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Singulair vs Advair
Introduction
Patients with asthma or other chronic obstructive pulmonary diseases often need medication that can help manage their symptoms and improve lung function. Singulair and Advair are two such drugs that are commonly prescribed for these conditions. Both of them have an impact on the inflammatory pathways in the lungs, but they work in different ways to achieve better control of respiratory symptoms.
Singulair is a leukotriene receptor antagonist, which works by blocking substances called leukotrienes. These substances contribute to inflammation, bronchoconstriction, mucus production and swelling in the airways of your lungs.
Advair, on the other hand, is a combination drug consisting of fluticasone (a corticosteroid) and salmeterol (a long-acting beta agonist). Fluticasone works by reducing inflammation while salmeterol relaxes smooth muscles around airways to open up breathing passages.
Singulair vs Advair Side By Side
| Attribute | Singulair | Advair |
|---|---|---|
| Brand Name | Singulair | Advair |
| Contraindications | Should not be taken with certain types of medications such as beta blockers, MAOIs, tricyclic antidepressants, or other drugs that can interact. Not to be used more frequently than prescribed. | Should not be taken with certain types of medications such as beta blockers, MAOIs, tricyclic antidepressants, or other drugs that can interact. Not to be used more frequently than prescribed. |
| Cost | Approximately $6.67 per day for brand name, as low as $1/day for generic (Montelukast) | Approximately $6.66 per day for brand name, $1.70 - $3/day for generic equivalent (Fluticasone/Salmeterol inhalation powder) |
| Generic Name | Montelukast | Fluticasone/Salmeterol |
| Most Serious Side Effect | Mood changes or feelings of aggression, agitation, anxiety, depression or suicidal thoughts | Uneven heartbeats, chest pain, blurred vision and eye pain, high blood sugar levels, low potassium level |
| Severe Drug Interactions | MAOIs require a period of up to 2 weeks after discontinuation before starting therapy with Singulair to prevent dangerous interactions. | MAOIs require a period of up to 2 weeks after discontinuation before starting therapy with Advair to prevent dangerous interactions. |
| Typical Dose | Adults and adolescents 15 years and older: one 10 mg tablet a day. Children aged 6-14: one chewable 5mg tablet daily. Toddlers from 2-5 years old: one chewable 4 mg tablet or packet of oral granules daily. | One inhalation of the prescribed strength (either 100/50, 250/50 or 500/50 mcg fluticasone propionate/salmeterol) twice a day, approximately 12 hours apart. |
What is Singulair?
Montelukast (the generic name for Singulair) is a leukotriene receptor antagonist used for the maintenance treatment of asthma, to relieve symptoms of seasonal allergies, and to prevent exercise-induced bronchospasm. Montelukast was first approved by the FDA in 1998. It works by blocking substances in your body called leukotrienes that cause the symptoms of asthma and allergic rhinitis. Singulair has a selective influence on specific receptors in the lungs and airways where it blocks leukotrienes, which results in fewer side effects compared with other drugs that have broader actions.
On the other hand, Advair Diskus or HFA (a combination of fluticasone propionate and salmeterol) is also used for managing asthma but additionally helps with chronic obstructive pulmonary disease (COPD). The combined action targets two aspects: inflammation prevention (fluticasone propionate being a corticosteroid) and relaxing muscles around airways to aid breathing (salmeterol being a long-acting beta agonist). This dual-action medication thus requires specific attention considering its stronger effects.
What conditions is Singulair approved to treat?
Singulair is approved for the management of multiple conditions related to respiratory health:
- Chronic treatment and prophylaxis of asthma in adults and children aged 1 year and older
- Relief from symptoms of seasonal allergic rhinitis (hay fever) in those aged 2 years and older
- Symptomatic relief from perennial allergic rhinitis (year-round allergies) in individuals aged 6 months or more.
Advair, on the other hand, is also used to manage several pulmonary disorders:
- Long-term maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD)
- Reduction of COPD exacerbations
- Maintenance treatment for asthma as a prophylactic therapy.
How does Singulair help with these illnesses?
Singulair, or montelukast, operates by blocking a substance called leukotrienes in the body. Leukotrienes are chemicals your body releases when you breathe in an allergen (such as pollen), and they cause swelling in your lungs and tightening of the muscles around your airways, leading to asthma symptoms. By inhibiting these substances, Singulair helps to prevent wheezing, shortness of breath, and other symptoms caused by asthma.
