Singulair (montelukast) and Suicide Risk

According to the TV station WNYT.com:

"A couple is blaming their teenage son's suicide on the allergy drug Singulair. On October 2, 2007, two months after Cody's death, Merck updated the warning for Singulair to include suicidal thoughts and actions. Company spokesman Ronald Rogers tells me the company received some post marketing events and changed the package insert, patient brochures and ads. Drug reps were instructed to share the information with clients, but none of the doctors or pharmacists we checked with was aware of the update."

A PDF with the updated Singulair adverse effects is available from the Merck website.

A mnemonic:

S
Singulair
Single daily dose
Suicude risk (potential)

As of 2/27/2008, a Pubmed search does not show any published reports on suicide risk and Singuair.

Leukotriene Receptor Antagonists (LTRA)

Antagonists of the CysLT1 receptor (LTRA) are efficacious as controller therapy in asthma and montelukast is FDA-approved for treatment of seasonal allergic rhinitis.

Mast cells quickly generate different mediators from the metabolism of arachidonic acid: leukotrienes and prostglandins (LTC4, LTB4, PGD2). These substances are produced within minutes of IgE-receptor crosslinking on the surface of mast cells.


Eicosanoids are signaling molecules made by oxygenation of 20-carbon essential fatty acids. There are 4 families of eicosanoids (PP-LT): prostaglandins (PG), prostacyclins (PGI), leukotrienes (LT) and thromboxanes (TX).


Mast cell mediators including (PP-LT): prostaglandins (PG), prostacyclins (PGI), leukotrienes (LT) and thromboxanes (TX). See more Allergy and Immunology mind maps here.

Update:

American Lung Association Study Finds No Evidence of Depression or Suicide Linked to Asthma and Allergy Drug Montelukast. MarketWatch, 09/2008.

References:
Suicide and a common allergy medication. NewsChannel 13, WNYT.com.
Mast Cells and Basophils. Allergy Cases.
Pathogenesis of Asthma. Allergy Cases.

Urinary leukotriene E(4)/exhaled nitric oxide ratio predicts montelukast response in childhood asthma http://goo.gl/i5cG
Image source: Montelukast, from Wikipedia, the free encyclopedia, public domain.

Updated: 09/02/2008