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Singulair vs Flonase
Introduction
For patients dealing with chronic allergies or asthma, certain medications that modulate the immune response can help in controlling symptoms and enhancing quality of life. Singulair and Flonase are two such drugs that are often prescribed for these conditions. Each has a different mechanism of action but both offer relief from allergy-related symptoms. Singulair, also known as montelukast, is a leukotriene receptor antagonist which works by blocking substances called leukotrienes that cause inflammation and constriction in the lungs while increasing fluid secretion which can lead to asthma symptoms. On the other hand, Flonase (fluticasone) is a corticosteroid nasal spray which decreases inflammation within the nasal passages thereby reducing sneezing, itching and runny nose associated with allergic rhinitis.
Singulair vs Flonase Side By Side
| Attribute | Singulair | Flonase |
|---|---|---|
| Brand Name | Singulair | Flonase |
| Contraindications | Should not be used with certain medications metabolized by the liver enzyme CYP2C8 without discussing with a doctor. | Can interact harmfully with certain antifungal and anti-HIV medicines. |
| Cost | For brand name: around $220 for 30 tablets (10 mg). For generic (Montelukast Sodium): ranges roughly between $0.16 and $1 per tablet. | For brand name: about $25 for a bottle containing 120 sprays (50 mcg/spray). For generic (fluticasone propionate nasal spray): costs anywhere from just under a dollar up to around five dollars. |
| Generic Name | Montelukast | Fluticasone Propionate |
| Most Serious Side Effect | Changes in behavior or mood, including thoughts about suicide or self-harm. | Signs of a hormonal disorder--worsening tiredness or muscle weakness; feeling light-headed; nausea/vomiting. |
| Severe Drug Interactions | Negative interactions with drugs metabolized by the liver enzyme CYP2C8 like paclitaxel. | Harmful interactions with certain antifungal and anti-HIV medications. |
| Typical Dose | Adults and adolescents over 15: one 10 mg tablet once a day. Children 6 to 14: one chewable 5 mg tablet per day. Children 2 to 5: one chewable 4 mg tablet or packet of oral granules daily. | 2 sprays (50 mcg/spray) in each nostril once daily, totaling 200 mcg/day. Can be increased to a maximum of 2 sprays in each nostril twice daily, or 400 mcg/day. |
What is Singulair?
Montelukast (the generic name for Singulair) signifies an important step in the development of leukotriene receptor antagonists, a new class of drugs designed to manage asthma and allergies. Montelukast was first approved by the FDA in 1998. It works by blocking substances called leukotrienes that cause inflammation and constriction in the airways, thereby reducing symptoms such as wheezing, coughing, chest tightness and shortness of breath. Unlike other allergy medications that only target histamines, Singulair specifically targets leukotrienes which are key contributors to allergic reactions.
Fluticasone propionate (the generic name for Flonase), on the other hand, is a nasal corticosteroid spray used to treat nasal congestion and inflammation caused by hay fever or other allergies. Approved by FDA in 1994 as prescription-only medication then later became available over-the-counter in 2006. Flonase lessens swelling inside your nose making it easier to breathe while also relieving sneezing and itchy or runny nose symptoms commonly associated with seasonal or perennial allergies.
Both medicines have different mechanisms of action but work towards alleviating allergy symptoms effectively with minimal side effects if taken correctly under medical supervision.
What conditions is Singulair approved to treat?
Singulair is approved for the treatment of various conditions, including:
- Chronic asthma in patients aged one year and older
- Exercise-induced bronchospasm (EIB) - a type of asthma that occurs due to exercise or physical activity - in people six years old and above
- Seasonal allergic rhinitis, also known as hay fever, in those two years old and up
- Perennial allergic rhinitis (all-year allergies) in those six months old and over.
Flonase on the other hand is approved for:
- Management of seasonal and perennial allergy symptoms such as runny nose, sneezing, itchy or watery eyes, nasal congestion etc.
- Non-allergic nasal symptoms.
How does Singulair help with these illnesses?
