Montelukast (trade names Singulair and Montelo-10) is a leukotriene receptor antagonist (LTRA) used for the maintenance treatment

of asthma and to relieve symptoms of seasonal allergies.

[1][2]

It is usually

administered orally. Montelukast is a CysLT1 antagonist; that is it blocks the action ofleukotriene D4 (and secondary ligands LTC4 and LTE4) on the cysteinyl leukotriene receptor CysLT1 in the lungs and bronchial tubes by binding to it. This reduces the bronchoconstriction otherwise caused by the leukotriene and results in less inflammation. Because of its method of operation, it is not useful for the treatment of acute asthma attacks. Again because of its very specific focus of operation, it does not interact with other asthma medications such as theophylline. Another leukotriene receptor antagonist is zafirlukast (Accolate), taken twice daily. Zileuton (Zyflo), an asthma drug taken four times per day, blocks leukotriene synthesis by inhibiting 5-lipoxygenase, an enzyme of the eicosanoid synthesis pathway. The Mont in Montelukast stands for Montreal, the place where Merck developed the drug.
[3

Uses
-blockers are used in the treatment of several conditions, such as Raynaud's disease, hypertension, and scleroderma.[2] -blockers can also be used to treat anxiety and panic disorders, such as generalized anxiety disorder, panic disorder or posttraumatic stress disorder (PTSD). Alpha2-adrenergic receptor agonists, such as clonidine and guanfacine, act at noradrenergic autoreceptors to inhibit the firing of cells in the locus ceruleus, effectively reducing the release of brain norepinephrine (3). Clonidine has shown promise among patients with Anxiety, Panic and PTSD in clinical trials and was used to treat severely and chronically abused and neglected preschool children. It improved disturbed behavior by reducing aggression, impulsivity, emotional outbursts, and oppositionality (4). Insomnia and nightmares were also reported to be reduced. Kinzie and Leung (5) prescribed the combination of clonidine and imipramine to severely traumatized Cambodian refugees with Anxiety, Panic and PTSD. Global symptoms of PTSD were reduced among sixty-six percent and nightmares among seventy-seven percent. Guanfacine produces less sedation than clonidine and thus may be better tolerated. Guanfacine reduced the trauma-related nightmares (6). A recently completed randomized double-blind trial among veteran patients with chronic PTSD showed that augmentation with guanfacine was associated with improvement in anxiety and PTSD. Prazosin is an alpha1-receptor antagonist. Raskin and colleagues (7) studied the efficacy of prazosin for PTSD among Vietnam combat veterans in a 20-week double-blind crossover protocol with a two-week

drug washout to allow for return to baseline (7). The CAPS and the Clinical Global Impressions-Change scale (CGI-C) were the primary outcome measures. Patients who were taking prazosin had a robust improvement in overall sleep quality (effect size, 1.6) and recurrent distressing dreams (effect size, 1.9). In each of the PTSD symptom clusters the effect size was medium to large: .7 for reexperiencing or intrusion, .6 for avoidance and numbing, and .9 for hyperarousal. The reduction in CGI-C scores (overall PTSD severity and function at endpoint) also reflected a large effect size (1.4). Prazosin appears to have promise as an effective treatment for PTSD-related sleep disturbance, including trauma-related nightmares, as well as overall Anxiety and PTSD symptoms. "Guanfacine extended-release (long-acting) tablets (Intuniv brand only) are used as part of a treatment program to control symptoms of attention deficit hyperactivity disorder (ADHD; more difficulty focusing, controlling actions, and remaining still or quiet than other people who are the same age) in children."

WHAT ARE THE PRECAUTIONS WHEN TAKING METHYLPREDNISOLONE (MEDROL)?

Before taking this medication, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: untreated active fungal infections. Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding problems, history of blood clots, brittle bones (osteoporosis), high blood pressure, certain heart problems (such as congestive heart failure), diabetes, certain eye diseases (such as cataracts, herpes infection

Medical uses

A capsule of gabapentin

Gabapentin is used primarily for the treatment of seizures, neuropathic pain, and hot flashes. [edit]Proven

[2]

