Usage
Ebastine + Montelukast is prescribed for the management of symptoms associated with seasonal and perennial allergic rhinitis (hay fever) in adults and children over 12 years of age. It is also indicated for the prevention of asthma exacerbations and the control of asthma symptoms. Additionally, it can provide relief from symptoms of chronic idiopathic urticaria (hives).
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Pharmacological Classification: This combination medication includes a second-generation antihistamine (Ebastine) and a leukotriene receptor antagonist (Montelukast).
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Mechanism of Action: Ebastine selectively blocks H1 histamine receptors, preventing histamine-mediated allergic symptoms. Montelukast blocks leukotriene D4 receptors, reducing bronchoconstriction, inflammation, and mucus secretion in the airways.
Alternate Names
No widely recognized alternate names exist for this specific combination. However, various brand names are used for marketing.
- Brand Names: Examples include Ebal M, Ebast M, EBAST M, Montevac EBS, EBAGRIP – M. (Note: Brand names can vary by region).
How It Works
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Pharmacodynamics: Ebastine reduces histamine-mediated vascular permeability, itching, sneezing, and rhinorrhea. Montelukast inhibits leukotriene-induced bronchoconstriction and inflammation in the airways.
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Pharmacokinetics: Ebastine is rapidly absorbed and extensively metabolized to its active metabolite, carebastine, with a long half-life (about 20 hours). Montelukast is also rapidly absorbed, extensively metabolized by CYP3A4 and CYP2C9 enzymes, and primarily excreted in bile.
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Mode of Action: Ebastine competitively antagonizes H1 receptors, while Montelukast competitively antagonizes cysteinyl leukotriene type-1 (CysLT1) receptors.
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Elimination Pathways: Ebastine’s metabolite, carebastine, is eliminated predominantly through biliary/fecal excretion. Montelukast is primarily excreted in bile.
Dosage
Standard Dosage
Adults:
One tablet (Ebastine 10 mg + Montelukast 10 mg) orally once daily. It can be taken in the morning or evening for allergic rhinitis, but evening administration is preferred for asthma.
Children:
For children aged 12 years and older, the adult dose applies. This combination is not typically recommended for children under 12. Refer to individual drug dosing guidelines (Ebastine and Montelukast) for younger children.
Special Cases:
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Elderly Patients: No specific dosage adjustment is generally required.
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Patients with Renal Impairment: Use with caution. Monitoring of kidney function may be necessary.
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Patients with Hepatic Dysfunction: Use with caution. Monitoring of liver function may be necessary.
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Patients with Comorbid Conditions: Exercise caution in patients with diabetes, cardiovascular diseases, and other conditions. Individualized dose adjustments may be needed based on specific comorbidities.
Clinical Use Cases
Ebastine + Montelukast is not specifically indicated for use in settings like intubation, surgical procedures, mechanical ventilation, ICU care, or emergency situations.
Dosage Adjustments
Dosage adjustments might be necessary based on patient-specific factors, such as renal or hepatic dysfunction, comorbid conditions, or concomitant medications. Close monitoring and individualized adjustments are crucial.
Side Effects
Common Side Effects:
Headache, drowsiness, dry mouth, nausea, upper respiratory infection, abdominal pain, diarrhea.
Rare but Serious Side Effects:
Neuropsychiatric events (e.g., mood changes, suicidal ideation, anxiety, depression, hallucinations), severe allergic reactions, angioedema, hepatic dysfunction.
Long-Term Effects:
The long-term effects of this combined medication are not fully established. Regular monitoring of liver and kidney function may be advisable with prolonged use.
Adverse Drug Reactions (ADR):
Severe hypersensitivity reactions, including anaphylaxis and angioedema, require immediate medical attention. Neuropsychiatric events also warrant prompt evaluation.
Contraindications
Hypersensitivity to Ebastine or Montelukast, acute asthma attacks, status asthmaticus. Use with caution in patients with hepatic or renal impairment.
Drug Interactions
Ebastine + Montelukast may interact with several medications, including:
- Antifungal medications (e.g., ketoconazole)
- Antibiotics (e.g., erythromycin)
- Antiepileptics (e.g., phenobarbital, phenytoin)
- Anti-tuberculosis drugs (e.g., rifampicin)
- Theophylline
- Ritonavir
- Gemfibrozil
Pregnancy and Breastfeeding
Consult a physician before use during pregnancy or breastfeeding. The safety profile during these periods is not fully established. Weigh the potential benefits against the potential risks. Consider safer alternative treatments if appropriate.
Drug Profile Summary
- Mechanism of Action: Dual action: H1 receptor antagonist (Ebastine) and Leukotriene receptor antagonist (Montelukast).
- Side Effects: Headache, drowsiness, dry mouth, nausea, abdominal pain, neuropsychiatric events (rare).
- Contraindications: Hypersensitivity, acute asthma attacks.
- Drug Interactions: Antifungals, antibiotics, antiepileptics, rifampicin, theophylline.
- Pregnancy & Breastfeeding: Consult a physician before use.
- Dosage: One tablet daily (10 mg Ebastine/10 mg Montelukast).
- Monitoring Parameters: Liver function tests, renal function tests, mood changes.
Popular Combinations
No specific commonly recommended combination therapies with Ebastine + Montelukast are routinely suggested. The need for additional medication should be evaluated on a case-by-case basis.
Precautions
- General Precautions: Evaluate liver and kidney function, screen for allergies to components.
- Specific Populations: Caution in pregnancy, breastfeeding, hepatic/renal impairment.
- Lifestyle Considerations: Avoid alcohol, as it may exacerbate drowsiness. Avoid driving or operating machinery if drowsiness occurs.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ebastine + Montelukast?
A: One tablet (Ebastine 10 mg + Montelukast 10 mg) orally once daily.
Q2: Can this combination be used in children?
A: Generally, it is indicated for patients 12 years and older. For younger children, consult individual drug dosing guidelines.
Q3: What are the common side effects?
A: Headache, drowsiness, dry mouth, nausea, upper respiratory infections.
Q4: Are there any serious side effects?
A: Rarely, neuropsychiatric events, severe allergic reactions, and liver dysfunction can occur.
Q5: Can pregnant or breastfeeding women take this medicine?
A: Consult a physician before use. Safety during pregnancy/breastfeeding is not fully established.
Q6: What should I do if I miss a dose?
A: Take the missed dose as soon as remembered, unless it is nearly time for the next dose. Do not double the dose.
Q7: Does this medicine interact with other medications?
A: Yes, potential interactions exist with certain antifungals, antibiotics, antiepileptics, and other drugs (see Drug Interactions section).
Q8: How long should I take this medication?
A: Continue taking it as prescribed by your physician. Do not stop abruptly without consulting your doctor.
Q9: Can I take it with or without food?
A: It can be taken with or without food. Taking it with food may help minimize potential gastrointestinal discomfort.
Q10: Can I drive or operate machinery after taking it?
A: If drowsiness occurs, avoid driving or operating machinery.