Singulair, also known as montelukast, helps to manage asthma and seasonal allergies by blocking the action of leukotrienes in the body. Leukotrienes are a group of naturally occurring chemicals that promote inflammation in asthma and allergic rhinitis. They work by inducing tightening of airway muscles and production of mucus and fluid, which can cause symptoms like wheezing, coughing, runny nose or congestion.
Singulair blocks the receptors where these leukotrienes act so levels can be maintained lower for longer periods of time. It is believed that individuals with asthma or allergies have relatively higher levels of leukotrienes. Therefore, by reducing the amount of active leukotriene molecules through receptor antagonism, Singulair can limit negative effects such as inflammation and constriction in lungs leading to relief from symptoms associated with conditions like asthma or allergy.
What is Flonase?
Flonase is a brand name for fluticasone, which is a corticosteroid that works by reducing inflammation in the nasal passages and sinuses. It was first approved by the FDA in 1994 as a prescription medication before becoming available over-the-counter in 2015. As fluticasone acts directly on inflamed tissues to inhibit responses from certain immune cells, it does not have many of the systemic side effects associated with oral steroids. Unique among intranasal corticosteroids like Singulair, Flonase has dual action: it reduces inflammation and also blocks histamines and other irritants responsible for triggering allergy symptoms such as runny nose, sneezing and itching. This gives Flonase an advantage over typical leukotriene receptor antagonists such as Singulair (montelukast), particularly for patients who suffer from moderate to severe allergies or those who do not respond adequately to antihistamine medications alone.
What conditions is Flonase approved to treat?
Flonase is FDA-approved for the management of both seasonal and year-round allergic rhinitis, as well as non-allergic nasal symptoms. Specifically, Flonase can be used to treat:
- Seasonal and perennial allergic rhinitis
- Nasal congestion, sneezing, runny nose, itchy nose
- Nonallergic (vasomotor) rhinitis
How does Flonase help with these illnesses?
Fluticasone, the active ingredient in Flonase, is a corticosteroid that helps to reduce inflammation within the nasal passages. As such, it plays an essential role in reducing symptoms associated with allergic rhinitis or hay fever, including stuffy or runny nose and sneezing. Similar to norepinephrine's action on wakefulness and focus, fluticasone works by decreasing the number of inflammatory cells present in the nasal lining. This alleviates some of the discomforts caused by allergies. Unlike Singulair which primarily blocks leukotrienes (chemicals that cause allergy symptoms), Flonase impacts multiple inflammatory substances including histamines and cytokines. Therefore, if a patient does not respond well to leukotriene inhibitors like Singulair, they may find more symptom relief with a broad-spectrum option like Flonase.
How effective are both Singulair and Flonase?
Both montelukast (Singulair) and fluticasone propionate (Flonase) have a proven track record in managing symptoms of allergic rhinitis, although they were approved by the FDA several years apart. Since they act on different biological pathways, they may be prescribed under differing circumstances. The efficacy of montelukast and fluticasone in alleviating symptoms of allergic rhinitis was directly compared in a double-blind clinical trial in 2004; both drugs displayed comparable effectiveness in reducing allergy symptoms, with similar safety profiles.
A 2010 review highlighted that montelukast is effective from the first dose at providing relief from allergy symptoms such as sneezing, runny nose, nasal congestion, and itchy eyes. It also pointed out that its side effect profile is favorable when compared to many other antihistamines due to its lack of sedative properties. This study noted that montelukast has become one of the most widely used leukotriene receptor antagonists for treating allergies worldwide.
On the other hand, a 2016 meta-analysis indicated that fluticasone seems to be more potent than placebo and similarly or more effective than common antihistamines for relieving symptoms associated with seasonal allergic rhinitis. Flonase can provide relief on its own but can also be combined with an oral antihistamine if required for better control over severe allergy symptoms.
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At what dose is Singulair typically prescribed?
Singulair is typically prescribed as one 10 mg tablet taken orally once a day for adults and adolescents over the age of 15. For children aged 6 to 14, a lower dose of one chewable 5 mg tablet per day is recommended. Children ages two to five can take one chewable 4 mg tablet or packet of oral granules daily. Dosage may be adjusted based on individual response and tolerability but should not exceed the maximum daily dosage in any case. Always consult with your healthcare provider for personalized dosing instructions.
