Singulair and time frame

I have been reading the posts at this site for two weeks, ever since the day I went to my GP for a check on blood pressure and general well being. As I was getting ready to leave the examining room, he asked how I had been since my last visit, and I responded that I'd been OK, except of course that I wasn't sleeping well. I didn't tell him that I'd had obsessive thoughts of death and dying, severe anxiety, morbid depression, horrible mood swings, and compulsive thoughts and actions. Yes, I've been taking Singulair since it was approved for seasonal rhinitis. It seemed to work well with Allegra, although when my allergies were extra severe, I also had to resort to Benadryl or one of the other "drowsy" antihistamines. When I mentioned sleep, he said "You have heard about Singulair, haven't you?" Guess how shocked I was when he told me about the latest information on the medicine I was taking every night for the last 5 years? Unfortunately, I had been under severe stress because of professional and families issues during the same general time frame, so it would never, ever have occurred to me that a prescribed medication could make me so miserable. My psychiatrist had recommending doubling my dose of Cymbalta, but after some trials of that, I became convinced that when I did so, I felt worse. About 6 months ago, my emotional state went from bad to worse. I began to feel a sense of panic when called upon to make the most innocuous decisions, and was always aggravated and nasty to the people I loved most. With my doctor's mention of Singulair, I stopped taking it. I slept better from the second day of not taking it. In the last 2 weeks, my emotional roller coaster has smoothed out, not perfectly, but enough so that I'm much more like my old self. The stresses are similar, but my reactions are different. Zyrtec (1/2 tablet) works much better for itchy eyes and nose than Singulair did in the first place. My husband and son both have continued to take Singulair with no apparent problems. I think that if one has developed unusual or unexpected emotional symptoms it is definitely worth a trial off Singulair. I wish I had been aware of even the smallest possibility of a reaction such as mine when I started taking it.

I don't think that anyone can predict a time frame for getting over an adverse drug reaction. Below is my opinion but I see a lot of evidence that it is basically shared by other people maybe not exactly as I state it.

Adverse drug reactions deplete many essential nutrients from our systems. Inflammatory response is very stressful on the body. It is sometimes a very big effort to work on the diet to put back what has been taken away. It can take a long time.

Quinolines particularly deplete B-vitamins, folic acid (B-9), calcium/magnesium/zinc and omega-3 fatty acid. Sometimes the blood-lab work shows elevated homocysteine which proves that the body has suffered inflammation. Cardiologists now use homocysteine levels to show whether someone is at risk for heart disease due to inflammation. Deficiencies of B-6, B-9, and B-12 are known to cause elevated homocysteine.

Here is the pharmaceutical company ZINGER. Now companies such as Merck and Pfizer are going to offer niacin products to lower cholesterol. Well, yeh, duh !. All of these drug reactions are causing depleted B vitamins which elevate cholesterol. Then after they have tried to kill us by depleting our B - vitamins, they want to sell us another pill to give the B vitamins back to us. How many people out there are on some kind of a pill with side effects that cause inflammation? What a business? It is win, win, win.

My son is almost 6 yrs old. He has been taking Singular for approx 3 years, in addition to Claritin and Nasonex. This is all for his allergy to mold. His doctor started him on these meds after a 6 month episode with sinus infections leading to asthma-like symptoms. We have not noticed anything unusual about his behavior until approx 3 months ago. He started waking up every night (2-3 hours after going to bed) with bad dreams. At first he would not fully awaken and fall back asleep immediately. After a month or so of this happening most nights, he had two nights in a row where he woke up screaming and was inconsolable for about 30 minutes. We initially thought it was night terrors, but he was not scared or fearful, he was just upset/angry. He would hit the bed repeatedly and yell. He didn't know what he was upset about but would talk about how he thought we hated him, he was dumb, etc. After about 30 min he would 'snap out of it' and return to his normal self and go back to sleep easily.
At first we thought these were night terror brought on by a recent fever, but he had another episode last night. He has also been falling apart at the littlest things and getting quite violent (for a 6 yr old). He was sent to his room yesterday evening because he was complaining about the dinner his mom made (lots of complaining these days..). He had a total melt down an started throwing things and hitting the door so hard he put a hole in it.
Some of this behavior I would chalk up to normal kid stuff, new baby brother, etc. But I am suspicious about the negative thoughts, bad dreams, and instant melt downs... I stopped giving him Singular today and we will see what happens. God bless you all as we figure these things out...

