Leukotriene modifiers

1. Leukotrienes increase production of mucus and edema of the airway wall, and may cause bronchoconstriction. Montelukast and zafirlukast are leukotriene receptor antagonists. Zileuton inhibits synthesis of leukotrienes.

2. Montelukast (Singulair) is modestly effective for maintenance treatment of intermittent or persistent asthma. It is taken once daily in the evening. It is less effective than inhaled corticosteroids, but addition of montelukast may permit a reduction in corticosteroid dosage. Montelukast added to oral or inhaled corticosteroids can improve symptoms.

3. Zafirlukast (Accolate) is modestly effective for maintenance treatment of mild-to-moderate asthma It is less effective than inhaled corticosteroids. Taking zafirlukast with food markedly decreases its bioavailability. Theophylline can decrease its effect. Zafirlukast increases serum concentrations of oral anticoagulants and may cause bleeding. Infrequent adverse effects include mild headache, gastroin testinal disturbances and increased serum aminotransferase activity. Drug-induced lupus and Churg-Strauss vasculitis have been reported.

4. Zileuton (Zyflo) is modestly effective for maintenance treatment, but it is taken four times a day and patients must be monitored for hepatic toxicity.

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