At what dose is Flonase typically prescribed?
Flonase treatment typically begins with a dosage of 2 sprays (50 mcg/spray) in each nostril once daily, totaling 200 mcg/day. If symptoms are not adequately controlled, the dose can be increased to a maximum of 2 sprays in each nostril twice daily, or 400 mcg/day. However, once symptoms have been managed effectively, it's recommended to reduce the dosage back down to one spray per nostril every day for maintenance therapy. This adjustment should be considered if there is no significant relief from symptoms after using the initial dosage consistently for about one week.
What are the most common side effects for Singulair?
Common side effects of Singulair and Flonase may include:
- Headache
- Dizziness
- Nervousness
- Tiredness (fatigue)
- Stomach pain, nausea, diarrhea or constipation
- Dry mouth or throat irritation for Flonase users
- Nasal congestion, sinusitis
- Coughing, sore throat due to viral infections like flu symptoms
- Difficulty sleeping (insomnia) particularly with Singulair
- Skin rashes in rare cases
Always consult your healthcare provider if you experience any uncomfortable symptoms while taking these medications.
Are there any potential serious side effects for Singulair?
While both Singulair and Flonase are used to control and prevent symptoms caused by allergies, they can potentially cause different side effects. For Singulair, these may include:
- Changes in behavior or mood, including thoughts about suicide or self-harm
- Signs of allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat
- Tingling or numbness in the arms or legs
- Flu-like symptoms: fever, sinus pain/swelling/tenderness
Flonase on the other hand can lead to:
- Signs of a hormonal disorder--worsening tiredness or muscle weakness; feeling light-headed; nausea/vomiting
- Vision changes such as blurred vision
- Nosebleeds (frequent), white patches inside nose/new nasal sores
If any severe reactions like these occur while using either medication it is crucial that you seek medical attention promptly.
What are the most common side effects for Flonase?
Common side effects of Flonase, a type of nasal spray used to relieve allergy symptoms, can include:
- Dryness or irritation in the nose and throat
- Headache
- Unpleasant taste or smell
- Nosebleeds
- Coughing
- Nausea or vomiting -Stomach pain or upset stomach.
In more severe cases, it may lead to vision problems like blurred vision. Some people using Flonase have also reported dizziness. It's important to note that these are potential side effects; not everyone who uses Flonase will experience them.
Are there any potential serious side effects for Flonase?
While Flonase is an effective treatment for nasal allergies, it can occasionally lead to serious side effects. These include:
- Signs of a severe allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue, or throat
- Unusual behavior or mood changes
- Blurred vision or seeing halos around lights
- Sores in the nose that won't heal
- Wheezing, tightness in chest, trouble breathing
- Flu-like symptoms (fever, chills)
If you experience any of these signs while using Flonase, stop its use immediately and seek medical attention right away. It's important to remember that these reactions are rare and most people tolerate Flonase well when used properly.
Contraindications for Singulair and Flonase?
Both Singulair and Flonase, like all medications for allergies or asthma, may have side effects that could warrant immediate medical attention. If you notice your symptoms worsening significantly after starting these medications, such as experiencing difficulty breathing or an increase in wheezing episodes, please seek immediate medical help.
Neither Singulair nor Flonase should be used if you're currently taking certain medications without first discussing it with your doctor. For instance, some drugs metabolized by the liver enzyme CYP2C8 (like paclitaxel) can interact negatively with Singulair. Similarly, steroid-based drugs like Flonase can interact harmfully with certain antifungal and anti-HIV medicines.
It's crucial to inform your physician about any medication you are currently taking before beginning a new regimen of either Singulair or Flonase; some medicines might require a period to clear from the system to prevent dangerous interactions with these allergy/asthma treatments.
How much do Singulair and Flonase cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Singulair (10 mg) averages around $220, which works out to approximately $7–14/day, depending on your dose.
