Singulair for Children With Allergies

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Singulair (montelukast) is a prescription medication used to treat severe allergies in children as young as 6 months. Although montelukast doesn't usually cause drowsiness, it does come with a risk of side effects, ranging from stomach pain and nausea to sleep disturbances and agitation.

As such, Singulair is typically reserved for children who cannot tolerate other allergy medications or do not respond effectively to them. Singulair is available in three forms: tablets, chewable tablets, and oral granules. The form prescribed depends on the age of the person taking it.

This article discusses the prescription medication Singulair and its use in children with asthma and/or allergies. Learn about how it works, possible side effects, and dosage information.

Mother wiping nose of daughter with tissue
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Uses for Singulair in Children

Singulair is approved by the Food and Drug Administration (FDA) for:

Not a Rescue Medication

Children should not take Singulair for the immediate relief of an asthma attack. In the event of an asthma attack, use a rescue inhaler immediately.

How Singulair Works

The active ingredient in Singulair is montelukast sodium, a leukotriene receptor antagonist.

Leukotrienes are immune system chemicals thought to cause many allergy and asthma symptoms. Thus, blocking them with Singulair may help control asthma and allergy symptoms.

Singulair is shown to help control children's allergy symptoms, including:

  • Sneezing
  • Stuffy nose
  • Runny nose
  • Itchy nose

Child-Friendly Forms and How to Use Them

Forms of Singulair include:

  • Singulair Oral Granules (ages 6 months to 5 years)
  • Singulair Chewable Tablets 4mg (ages 2 to 5 years)
  • Singulair Chewable Tablets 5 mg (ages 6 to 14 years)
  • Singulair Tablets 10 mg (ages 15 and above)

Oral granules and chewable tablets are the easiest for young kids who can't swallow pills and won't drink liquid allergy medicine.

You can dissolve the granules in a teaspoon of infant formula or breast milk. You can also mix them with a spoonful of soft food, such as baby food, applesauce, rice, or ice cream, or put them directly in your child's mouth.

Singulair is a once-a-day medication, but children with asthma should take Singulair in the evening. Children with allergies can take it whenever convenient, preferably at about the same time each day.

Possible Side Effects of Singulair

Singulair is generally well tolerated by children.

The most common side effects include:

Less common side effects include:

  • Agitation and aggressive behavior
  • Allergic reactions
  • Hives and itching
  • Bad or vivid dreams
  • Increased bleeding tendency
  • Bruising
  • Diarrhea
  • Drowsiness
  • Hallucinations
  • Hepatitis
  • Indigestion
  • Pancreatitis
  • Irritability
  • Joint pain
  • Muscle aches
  • Muscle cramps
  • Nausea
  • Palpitations
  • Pins and needles/numbness
  • Restlessness
  • Seizures
  • Swelling
  • Trouble sleeping
  • Vomiting

Tell your healthcare provider right away if your child experiences any of the following potentially serious symptoms:

  • Pins and needles or numbness in the arms or legs
  • Flu-like illness
  • Rash
  • Severe pain and swelling of the sinuses

The FDA in 2009 required the manufacturer of Singulair to include a warning about an increased risk of depression, suicidal thoughts, and suicide. A 2018 study found the link between Singulair use and depression was weak and more likely represented a link between asthma and depression. Children taking Singulair and their parents should be aware of the warning.

Dosing Guidelines for Allergies

Singulair dosage guidelines for allergies vary by age and formulation:

Age Dosage
15 years and older One 10-mg tablet
6 to 14 years One 5-mg chewable tablet
2 to 5 years One 4-mg chewable tablet, or one packet of 4-mg oral granules
6 to 23 months One packet of 4-mg oral granules

Only one dose of Singulair should be taken per day. Oral granules should be taken within 15 minutes after opening the packet. Singulair can be taken with or without food.

If you or your child misses a dose of Singulair, take the next dose at your regular time. Do not take two doses at the same time. If too much Singulair is taken, call a healthcare provider right away.

Singulair In Asthma and Bronchoconstriction

Singulair may be prescribed to prevent exercise-induced bronchoconstriction (EIB) in people ages 6 years and older. It may also be used to prevent asthma in people ages 12 months and older.

Bronchoconstriction

Exercise-induced bronchoconstriction (EIB) is the transient (temporary) tightening of smooth muscles in the airways following exercise.

You may have EIB if you experience the following symptoms within 10 minutes of exercise:

  • Coughing
  • Chest pain
  • Tightness in the chest
  • Trouble breathing
  • Wheezing
  • Shortness of breath

Exercise-induced bronchoconstriction can happen to anyone, including people with allergies and even healthy athletes who do not have asthma.

For the prevention of EIB, a single dose of Singulair should be taken at least two hours before exercise. Dosage guidelines are as follows:

  • Ages 15 years and older: Take one 10-mg tablet
  • Ages 6 to 14: Take one 5-mg chewable tablet

Only one dose of Singulair should be taken per day, regardless of how many times you exercise. If you are already taking Singulair for another reason (e.g., asthma or allergies), do not take an additional dose to prevent EIB.

Clinical studies show that a single dose of Singulair has a significant protective benefit against EIB when taken two hours before exercise, and may continue to protect against EIB for up to 24 hours after it is taken in some people.

Asthma

Singulair may be prescribed to help prevent asthma attacks. Like all other indications for Singulair, it may be taken once per day in the evening, with or without food.

Dosage guidelines for asthma are as follows:

  • Ages 15 years and older: Take one 10-mg tablet
  • Ages 6 to 14 years: Take one 5-mg chewable tablet
  • Ages 2 to 5 years: Take one 4-mg chewable tablet or one packet of 4-mg oral granules
  • Ages 12 to 23 months: Take one packet of 4-mg oral granules

Singulair is not an effective treatment for an acute asthma attack. In the event of an asthma attack, use a rescue inhaler immediately.

Signs of an asthma attack include:

  • Coughing
  • Shortness of breath
  • Wheezing
  • Light-headedness
  • Tightness or pressure in the chest
  • Fast heartbeat
  • Confusion

If a rescue inhaler does not appear to be working, go to the ER right away.

Summary

The prescription medication Singulair is approved for use in children as young as 6 months. It can treat allergies and asthma and is available in child-friendly forms such as oral granules and chewable tablets.

Singulair may be a good option for treating your child's allergies if you are concerned about drowsiness as a side effect.

This medication can have other side effects, however, such as stomach pain and upset, dizziness, and upper respiratory infection.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  3. Merck & Co., Inc. Patient information: Singulair.

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  5. Merck & Co., Inc. Singulair (Montelukast Sodium).

  6. Winkel JS, Damkier P, Hallas J, Henriksen DP. Treatment with montelukast and antidepressive medication—a symmetry analysis. Pharmacoepidemiol Drug Saf. 2018;27(12):1409-15. doi:10.1002/pds.4638

  7. Bacsi A, Pan L, Ba X, Boldogh I. Pathophysiology of bronchoconstriction: Role of oxidatively damaged DNA repair. Curr Opin Allergy Clin Immunol. 2016 Feb;16(1):59-67. doi:10.1097/ACI.0000000000000232

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By Vincent Iannelli, MD
 Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.