On the other hand, Advair is a combination medication that contains fluticasone propionate - a corticosteroid which reduces inflammation in the respiratory tract - and salmeterol - a long-acting beta agonist (LABA) that works by relaxing muscles in the airways to improve breathing. This dual action makes it effective for controlling asthma symptoms but also requires more careful monitoring due to potential side effects associated with LABAs.
Choosing between these two medications depends on individual patient factors such as severity of condition, response to previous treatment regimens among others. Always consult with a healthcare professional before making any changes.
What is Advair?
Advair, a brand name for the combination of fluticasone and salmeterol, is a long-acting beta agonist (LABA) with an inhaled corticosteroid. This means it reduces inflammation in the airways and relaxes the muscles surrounding them. It also helps to prevent symptoms of asthma and improve lung function. Advair was first approved by the FDA in 2000 as a treatment option for patients who are not adequately controlled on other asthma-controller medications or whose disease severity clearly warrants initiation therapy with two maintenance therapies.
Unlike montelukast (Singulair), which only blocks leukotrienes—substances that cause inflammation, fluid retention, bronchoconstriction, and mucus production—Advair has dual action by both reducing inflammation and opening up airways. Its side-effect profile is different from leukotriene receptor antagonists like Singulair because it can lead to an increased risk of pneumonia in people with COPD and may worsen existing tuberculosis, fungal, bacterial or viral infections of the airway. The effects on reducing inflammation while relaxing airway muscles make Advair more beneficial for treating persistent asthma compared to “typical” leukotriene modifiers such as Singulair.
What conditions is Advair approved to treat?
Advair is an FDA-approved medication used for the management of:
- Chronic obstructive pulmonary disease (COPD) with chronic bronchitis
- Asthma in patients aged 4 years and older who have not adequately responded to other asthma-controller medications or whose disease severity warrants initiation of treatment with both an inhaled corticosteroid and a long-acting beta2-adrenergic agonist.
How does Advair help with these illnesses?
Advair, much like Singulair, is used in the management of asthma and chronic obstructive pulmonary disease (COPD). It acts by reducing inflammation and widening airways to aid breathing. Advair has a dual mechanism of action. One component, fluticasone propionate, is a corticosteroid that reduces swelling in the airways. The second component - salmeterol - belongs to a class of drugs known as long-acting beta agonists which work by opening up the bronchial tubes for an elongated period, allowing more comfortable respiration over time. This dual-action approach can be particularly beneficial for patients not responding adequately to single mechanism medications such as Singulair or when combination therapy is deemed necessary.
How effective are both Singulair and Advair?
Both montelukast (Singulair) and fluticasone/salmeterol (Advair) have established histories of success in treating patients with asthma, and they were approved by the FDA within a few years of each other. They operate differently: Singulair is a leukotriene receptor antagonist that reduces inflammation in the lungs, while Advair combines a corticosteroid (fluticasone) that reduces inflammation with a long-acting bronchodilator (salmeterol) that relaxes muscles in the airways to improve breathing.
A 2003 study compared montelukast to fluticasone for control of asthma; it found no significant difference between the two drugs regarding their ability to manage symptoms or prevent exacerbations. A 2010 clinical trial comparing monotherapy of either drug versus combination therapy using both found improved lung function and symptom control among those receiving combination therapy.
A review on montelukast published in 2004 demonstrated its efficacy as an add-on treatment for managing chronic asthma, particularly when first-line treatments such as low-dose inhaled corticosteroids are insufficient. It also has benefits beyond respiratory health, reducing exercise-induced bronchoconstriction and seasonal allergic rhinitis symptoms.
Fluticasone/salmeterol's effectiveness was confirmed by a comprehensive review conducted in 2016. The review noted that this combination treatment generally improves lung function better than individual components alone or placebos. However, despite being effective at controlling symptoms and improving quality of life for many patients, some people may experience side effects such as throat irritation or fungal infections of the mouth due to fluticasone component.
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At what dose is Singulair typically prescribed?