- The price of a bottle containing 120 sprays of Flonase (50 mcg/spray) is about $25. Since the typical adult dosage is two sprays per nostril once daily, this bottle should last for one month, working out to approximately $0.80/day.
Thus, if you are in the higher dosage range for Singulair (i.e., two tablets daily), then brand-name Flonase is less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.
For the generic versions - Montelukast Sodium (Singulair) and fluticasone propionate nasal spray(Flonase), costs are significantly lower:
- Montelukast Sodium comes in packs from as low as 10 up to 90 tablets with prices ranging roughly between $0.16 and $1 per tablet depending on quantity purchased,based on an average dose being one tablet per day it would work out at between $0.16 & £1 /day.
- Fluticasone Propionate nasal spray tends to come in bottles containing either 60 or 120 metered sprays costing anywhere from just under a dollar up to around five dollars , based off two sprays into each nostril once a day this makes it slightly more economical than its branded counterpart at just over ¢20 – ¢83/Day
Popularity of Singulair and Flonase
Montelukast, available under the brand name Singulair, is a popular leukotriene receptor antagonist used for managing asthma and seasonal allergies. It was prescribed to approximately 4 million patients in the US in 2020. Montelukast accounts for nearly half of all prescriptions within its class of drugs due to its efficacy and once-daily dosing convenience.
Fluticasone propionate nasal spray, sold as Flonase among other brands, is an intranasal corticosteroid commonly used to treat allergic rhinitis symptoms. In 2020, it was estimated that around 6 million people were prescribed this medication. This represents about a quarter of overall intranasal steroid prescriptions in the USA during that year. Over-the-counter availability has boosted usage since receiving non-prescription status approval from FDA in recent years.
Conclusion
Both Singulair (montelukast) and Flonase (fluticasone propionate) are commonly used in managing symptoms of allergies and asthma. They have been proven to be effective through numerous clinical studies, demonstrating greater efficacy than placebo treatments. On occasion, the two medications may be combined for comprehensive management of symptoms, though this is subject to careful consideration by a healthcare provider due to potential drug interactions.
Singulair works primarily as a leukotriene receptor antagonist which helps control allergic reactions and reduce inflammation in the airways whereas Flonase is a corticosteroid that reduces nasal inflammation. Consequently, they are often prescribed under different circumstances: Singulair is typically considered for long-term control of asthma or severe seasonal allergies while Flonase tends to be utilized more frequently for relief from nasal allergy symptoms such as congestion or runny nose.
Both montelukast and fluticasone propionate are available in generic forms which can significantly cut costs especially for those paying out-of-pocket. It's also worth noting that both Singulair and Flonase might require an adjustment period where effects may not be immediately noticeable.
In terms of side effects profile, both drugs are generally well-tolerated although they come with their set of potential side effects; Montelukast has been associated with neuropsychiatric events while fluticasone usage could lead to nosebleeds or throat irritation. As with all medications, patients must closely monitor their health status when starting treatment and should promptly seek medical help if any adverse reactions occur.
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Refrences
- Henriksen, D. P., Davidsen, J. R., Laursen, C. B., Christiansen, A., Damkier, P., Hallas, J., & Pottegård, A. (2017, June 22). Montelukast use—a 19-year nationwide drug utilisation study. European Journal of Clinical Pharmacology. Springer Science and Business Media LLC.http://doi.org/10.1007/s00228-017-2286-3
- Storms, W. (2007, August 23). Update on montelukast and its role in the treatment of asthma, allergic rhinitis and exercise-induced bronchoconstriction. Expert Opinion on Pharmacotherapy. Informa UK Limited.http://doi.org/10.1517/14656566.8.13.2173
- Katial, R. K., Oppenheimer, J. J., Ostrom, N. K., Mosnaim, G. S., Yancey, S. W., Waitkus-Edwards, K. R., … Ortega, H. G. (2010, January 1). Adding montelukast to fluticasone propionate/salmeterol for control of asthma and seasonal allergic rhinitis. Allergy and Asthma Proceedings. Oceanside Publications Inc.http://doi.org/10.2500/aap.2010.31.3306