<unk>  is generally well tolerated, though headache and gastrointestinal (GI) upset can occur. The incidence of headache is between 12 and 20%, which is similar to the incidence of headache found in patients taking placebos in the studies that lead to<unk> 's approval. GI upset may include nausea, stomach discomfort/pain, and diarrhea. GI complaints can be lessened by taking<unk>  with food, though this can dramatically impair the amount of drug that gets absorbed into the body (see the section on drug-food interactions below). Other common side effects include flu-like symptoms, sleep disturbances (abnormal dreams, insomnia), hallucinations, and daytime drowsiness. Neuropsychiatric effects Neuropsychiatric side effects have been reported with the use of<unk>  and other LTRAs. While some side effects are less severe (e.g. abnormal dreams), others are more serious (e.g. hallucinations, tremor, suicidality). These effects were discovered through post-marketing reports, as the initial trials were not designed to monitor for neuropsychiatric side effects. Hepatotoxicity<unk>  can also cause rare but serious side effects like acute liver injury.<unk> -induced hepatotoxicity generally occurs within the first 2–6 months of initiating therapy, though cases have been reported up to 13 months after starting<unk> .<unk> -induced hepatotoxicity is characterized by a spectrum of liver damage symptoms, including fatigue, nausea, and right upper quadrant pain followed by dark urine, jaundice and pruritus. Liver enzyme elevations are common, and the pattern usually reflects hepatocellular damage, resembling acute viral hepatitis. It is unclear how the hepatotoxicity occurs, but it may be due to a metabolic intermediate of<unk> , since it is metabolized in the liver through the enzyme CYP2C9. When it does occur it can be fatal, and reexposure with<unk>  may result in a worse injury. Switching<unk>  to another medication in the same class (e.g. montelukast) or in the related class of 5-lipoxygenase inhibitors can be attempted, but caution should be employed. According to the "Dear Health Care Provider" letter from AstraZeneca,<unk> -induced hepatotoxicity has occurred predominantly in females. Churg-Strauss syndrome Several cases of Churg-Strauss syndrome, also known as allergic angiitis and granulomatosis, have been reported with the use of<unk> , montelukast, pranlukast, and other asthma medications. When Churg-Strauss syndrome occurs, it tends to occur in people with long-standing asthma and sinus inflammation, chronic oral corticosteroid use, and the recent initiation of a new anti-asthma therapy (like<unk>  in conjunction with tapering the corticosteroids. While the exact etiology of the development of Churg-Strauss symptoms in proximity to initiating<unk>  is unknown, it is thought that withdrawal of chronic corticosteroids "unmasks" the previously undetected disease. Because corticosteroid withdrawal often happens while starting a new anti-asthma medication (like<unk> , this explains the rare but notable association. These cases may represent misdiagnosed asthma, as Churg-Strauss syndrome can induce symptoms of airway obstruction that are akin to an acute asthma exacerbation. As these asthma-like symptoms are reduced by<unk> , the symptoms of Churg-Strauss (e.g. neuropathy) increase due to the lack of the broader, anti-inflammatory coverage that the steroid was providing.
Zafirlukast
Pranlukast
Seratrodast
Montelukast
Levosalbutamol
Salbutamol
Lifitegrast
Pemirolast