Oral dosages of Singulair for adults and adolescents 15 years of age and older is one 10 mg tablet a day. For children aged 6-14, the recommended dosage is one chewable 5mg tablet daily. In toddlers from 2-5 years old, the dose drops to one chewable 4 mg tablet or packet of oral granules daily. The effectiveness of Singulair in treating asthma symptoms may be seen after a few weeks, so it's important to take it consistently as prescribed by your physician even when you feel well. Advair, on the other hand, comes in different strengths: Advair Diskus is available in forms containing fluticasone propionate/salmeterol (100/50 mcg, 250/50 mcg or 500/50 mcg) while Advair HFA is available as an aerosol inhaler with doses at fluticasone propionate/salmeterol (45/21mcg ,115/21mcg or230/21mcg). The appropriate strength depends on the severity of your condition and should not exceed two inhalations twice per day regardless.
At what dose is Advair typically prescribed?
Advair treatment typically starts with one inhalation of the prescribed strength (either 100/50, 250/50 or 500/50 mcg fluticasone propionate/salmeterol) twice a day, approximately 12 hours apart. If an adequate response is not achieved after two weeks of therapy at this initial dosage, your healthcare provider may consider increasing it to a higher strength. The maximum recommended dose is one inhalation of Advair Diskus 500/50 mcg twice daily. This maximum dose should be considered only if there's no significant improvement in symptoms even after several weeks on the lower strengths.
What are the most common side effects for Singulair?
Common side effects of Singulair may include:
- Upper respiratory infection
- Fever
- Headache
- Sore throat
- Cough
- Stomach pain or upset
- Flu-like symptoms
- Ear infection (otitis media)
- Dizziness
On the other hand, Advair can cause:
- Throat irritation and dryness
- Hoarseness and voice changes
- Bronchitis
- Headaches and dizziness
- Nausea and vomiting
- Diarrhea
- Rash or hives on the skin
Are there any potential serious side effects for Singulair?
Singulair and Advair are both effective medications for managing asthma symptoms, but they can sometimes have serious side effects. For Singulair, these may include:
- Mood changes or feelings of aggression, agitation, anxiety, depression or suicidal thoughts
- Allergic reactions such as hives; difficulty breathing; swelling of your face, lips, tongue or throat
- Numbness in the arms or legs
- Painful sinuses accompanied by fever
- Unexplained rash that might be accompanied by bruising
On the other hand with Advair:
- Uneven heartbeats
- Chest pain or heavy feeling on chest along with nausea and sweating
- Blurred vision and eye pain associated with halos around lights
- White patches in mouth/throat indicative of oral thrush (yeast infection)
These severe adverse events are quite rare. However if you experience any of them while taking either medication it's important to discontinue use immediately and seek medical help urgently.
What are the most common side effects for Advair?
When it comes to Advair, users may experience the following side effects:
- Dry mouth or throat irritation
- Hoarseness and voice changes
- Coughing and shortness of breath
- Headaches and dizziness
- Nausea or vomiting
- Muscle pain or joint discomfort
- Rapid heartbeat
- Insomnia or sleep disturbances
- Vision problems, such as blurred vision Additionally, there could be skin issues like rashes. In some cases people also report experiencing nervousness, tremors, increased urination, and even unexplained weight loss. If any of these symptoms persist or become severe it is advised to contact your healthcare provider immediately.
Are there any potential serious side effects for Advair?
Advair, while generally well-tolerated, can have serious side effects in rare cases. Possible severe symptoms include:
- Signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat
- Vision problems and eye pain (which could indicate a possible glaucoma complication)
- High blood sugar levels - increased thirst or urination
- Low potassium level - leg cramps, constipation irregular heartbeats
- Rapid weight gain with no clear cause
- Chest pain and fast/pounding heartbeats
If you notice any of these signs after starting Advair treatment, it's important to seek immediate medical attention.
Contraindications for Singulair and Advair?
Both Singulair and Advair, like many other medications used to treat asthma or allergies, may worsen symptoms in some people. If you notice your condition worsening, including increased difficulty breathing or chest tightness, please seek immediate medical attention.
Neither Singulair nor Advair should be taken if you are using certain types of medications such as beta blockers, MAOIs (monoamine oxidase inhibitors), tricyclic antidepressants, or other drugs that can interact with these medicines. Always inform your doctor about the medications you are taking; for example, MAOIs will require a period of up to 2 weeks after discontinuation before starting therapy with either Singulair or Advair to prevent dangerous interactions.
Furthermore, it's crucial not to use either medication more frequently than prescribed by your doctor since overuse can lead to serious consequences including heart problems and bronchospasm (tightening of muscles around the airways).
How much do Singulair and Advair cost?
