News
Assisting with patient concerns about a prevalent asthma medication
Dr Kerry Hancock, GP and Chair of the RACGP Respiratory Medicine Specific Interests network, talks to newsGP about prescribing the asthma medication, montelukast.
Dr Kerry Hancock believes it is vital for GPs to discuss montelukast’s potential psychological side effects with parents when prescribing.
Asthma medication montelukast has recently been featured in the news, with some parents saying their children experienced serious psychological side effects after taking the drug, ranging from nightmares through to suicide. In response, Federal Health Minister Greg Hunt said he would instruct the Therapeutic Goods Administration (TGA) to review warnings about the medication.
However, Dr Kerry Hancock explained to newsGP that the potential side effects of montelukast have long been well known and are also very rare.
‘According to the Australian Medicines Handbook, the neuropsychiatric effects of montelukast, including nightmares, hallucinations, or mood and behavioural changes such as anxiety, depression and aggression, have an incidence of less than 0.1%, or one patient in 1000,’ Dr Hancock told newsGP.
While she still recommends montelukast as an effective asthma drug for children in most cases, Dr Hancock believes it is vital for GPs to discuss its potential side effects with parents, particularly in the wake of strong media focus on the drug – although she understands the challenges of doing so.
‘It is sometimes difficult, because of time pressures, for GPs to give patients as much information as they would like,’ she said. ‘However, they have a responsibility to inform patients about the purpose, importance, benefits and risks of their medicines.
‘Usual practice would be for the prescriber to inform the patient and/or their carer or parent of the more common, expected or serious side effects, or those that a GP thinks are relevant to that particular patient.’
It is also important for the GP to monitor patient for adverse medication effects, and instruct the parents to do so as well.
‘Patients and prescribers should be alert for neuropsychiatric events, and patients should be instructed to notify their prescriber if these changes occur,’ Dr Hancock said. ‘Prescribers should also carefully evaluate the risks and benefits of continuing treatment with montelukast if such events take place.’
Dr Hancock also suggests a range of resources to help GPs in having conversations with their patients about asthma medications.
‘It is important we address the concerns parents may have about medicines making use of the resources that we have available, such as the Australian Medicines Handbook, the drug’s product information and consumer medicines information, the Australian Asthma Handbook, NPS MedicineWise, and advice from community and clinical pharmacists, with a further opportunity to discuss those concerns at a subsequent review,’ she said.
RACGP President Dr Bastian Seidel acknowledged that montelukast can be an extremely important intervention for children experiencing asthma.
‘It is a drug that works well for quite a few patients who have tried everything else,’ he told nine.com.au. ‘No doubt about it, for some patients it’s a complete game changer.
‘But for some there are adverse reactions and we should take them very seriously and really discuss with parents what are the benefits and potential negative reactions to the drug.’
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