Zafirlukast: Asthma Control with Leukotriene Receptor Antagonist

Summary of Key Points

Zafirlukast is a prescription medication used to manage asthma and other respiratory conditions. It helps reduce inflammation in the airways, making breathing easier. Zafirlukast is typically prescribed for long-term asthma control and is not intended for sudden asthma attacks. Always follow your healthcare provider’s instructions and consult them before making any changes to your medication.

Names of Medication

US Brand Name: Accolate

Generic Name: Zafirlukast

The generic name refers to the active ingredient, while the brand name is assigned by the manufacturer. The generic name is often listed in parentheses.

Pharmacologic Category: Leukotriene Receptor Antagonist

Zafirlukast belongs to a class of medications known as leukotriene receptor antagonists (LTRA). These medications work by blocking leukotrienes, substances in the body that can trigger asthma symptoms. By reducing lung inflammation, Zafirlukast helps manage asthma more effectively.

Zafirlukast Dosage

Zafirlukast is used to treat various respiratory conditions, with the dosage depending on the specific condition being treated. Always consult your healthcare provider before adjusting your dose.

1. Asthma (Adults): The typical dose is 20 mg taken twice daily. Zafirlukast is often used as a long-term treatment to help control asthma symptoms.
2. Allergic Rhinitis: While not commonly prescribed for allergic rhinitis, some healthcare providers may recommend Zafirlukast at 20 mg twice daily.
3. Exercise-Induced Bronchoconstriction: Zafirlukast may help prevent breathing difficulties triggered by exercise. The usual dose is 20 mg twice daily.
4. Chronic Obstructive Pulmonary Disease (COPD): Although Zafirlukast is not a first-line treatment for COPD, it may be used in certain cases. The dose is typically 20 mg twice daily.
5. Allergic Asthma: For allergic asthma, the standard dose is 20 mg twice daily.
6. Seasonal Allergic Rhinitis: The dose for seasonal allergic rhinitis is generally 20 mg twice daily.
7. Aspirin-Induced Asthma: Zafirlukast is effective in managing asthma symptoms triggered by aspirin. The recommended dose is 20 mg twice daily.
8. Eosinophilic Asthma: For eosinophilic asthma, Zafirlukast may be prescribed at 20 mg twice daily.
9. Cough-Variant Asthma: In cases of cough-variant asthma, the usual dose is 20 mg twice daily.

Dosage Forms and Strengths

Zafirlukast is available in tablet form with the following strengths:

1. Tablet: 10 mg
2. Tablet: 20 mg

Administration Instructions for Zafirlukast

Zafirlukast should be taken on an empty stomach, either 1 hour before or 2 hours after meals. Swallow the tablet whole with a glass of water. It’s important to take Zafirlukast regularly, even if you feel well, to maintain control over your asthma symptoms. Do not stop taking this medication without consulting your healthcare provider. If you miss a dose, take it as soon as you remember, unless it is almost time for your next dose.

Zafirlukast Side Effects and Adverse Reactions

Like all medications, Zafirlukast may cause side effects. Most are mild, but some can be more serious. If you experience any unusual symptoms, contact your healthcare provider immediately.

1. Common Side Effects: These may include headache, nausea, diarrhea, and stomach pain. These side effects are generally mild and may improve as your body adjusts to the medication.
2. Less Common Side Effects: Some individuals may experience rash, dizziness, or fatigue. If these symptoms persist or worsen, contact your healthcare provider.
3. Serious Side Effects: In rare cases, Zafirlukast can cause liver problems. Symptoms may include yellowing of the skin or eyes (jaundice), dark urine, or severe stomach pain. Seek medical attention immediately if you notice any of these symptoms.

Contraindications for Zafirlukast

A contraindication is a specific condition where a medication should not be used because it may cause harm. For Zafirlukast, there are several conditions where taking this medication could be dangerous or worsen a patient’s health.

1. Liver Disease: Zafirlukast is processed by the liver. If you have liver disease, the medication may not be broken down properly, leading to increased levels in the body and potential toxicity.
2. Hypersensitivity or Allergy to Zafirlukast: If you have had an allergic reaction to Zafirlukast, taking it again could cause serious allergic reactions, such as rash, swelling, or difficulty breathing.
3. Acute Asthma Attacks: Zafirlukast is not designed to treat sudden asthma attacks. It works as a long-term controller medication, and using it during an acute asthma attack could delay proper treatment with fast-acting inhalers like albuterol.

Drug Interactions with Zafirlukast

Several medications can interact with Zafirlukast, potentially affecting its effectiveness or increasing the risk of side effects. Always inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements.