For the brand name versions of these drugs:
- The price for one diskus (60 doses) of Advair (250/50 mcg) averages around $400, which works out to approximately $6.66 per day.
- The price for 30 tablets of Singulair (10 mg) is about $200, working out to roughly $6.67 per day.
Thus, if you are using a single dose daily for both medications, then the cost per-day treatment basis is comparable between brand-name Singulair and Advair. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.
Regarding generic versions; Montelukast (generic version of Singulair), costs are significantly lower:
- Montelukast comes mostly in packs ranging from 30 to 90 tablets with approximated costs starting from as low as $1/day.
Unfortunately, there's no exact generic equivalent available for Advair yet but Fluticasone/Salmeterol inhalation powder has similar ingredients and can serve as an alternative:
- Fluticasone/Salmeterol inhalation powder ranges from about $100–$200 depending on the dosage strength equating to approximately between $1.70 -3/day if considering a monthly pack.
Remember that drug effectiveness varies among individuals and therefore it’s crucial to consult with your healthcare provider before switching medication based on cost alone.
Popularity of Singulair and Advair
Montelukast, in generic form as well as under the brand name Singulair, was prescribed to around 7.5 million people in the US in 2020. Montelukast accounted for approximately 15% of prescriptions for asthma medications that year. It's a type of medication known as a leukotriene receptor antagonist used primarily for preventing asthma attacks and relieving symptoms of seasonal allergies.
Fluticasone/salmeterol, also known by its brand name Advair, was prescribed to about 4.1 million individuals in the USA during the same period. In terms of prescriptions written for combination inhaler medications for respiratory diseases such as asthma and COPD (chronic obstructive pulmonary disease), fluticasone/salmeterol accounts for roughly 23%. The prevalence has remained relatively steady over recent years.
Both drugs are commonly utilized in managing respiratory conditions like asthma but have different mechanisms and scopes of action: while montelukast works by blocking substances called leukotrienes to reduce inflammation and constriction in airways, fluticasone is a corticosteroid that reduces inflammation whereas salmeterol is a long-acting bronchodilator relaxing muscles around air passages.
Conclusion
Both Singulair (montelukast) and Advair (fluticasone/salmeterol) have established roles in managing asthma symptoms, with numerous clinical studies supporting their efficacy over placebo treatments. While these medications can be used simultaneously for severe asthma cases, this should be under careful supervision by a physician due to potential drug interactions.
Singulair operates primarily by blocking leukotriene receptors which play a significant role in the inflammation and constriction of airways during an asthma attack. On the other hand, Advair uses a combination approach: fluticasone is a corticosteroid that reduces inflammation while salmeterol is a long-acting bronchodilator that helps open up the airways.
In terms of prescription trends, Singulair may often serve as additional therapy to inhaled steroids like fluticasone or for patients who dislike using inhalers. Conversely, Advair is typically prescribed when low-dose inhaled corticosteroids alone are insufficient in controlling asthma symptoms.
Both drugs come as generic versions providing cost-effective options for those paying out-of-pocket. It's important to note that neither medication provides instant relief; they require regular use over time for optimal benefit.
Side effect profiles differ between both drugs although generally well-tolerated: Singulair has been associated with neuropsychiatric effects such as agitation and depression while Advair may increase risk of oral thrush and hoarseness due to its steroid component. Patients starting either treatment need close monitoring of their symptoms and must seek immediate medical attention if breathing difficulties worsen dramatically.
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Refrences
- Ilowite, J., Webb, R., Friedman, B., Kerwin, E., Bird, S. R., Hustad, C. M., & Edelman, J. M. (2004, June). Addition of montelukast or salmeterol to fluticasone for protection against asthma attacks: a randomized, double-blind, multicenter study. Annals of Allergy, Asthma & Immunology. Elsevier BV.http://doi.org/10.1016/s1081-1206(10)61430-5
- Skoner, D. (2001). Montelukast in 2-to 5-year-old children with asthma. Pediatric Pulmonology. Wiley.http://doi.org/10.1002/ppul.2006
- Allen-Ramey, F. C., Anstatt, D. T., Sajjan, S. G., & Markson, L. E. (2005, December). Asthma-Related Health Care Resource Use Among Patients Starting Fluticasone or Montelukast Therapy. Pharmacotherapy. Wiley.http://doi.org/10.1592/phco.2005.25.12.1752