Gabapentin was originally approved by the U.S. Food and Drug Administration (FDA) in 1994 for use as an adjunctive medication to control partial seizures(effective when added to other antiseizure drugs). In 2002, an indication was added for treating postherpetic neuralgia (neuropathic pain following shingles), other painful neuropathies, and nerve-related pain.[3] Gabapentin (administered orally) is one of two medications (the other being flumazenil, that is administered intravenously) used in the expensive PrometaTreatment Protocol for methamphetamine,

cocaine and alcohol addiction. Gabapentin is administered at a dosage of 1200 mg taken at bedtime for 4060 days. Though the combination of flumazenil infusions and gabapentin tablets is a licensed treatment, there is no prohibition against a physician prescribing gabapentin outside the Prometa protocol. There have been reports by methamphetamine addicts that gabapentin alone in doses of 1200 mg at bedtime taken for 4060 days has been effective in reducing cravings or desire to use methamphetamine. It also attenuates the severity of withdrawal symptoms experienced by those physically dependent on opioid analgesics, such as heroin, morphine, and oxycodone.
[5] [4]

One study also

[6]

demonstrates a significant reduction in the severity of benzodiazepine withdrawal syndrome. [edit]Positive

Gabapentin is frequently used to treat various types of neuralgia. It has been found to be effective in prevention of frequent migraine headaches,[7]neuropathic pain[8] and nystagmus,[9] and is prescribed offlabel (that is, without formal regulatory agreement) for these conditions. Gabapentin is widely believed to help patients with post-operative chronic pain (usually caused by nerves that have been severed accidentally in an operation and when grown back, have reconnected incorrectly) and nerve pain associated with spinal cord injury. It may be effective in reducing pain and spasticity in multiple sclerosis,[10] and has also had success in treating certain instances of Complex Regional Pain Syndrome.[11][12] Gabapentin is a very promising medication in the treatment of postherpetic neuralgia and pain. Because dermatological patients suffer pain from painful tumors, after surgery, in conjunction with neuropathic ulcers, during dressing changes involving serious medical conditions, its applications seem manifold.[13] Gabapentin has been used to treat some symptoms of opiate withdrawal,[14] but tests for smoking cessation treatment have had mixed results.[15][16] Additionally, gabapentin has been prescribed to menopausal patients being treated with anti-androgenic compounds to reduce the incidence and intensity of the accompanying hot flashes.[17] Gabapentin may help deepen sleep, positively affecting deep, slow wave sleep, and reducing arousals during the night.[18] [edit]Negative Gabapentin has been prescribed in the mental health context. Numerous trials show that it is not effective as a mood-stabilizing treatment for bipolar disorder and so has no therapeutic advantage in having fewer side-effects over better established bipolar drugs such as lithium and valproic acid. Gabapentin has limited usefulness in the treatment ofanxiety disorders such as social anxiety disorder and obsessivecompulsive disorder, in treatment-resistant depression, and for insomnia. cause weight gain.
[21] [19][20]

Gabapentin can also

A double blind, randomized controlled trial found gabapentin ineffective for the treatment of idiopathic subjective tinnitus.[22]

[edit]Adverse

effects

Gabapentin's most common side effects in adult patients include dizziness, drowsiness, and peripheral edema (swelling of extremities);[23] these mainly occur at higher doses in the elderly. Also, children 312 years of age were observed to be susceptible to mild-to-moderate mood swings, hostility, concentration problems, and hyperactivity. Although rare, there are several cases ofhepatotoxicity reported in the literature.[24][25] Gabapentin should be used carefully in patients with renal impairment due to possible accumulation and toxicity.[26][27] An increase in formation of adenocarcinomas was observed in rats during preclinical trials; however, the clinical significance of these results remains undetermined. Gabapentin is also known to induce pancreatic acinar cell carcinomas in rats through an unknown mechanism, perhaps by stimulation of DNA synthesis; these tumors did not affect the lifespan of the rats and did not metastasize.[28] [edit]Suicide Gabapentin has been associated with an increased risk of suicidal acts or violent deaths.[29] In 2009, the FDA issued a warning of an increased risk of depression and suicidal thoughts and behaviors in patients taking gabapentin, along with other anticonvulsant drugs this.
[23] [30]

modifying the packaging insert to reflect

In July 2009, the manufacturer of gabapentin (Pfizer) went to trial regarding the association

between gabapentin and the increased risk of suicide.[31] [edit]Withdrawal Gabapentin should not be discontinued abruptly after long term use. Abrupt or over rapid withdrawal may provoke a withdrawal syndrome reminiscent to alcohol or benzodiazepine withdrawal.[32][33]Gradual reduction over a period of weeks or months helps minimize or prevents the withdrawal syndrome.[32] Side effects upon discontinuation of gabapentin that have been reported in medical literature include insomnia, restlessness, agitation, anxiety, disorientation, confusion, light sensitivity, diaphoresis,headaches, palpitations, hypertension, chest pain, and flu-like symptoms.[32][34][35][36] In at least one case, abrupt cessation of a high dose (4000mg) of gabapentin triggered a seizure in an individual with no history of epilepsy.[35] [edit]Overdosage