I spent the weekend reading about the development of Singulair. The early studies recognized that the first phase of the acute asthma response bronco-constriction was probably not caused by leukotrienes. They identified histamines and prostaglandins as the probable sources. I don't think that changed because the Singulair literature states that it should not be considered as a treatment for that. Leukotrienes were a source of inflammation caused by eosinophils and mast cells present in greater numbers (than normal) in airway tissue. So, it was beneficial to find a way to decrease that.

The cysLT1 receptor was identified as source of the signals that tell the cells to produce leukotriene. The receptor, a gene, consist of 337 (they think) amino acids. They modified a compound that would bind to that receptor thus blocking the cells ability to produce leukotrienes. This compound is very specific. It was formulated to bind to the "model" receptor. This compound will not even bind to cysLT receptor sub-types. (That is the good thing.) There is an enormous amount of research that discusses the genetic variability of the chemical reactions that occur in the leukotriene (calling it this for simplicity) pathway. We are also seeing that a number of researchers would like to use gene profiles to predict whether patients will respond favorably to different asthma/allergy drugs. ALL PATIENTS HAVE A RIGHT TO KNOW IF IT IS INHERENT THAT SOME PEOPLE WILL NOT RESPOND TO SINGULAIR OR RESPOND ADVERSELY.

There are many studies from the 1998 era that conclude that montelukast is not effective for everyone. Those researchers stated that it can be predicted that those people who are going to respond favorably will do that within the first 14 days or so. That conclusion would be consistent with a genetic component for efficacy and safety of Singulair. Those doctors concluded that those who did not respond within that time frame should not take Singulair for fear of harming them. That makes good sense.

The Italian researchers wanted to know if there was more going on than blocking leukotrienes in the action of montelukast. They set up a "test tube" study regarding montelukast, the cysLT1 receptor, and some t-cells that they selected. Why? Researchers always have something on their minds. They observed the death of these particular t-cells.

Montelukast is a quinoline. We basically know of quinilines and quinolones as compounds that were invented as broad spectrum antibiotics. They work because they interference with bacterial DNA so they cannot replicate themselves. Montelukast is a quinoline modified to bind with the cysLT1 receptor (a gene) and prevent that gene from activating. That's consistent with what a quinoline/quinolone does.

So what does montelukast do in blood plasma if it does not bind to the receptor because of genetic mis-match? (If montelukast does bind, then a chemical reaction has occurred and the liver will break down the by-products. Montelukast metabolized in 10-12 hours.) What happens if it doesn't bind? How long before it breaks down? Does it produce toxic by-products?

I want to know what happens to lymphocytes such as t-cells just because montelukast is a quinoline. Maybe nothing but what's up with the Italians researchers? I want to know if montelukast has the capability to interfere with lymphocytes who can clone themselves. That could be a good thing under circumstances when these lymphocytes are causing inflammation. But it could be a bad thing in the case of normal individuals with no problems.

I want to know if the bad side effects are due to the fact that the body has to break down and metabolize a quinoline that did not bind to the receptor for which it was created. The side effects of Singulair are strangely similar to what is observed in the quinolones such as levaquin. I have not as yet been able to compare montelukast as a quinoline to levaquin as a quinolone. I am hoping to find something on these categories. There may be no reason to worry that they cause similar damage. But frankly, I think that there is. There is some terrible chit happening to some people. The scariest is the neurological damage.

All of these questions would be in the everybody pharma knows to ask category. I don't know where the answers are. I haven't found them as of yet. Maybe there are no answers. We have to remember that Singulair and Vioxx were released in the same year. They have continued to be drugs under the current executive management of Merck. If the Vioxx marketing promoters had their ghost writers, why not the Singulair marketing promoters. The genetic component appears to be widely accepted but we haven't heard one thing about even that.

I think that it is sad that maybe the marketing of Singulair as one stop shopping for asthma/allergies may have destroyed the original concept. I really think from reading the original work that they knew that they couldn't engineer a drug for one size fits all. Everybody gets harmed when information is withheld.

Shame on the allergist who yelled at the mother who wanted to discuss issues. Does he know exactly who is allergic to Singulair and who isn't? Get him a dunce hat. Just because Singulair is marketed for allergies does not mean that you cannot be allergic to it. See the power of Madison Avenue? The ad agencies focus group these drugs to death. The ad agencies cleverly craft the product information. A good piece of legislation would be to prohibit consumer drugs ads.

My 13 year old daughter has been taking Singulair for 3 months and has recently been complaining about stomache aches and abdominal pain. It just occurred to me the time frame and I have now taken her off Singulair - and read that the number one side effect is abdominal pain. After reading here, I wonder if her recent nightmares are related as well.