1. Warfarin (Coumadin): Zafirlukast can increase the effects of warfarin, a blood thinner, raising the risk of bleeding.
2. Theophylline (Theo-24, Elixophyllin): Zafirlukast may reduce the effectiveness of theophylline, a medication used to treat asthma and other lung conditions.
3. Erythromycin (Ery-Tab): This antibiotic can decrease Zafirlukast levels in your body, making it less effective.
4. Aspirin: Taking aspirin with Zafirlukast may increase the risk of side effects, particularly in patients with aspirin-induced asthma.

Zafirlukast in Pregnancy

Is it safe to take Zafirlukast when pregnant?

The safety of Zafirlukast during pregnancy has not been fully established. While animal studies have indicated some potential risks, data on its effects in human pregnancies remain limited. If you are pregnant or planning to become pregnant, it’s important to discuss the potential risks and benefits of Zafirlukast with your healthcare provider. They may suggest safer alternatives during pregnancy. You can also consult one of our telemedicine providers to explore your options and receive personalized guidance.

Zafirlukast While Breastfeeding

Is it safe to take Zafirlukast while breastfeeding?

There is limited information on whether Zafirlukast passes into breast milk. Given the potential risks to a nursing infant, it’s essential to carefully weigh the benefits of continuing Zafirlukast against any possible risks. Your healthcare provider may recommend alternative treatments or advise you to discontinue breastfeeding while taking the medication. If you have concerns, speaking with one of our telemedicine providers can help you make an informed decision.

Estimated Cost of Zafirlukast Medication

A 30-day supply of Zafirlukast (20 mg tablets, taken twice daily) typically costs between $30 and $50 without insurance when using a GoodRx coupon. Prices may vary depending on the pharmacy and location. Be sure to check for available discounts or speak with your healthcare provider about cost-saving options that may be available to you.

Possible Alternatives to Zafirlukast

Depending on your condition, there may be alternative treatments or lifestyle changes that can help manage your symptoms. Always consult your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are also available to help you explore these options.

Asthma

Alternative treatments for asthma include inhaled corticosteroids (e.g., Fluticasone), long-acting beta agonists (e.g., Salmeterol), or combination inhalers. In addition to medication, lifestyle changes such as avoiding triggers like smoke and allergens, and incorporating regular exercise, can help manage asthma symptoms effectively.

Allergic Rhinitis

For allergic rhinitis, antihistamines (e.g., Cetirizine), nasal corticosteroids (e.g., Fluticasone nasal spray), and decongestants are commonly used alternatives. Reducing exposure to allergens, such as pollen or pet dander, can also provide relief.

Exercise-Induced Bronchoconstriction

Short-acting beta agonists (e.g., Albuterol) taken before exercise can help prevent symptoms of exercise-induced bronchoconstriction. Additionally, warming up before physical activity and avoiding cold, dry air may reduce the likelihood of symptoms.

Chronic Obstructive Pulmonary Disease (COPD)

For COPD, bronchodilators (e.g., Tiotropium), inhaled corticosteroids, and pulmonary rehabilitation are common treatment options. Quitting smoking and maintaining a healthy lifestyle are also crucial in managing COPD effectively.

Allergic Asthma

Treatment options for allergic asthma may include inhaled corticosteroids, leukotriene receptor antagonists like Montelukast, and biologics (e.g., Omalizumab). Additionally, avoiding allergens and using air purifiers can help reduce symptoms.

Seasonal Allergic Rhinitis

Common alternatives for managing seasonal allergic rhinitis include antihistamines, nasal corticosteroids, and allergy shots (immunotherapy). Limiting outdoor activities during high pollen seasons may also help alleviate symptoms.

Aspirin-Induced Asthma

Avoiding aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) is essential for managing aspirin-induced asthma. Your healthcare provider may recommend alternative pain relievers, such as acetaminophen, to avoid triggering symptoms.

Eosinophilic Asthma

Biologic therapies (e.g., Mepolizumab, Benralizumab) that target underlying inflammation are often used to treat eosinophilic asthma. Inhaled corticosteroids and lifestyle modifications may also be part of the treatment plan.

Cough-Variant Asthma

Inhaled corticosteroids and bronchodilators are commonly prescribed for cough-variant asthma. Identifying and avoiding triggers, such as cold air or allergens, can help reduce the frequency of coughing episodes.

Recent Updates on Zafirlukast Research

Recent studies have explored Zafirlukast’s role in managing asthma and its potential benefits in treating other inflammatory conditions. Researchers are investigating whether Zafirlukast may have applications beyond asthma, such as in managing chronic rhinosinusitis and other allergic disorders. However, more clinical trials are needed to confirm these findings. Additionally, ongoing research is examining the long-term safety of Zafirlukast, particularly its effects on liver health. Always consult your healthcare provider before making any changes to your medication regimen. If you have questions about the latest research or your treatment plan, our telemedicine providers are available to assist you.

James Kingsley

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