Sleeptalking! Sleepwalking! Side Effects of Montelukast

A 16-year-old Caucasian female presented to the pulmonary clinic for a followup on her asthma. Due to the worsening of allergy-related symptoms, therapy with montelukast 10？mg daily was started and resulted in good relief of the patient’s symptoms. In the nights following initiating therapy with montelukast, the patient’s mother reported daily parasomnias in the form of sleeptalking and sleepwalking. Montelukast was discontinued, and that resulted in absence of the parasomnias. In a second attempt montelukast was reinstituted to control the patient’s symptoms. Parasomnias were immediately reported after resuming therapy. Montelukast was then discontinued indefinitely. Our patient has never had any history of parasomnias, and since the discontinuation of montelukast, parasomnias were never reported again. Parasomnias in the form of sleeptalking or sleepwalking were not previously reported as adverse effects of montelukast. Alternative modalities to treat allergy-related symptoms in patients, who develop parasomnias while receiving montelukast, should be explored. 1. Introduction A 16-year-old Caucasian female presented to the pulmonary clinic for a followup on her asthma which has been treated with fluticasone propionate 250？mcg/salmeterol 50？mcg and albuterol sulfate inhalers. Past medical history included asthma and allergic rhinitis. There were no reported symptoms related to obstructive sleep apnea (OSA), and no history of any psychological disorders. There was no family history of sleepwalking, sleeptalking, or other forms of parasomnias. Due to the worsening of allergy-related symptoms (ARS), including allergic rhinitis, therapy with montelukast 10？mg daily was started and resulted in good relief of the patient’s ARS. In the nights following initiating therapy with montelukast, the patient’s mother reported daily parasomnias in the form of sleeptalking and sleepwalking. Montelukast was discontinued, and that resulted in absence of the parasomnias. A few days later, montelukast was reinstituted in a second attempt to control the patient’s ARS; however, sleeptalking and sleepwalking were reported again immediately after resuming therapy. Montelukast was discontinued indefinitely. Our patient has never had any history of parasomnias, and since the discontinuation of montelukast, parasomnias were never reported again. The application of Naranjo scale (Table 1) revealed a score of eight, indicating a probable adverse drug effect [1]. The use of the World Health Organization-The Uppsala Monitoring Center (WHO-UMC) system for standardized case causality