age of 9 when she was actually underweight (BMI went from 17 to 21). To make a long story short, after being off Singulair for over a year, she is now over-weight, and diet/exercise have never made a big difference (gymnastics, swim team, figure skating, trampoline, etc.) Extensive labwork is always normal & there is no family history of obesity. It's a shame the quality of life of a child is RUINED by a drug that is deemed to have "no side effects", and the many drs. & specialists out there take it very lightly. We continually worry about our daughter's self-esteem, risk of diabetes, and other complications from weight gain which is not hereditary and goes on unexplained by the drug co. Reversing this weight gain has been nearly impossible. Everytime I hear a news report about our children being overweight and obese, it makes me angry because I think about the many kids that are taking this highly prescribed drug (for even the mildest allergy or asthma) and who knows how many parents don't make the connection!

From the Netherlands 2006.

This is the html version of the file http://www.lareb.nl/documents/kwb_2006_4_montel.pdf.

Page 1
Nederlands Bijwerkingen Centrum LarebMei 2007Montelukast and depressive symptomsIntroductionMontelukast (Singulair®)is a leukotriene receptor antagonist available on the Dutchmarket since 1998. It is indicated for the treatment ofasthma as combination therapy forpatients with light to moderate forms of chronic asthma which cannot be adequately controlledby inhalation corticosteroids and short-acting ß-agonists. For asthma patients for whommontelukast is indicated as asthma treatment it can also relieve symptoms of seasonal allergicrhinitis. Montelukast is also indicated in asthma prevention, if exercise-inducedbronchoconstriction is the main factor

.ReportsOn September 20, 2006 the database of the Netherlands Pharmacovigilance Centre Lareb contained four reports of depressive reactions associated with theuse of montelukast.Patient A is a female aged 55 who used montelukast 10 mg once daily for asthmaassociated with COPD. Concomitant medication included ipratropiumbromideinhalation, salmeterol inhalation, fluticasone inhalation, acetylcysteine, budesonide nose spray and desloratadine. Two weeks after montelukast therapy was initiated the patient experienced nightmares, a depressive symptoms, fatigue and increaseddyspnoea. When montelukast was withdrawn, the first three symptoms resolved. Itis not known if the dyspnoea resolved. The reporting pneumonologist stated thatthe increased dyspnoea also could be a sign of progressing COPD.Patient B, reported by a pneumonologist, is a female aged 39 who used montelukast 10 mg once daily for asthma. Concomitant medication included salmeterol/fluticasone inhalation, mebeverine and psyllium seed. One week afterstarting montelukast treatment the patient experienced chest discomfort, malaise,depressive symptoms and dizziness. Montelukast was withdrawn, patient outcomeis unknown.Patient C, reported by a pharmacist, is a male aged 46 who used montelukast 10mg once daily for asthma. Concomitant medication included omeprazole,salbutamol inhalation and budesonide/formoterol inhalation. Six days after startingmontelukast treatment the patient got in a depressed state. The patient continued to use montelukast for four weeks but the depression did not resolve. Whenmontelukast was withdrawn, the patient recovered.Patient D, reported by a pharmacist, is a female aged 59 who used montelukast 10mg once daily for mild to moderate asthma. Concomitant medication included mometasone nose spray, salmeterol/fluticason inhalation, oxazepam and paroxetine. Three days after starting treatment with montelukast the patientexperienced insomnia and aggravation of her depression. When montelukast waswithdrawn the symptoms resolved.
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Page 2
Nederlands Bijwerkingen Centrum LarebMei 2007Other sources of informationLiteratureSeveral drugs are known to cause depressive symptoms. However montelukasthas not been associated with depressive symptoms earlier . A Medline searchbased on the MeSH terms montelukast, leukotriens, depressive disorder and mooddisorders did not yield any relevant publication.DatabasesOn September 20, 2006 the database of the Netherlands Pharmacovigilance Centre Lareb contained four reports of depression associated with the use ofmontelukast (ROR 2.1 95% CI 0.8 - 5.7). The same day the database of the WHOcontained 3466 reports on montelukast, 43 of these concerned depression (ROR1.2 95% CI 0.9 – 1.6)MechanismThe mechanism of montelukast-induced depressive symptoms is unknown.However montelukast has earlier been associated with adverse drug reactionssuch as abnormal dreaming, nightmares, hallucinations, agitation with aggressive behavior, irritability and restlessness, which suggests that montelukast can penetrate the blood brain barrier and exert an effect in the brain .Discussion and conclusionLareb received four reports of depressive symptoms in patients using montelukast.Possible confounding includes that asthma itself has been associated with the development of depression . Inhalated corticosteroids can also exert effects onthe central nervous system. Fluticason in combination with salmeterol which isused by patients A, B and D, is associated with hyperactivity and irritability where as budesonide, which is used by patient C also has been associated with depression . The latency of montelukast-induced depressive symptoms variesfrom 3-14 days. In three of the cases a positive dechallenge was seen.The fact that the patients (except for one) did not suffer from depressive symptomsbefore they started montelukast, the short latency, and recovery after withdrawal ofthe drug all strengthen our hypothesis that depressive symptoms are an ADRrelated to the use of montelukast. According to the Marketing Authorisation Holderof montelukast, depression will be added to the product information.References1. Dutch SPC Singulair®. (version date 11-7-2005) http://www.cbg-meb.nl/IB-teksten/23164.pdf.2. M.N.G Dukes and J.K Aronson, editors. Meyler's Side Effects of Drugs. 14 ed. Elsevier; 2000.3. Price D. Tolerability of montelukast. Drugs 2000;59 Suppl 1:35-42.4. Goldney RD, Ruffin R, Fisher LJ, Wilson DH. Asthma symptoms associated with depression and lower qualityof life: a population survey. Med J Aust. 2003;178(9):437-41.5. Dutch SPC Seretide®. (version date 12-8-2005) http://www.cbg-meb.nl/IB-teksten/23529-23530-23531.pdf.6. Dutch SPC Pulmicort®. (version date 20-10-2003) http://www.cbg-meb.nl.
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Nederlands Bijwerkingen Centrum LarebMei 2007

