5 Common Questions About Montelukast (Singular) Interactions Answered

If you have asthma or seasonal allergies, you may have tried a variety of inhalers, nasal sprays, and oral medications to help keep your symptoms at bay. One option your healthcare provider may recommend if other options haven’t worked is montelukast (Singulair). 

While montelukast doesn’t have many potential drug interactions that are significant, it’s helpful to know how other substances affect it. Below, we answer five common questions about montelukast interactions — from antihistamines to alcohol.

1. What medications interact with montelukast?

Montelukast is eliminated from the body by the liver. Some medications can interfere with this process, resulting in higher or lower montelukast levels in the body.

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Medications that can decrease montelukast levels in the body include:

• Phenobarbital

• Rifampin

• Carbamazepine (Tegretol)

• Phenytoin (Dilantin)

Gemfibrozil (Lopid) can have the opposite effect, increasing levels of montelukast in the body.

There aren’t any recommended montelukast dosage adjustments for these interactions. But your healthcare provider may want to monitor you more closely if you’re taking a medication that could affect montelukast levels. And if you’re taking gemfibrozil, let your provider know if you experience new or worsening montelukast side effects.

Keep in mind: Providing your healthcare team with your current medication list helps them check for potential montelukast interactions ahead of time.

2. Can you drink alcohol while taking montelukast?

Montelukast and alcohol aren’t known to directly interact with each other. But there are a few things to consider before combining them.

If you have allergies or asthma, you may be more likely to develop alcohol intolerance. Symptoms can include facial flushing, stomach upset, and a runny or stuffy nose after drinking alcohol. So drinking may cause you not to feel well, with or without montelukast.

What’s more, montelukast can upset your stomach and make you feel dizzy. While less common, some people find that it makes them feel drowsy. Alcohol can have similar effects, and these effects may be worse if alcohol and montelukast are combined.

While rare, liver damage has been reported in some people taking montelukast. Alcohol can also damage the liver, especially with long-term or heavy use. The risk of liver damage from drinking alcohol while taking montelukast hasn’t been extensively studied. But it’s possible that combining the two may increase this risk.

Everyone responds to medications and alcohol differently. Talk to your healthcare provider if you have questions about how much alcohol (if any) may be safe for you to drink while taking montelukast.

3. Can you take Benadryl with montelukast?

Generally, yes, you can take Benadryl (diphenhydramine) with montelukast. But there may be safer alternatives for treating allergy symptoms.

As mentioned above, some people experience drowsiness with montelukast. Antihistamines like Benadryl can make you drowsy, too. Combining montelukast and Benadryl may worsen this drowsiness.

If you’re dealing with allergy symptoms on top of asthma, there are plenty of nondrowsy options to choose from. Examples include oral medications like fexofenadine (Allegra) and nasal sprays like azelastine (Astepro). Your pharmacist can help you navigate your options.

If you’re considering taking Benadryl to help you sleep, talk to your healthcare provider first. Sleep problems, such as vivid dreams and insomnia, are a possible side effect of montelukast. If montelukast is the cause of your sleep issues, your provider can help you determine the next steps. These may include changing when you take your montelukast dose or switching you to a different medication.

Good to know: Benadryl is a first-generation antihistamine, which means it causes more drowsiness than newer, second- and third-generation antihistamines like cetirizine (Zyrtec). Doxylamine (Unisom) and chlorpheniramine are also first-generation antihistamines.

4. Can you take montelukast and cetirizine at the same time?

Yes, it’s safe to take montelukast and cetirizine at the same time. In fact, this combination has been studied for the treatment of seasonal allergies.

Cetirizine is an antihistamine like Benadryl. But, unlike Benadryl, cetirizine is considered a nondrowsy antihistamine. However, some drowsiness may still be possible. The drowsiness is usually less than what you would experience with first-generation antihistamines.

There are other nondrowsy allergy medications, such as levocetirizine (Xyzal) and fexofenadine, that have also been studied with montelukast. If you’re experiencing drowsiness with montelukast and cetirizine, one of these may be a good alternative.

5. Is it OK to take montelukast and ibuprofen?

Yes, most people can safely take ibuprofen (Advil, Motrin) and montelukast together. But there’s one thing to keep in mind before you do.

If you have asthma, it’s possible that you may be more sensitive to nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen. In some cases, you may have aspirin-exacerbated respiratory disease (AERD). AERD is a condition involving asthma, sinus problems, and worsening of symptoms after taking an NSAID.

If you have symptoms such as nasal congestion, sinus pain, or coughing after taking an NSAID, you might have AERD. Your healthcare provider can tell you if that’s the case and suggest safer alternatives to NSAIDs, if so. Montelukast can also help lessen inflammation caused by this condition.

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Written by:

Sandy P. Bonfin, PharmD, BCPS

Sandy Bonfin has 9 years of experience as a pharmacist and has been working as a clinical pharmacist in a hospital in Florida for the past 7 years after a short stint as a mail-order retail pharmacist. Sandy has worked in pediatric medicine, emergency medicine, internal medicine, and intensive care.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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