We lost our home to a house fire this past August so when my 8 year old daughter experienced severe depression, night terrors, and was constantly acting out we naturally blamed it on the house fire. The odd thing was that she had the "normal" depression immediately after the fire and started to become herself again. Several months past when she started this severe depression and horrible behavior. We brought her to a psychiatrist because this was just not the depression she was experiencing after the fire.The psychiatrist diagnosed her with post traumatic stress disorder and explained that with children it can take months for this to "come out". Well, with allergy season on us in the South, my daughter started her Singulair treatment the exact time of this recent behavior. Needless to say, we are taking her off the Singulair, I will post again to let you know if she makes a turnaround.
---by rlhulsen

As a pediatrician I write for singulair every day.
The medication is for allergies.
Allergies cause adenoidal swelling, which cause sleep disturbances which makes the child tired the next day with makes him over weight, less attentive, hyper and eventually act out.
This in turn makes the child experience parental, peers and teachers criticism/ abuse, with leads to the child feel inadequate, embarrassed, frustrated and eventually depressed and suicidal.

Yes, singulair does cause behavioral change but they appear within the first couple of peels, the rest is due to allergies, lack of medical care, i.e. sleep, singulair, and zyrtec deficiency.
Allergy shots cause 4 times the incidence of suicidally than singulair, and Ritalin 10 times more.
They say in hebrew "once a stone is thrown into a well, thousands of smart people won't find it".
Check it, it's true.

New FDA Warning:

FDA informed health care professionals and patients of the Agency's investigation of the possible association between the use of Singulair and behavior/mood changes, suicidally (suicidal thinking and behavior) and suicide. Singulair is a leukotriene receptor antagonist used to treat asthma and the symptoms of allergic rhinitis, and to prevent exercise-induced asthma. Patients should not stop taking Singulair before talking to their doctor if they have questions about the new information. Healthcare professionals and caregivers should monitor patients taking Singulair for suicidally (suicidal thinking and behavior) and changes in behavior and mood.
This early communication is in keeping with FDA’s commitment to inform the public about its ongoing safety reviews of drugs. Due to the complexity of the analyzes, FDA anticipates that it may take up to 9 months to complete the ongoing evaluations. As soon as this review is complete, FDA will communicate the conclusions and recommendations to the public.

Read the complete 2008 MedWatch Safety Summary, including a link to the FDA Early Communication About An Ongoing Safety Review regarding this issue at: http://www.fda.gov/medwatch/safety/2008/safety08.htm#Singulair

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